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2012年11月 1日 (木)

高齢者の医療費 「世代間格差」の改善が必要だ

The Yomiuri Shimbun (Nov. 1, 2012)
Time to rectify generational gap in burdens for medical bills
高齢者の医療費 「世代間格差」の改善が必要だ(10月31日付・読売社説)

As the nation's population grays, ensuring that the ballooning cost of medical care is evenly shared among all generations of society is an urgent task.
 高齢化で膨らむ医療費の負担を世代間で公平にすることが急務だ。

The Fiscal System Council, a government advisory body, has agreed to abolish a special measure that limits the out-of-pocket payments for medical bills people aged 70 to 74 pay to 10 percent of the total, and raise the limit to 20 percent as prescribed by law. The panel will shortly recommend that the finance minister review the special measure.
 政府の財政制度等審議会が、70~74歳の医療費の窓口負担を1割に抑える特例措置を廃止し、法律の規定通り2割負担にすべきだとの見解で一致した。財務相に近く措置の見直しを提言する。

It is inevitable that senior citizens will be asked to bear a greater share of medical costs to prevent the working population, which provides the bulk of the money used for government medical spending, from becoming excessively squeezed.
 医療費の大半を賄う現役世代の負担が過重になるのを防ぐため、高齢者に応分の負担を求めることはやむを得ない。

In 2008, when the medical system for people aged 75 or older started, the out-of-pocket burden of medical bills was increased from 10 percent to 20 percent for people aged 70 to 74 and kept at 10 percent for those 75 or older. This was decided by law.
 後期高齢者医療制度が始まった2008年、医療機関で払う窓口負担は70~74歳がそれまでの1割から2割に、75歳以上は従来通り1割とすると法律で決まった。

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Public backlash feared

But the then coalition government of the Liberal Democratic Party and New Komeito decided to retain the 10 percent cap for people 70 to 74 as an exceptional step out of fear that increasing it would trigger a backlash from the public.
 だが、当時の自公政権は国民の反発を恐れ、70~74歳の負担を1割に抑える特例措置を決めた。

The Democratic Party of Japan-led administrations have retained this line.
 民主党政権も継続している。

As a result, the percentage of medical bills paid by patients in their average per capita income bracket stands at 2.4 percent for people aged 70-74--far below the 3.8 percent for the 65-69 bracket and 4.6 percent for those 75 or older. This shows the unfair distribution of medical cost burdens is expanding.
 この結果、1人当たりの平均収入に占める患者負担割合は、65~69歳の3・8%、75歳以上の4・6%に対し、70~74歳は2・4%と、格段に低い。歪(ひず)みが広がっていると言えよう。

However, at a recent news conference, Health, Labor and Welfare Minister Wakio Mitsui was guarded about reviewing the exceptional measure. This is because he wants to avoid antagonizing elderly people by asking them to shoulder an additional financial burden ahead of the next House of Representatives election.
 三井厚生労働相は、この問題について、記者会見で、特例措置の見直しに慎重な姿勢を示した。次期衆院選を控えて、高齢者に新たに負担を求めることは避けたいからだろう。

But it must be noted that about 200 billion yen is spent annually to implement the special measure. This is one cause of swelling fiscal deficits. Bills for that will inevitably be left for future generations to cover.
 だが、特例措置を維持するため、毎年約2000億円の国費が投入されている。財政赤字を拡大させる要因になっており、そのツケは将来世代へ回ることになる。

Older generations can receive pensions and medical services worth more than their tax burdens and insurance premium payments, which are lower than those paid by young generations. The special measure, thus, helps widen the gap between generations.
 高齢世代は、若い世代に比べて、税や保険料の負担を上回る年金や医療サービスを受けることができる。窓口負担の特例措置は、世代間の格差も助長するものだ。

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Give needy patients a break

As we see it, the special measure must be reexamined and a decision made to raise the proportion paid by elderly people. The government is considering applying the hiked rate to people who will turn 70 and not those who are over this age at the time of implementation.
 やはり、特例措置を見直し、負担の引き上げを決断すべきだ。政府は、負担を引き上げる場合は、今後70歳になる人から順次行い、既に70歳を超えた人は対象にしないことを検討している。

Japanese make far more clinic or hospital visits than people in Britain and the United States, which has caused a rise in government medical spending and a shortage of doctors. Increasing charges could prevent people from seeking nonessential or nonurgent medical treatment.
 日本人の外来受診回数は、英米を大きく上回り、医療費の増加や医師不足につながっている。窓口負担の引き上げで、不要不急の受診を防ぐ効果も期待できよう。

Of course, some patients are seriously ill and cannot reduce the frequency of their visits to clinics or hospitals. To help these people, we suggest a system in which seriously needy patients, even those aged below 75, are transferred to the medical insurance system for people aged 75 or older to keep their financial burden low.
 無論、症状が重く、通院を減らせない人もいる。その場合には、75歳未満であっても、75歳以上が対象の後期高齢者医療制度に移行し、負担を抑える仕組みを活用してはどうか。

Keeping public pension payments higher than stipulated levels due to the adoption of a separate exceptional measure is another problem. This has caused the payment of overly generous pensions.
 一方、公的年金も、本来より高い給付水準に据え置く特例措置により、過払いになっているという問題もある。

The government should stop passing the burden of paying for medical services and pension payments onto future generations.
医療、年金財源の負担を将来世代に先送りし続けることは、もうやめるべきである。

(From The Yomiuri Shimbun, Oct. 31, 2012)
(2012年10月31日01時16分  読売新聞)

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