混合診療 適用拡大が患者の利益になる

The Yomiuri Shimbun (Feb. 23, 2013)
Wider use of mixed treatment beneficial to patients
混合診療　適用拡大が患者の利益になる（2月22日付・読売社説）

Everyone wants to receive advanced, effective medical treatment. The medical insurance system should be improved from the viewpoint of patients.
　先進的で効果のある治療であるなら、誰でも受けたい。患者の立場で、保険医療制度を改善していくべきだろう。

The government's advisory panel on regulatory reform has put expanded application of so-called mixed treatment on its list of topics to to be discussed.
　政府の規制改革会議が「混合診療」の適用範囲の拡大を検討課題に掲げた。

Mixed treatment is defined as the combination of medical practices, such as examination and medication, that are covered by public health insurance with those that are not. Currently, it is permitted only in exceptional cases in the health insurance system.
　混合診療とは、公的医療保険で認められた検査や投薬とともに、保険が適用されていない治療法を併用することだ。現在は例外的にしか認められていない。

Mixed treatment is currently limited to about 100 types of treatments designated by the Health, Labor and Welfare Ministry, including heavy particle radiotherapy, which is an advanced radiation therapy for cancer, and genetic diagnosis for hereditary Alzheimer's disease.
　その対象は、高度がん放射線療法の重粒子線治療や、家族性アルツハイマー病の遺伝子診断など、厚生労働省が指定した約１００種類にとどまる。

If patients receive new treatments that have yet to be approved by the ministry, they have to pay all the medical bills, including examination and hospital expenses that otherwise would be covered by the insurance system.
　指定外で未承認の新しい治療を受けると、本来は保険が適用される検査や入院費用も含め全額が自己負担となってしまう。

Even if patients want to receive advanced therapies for cancer and intractable diseases, therefore, they often have to give up on that hope for economic reasons.
　がんや難病の患者が最先端治療に希望を託したくても、経済的理由であきらめざるを得ないケースもあるのが現状だ。

===

Right path to take

The government panel named mixed treatment as a topic for discussion because it considers deregulation of the medical treatment sector a part of growth strategy.
　規制改革会議が混合診療の見直しを検討課題に挙げたのは、医療分野の規制緩和を成長戦略の一環と位置付けているからだ。

Expanding the application of mixed treatment to all types of medical techniques, including regenerative medicine, is a reasonable step to take.
　再生医療を含む先進的な医療技術全般に混合診療の適用範囲を拡大するのは妥当と言えよう。

In its campaign platform for the House of Representatives election in December, the Liberal Democratic Party called for swift introduction of the latest drugs, medical equipment and therapies that could help patients. Reexamining mixed treatment will be a first step toward realizing the party's campaign pledge.
　自民党は昨年の衆院選の公約で、患者の利益にかなう最先端の薬や医療機器、治療法の迅速な導入を掲げた。混合診療の見直しは公約を具体化する一歩となる。

If the government takes a definite stance to support advanced medical treatments, it could encourage doctors to adopt new medical techniques more actively.
　政府が先進的な医療を後押しする姿勢を明確に打ち出すことで、医師が新しい医療技術に積極的に取り組む効果が期待できる。

===

Certain restraint needed

However, mixed treatment cannot be allowed to expand without restrictions.
　ただし、混合診療を野放図に拡大するわけにはいかない。

The health ministry has banned mixed treatment in principle, on the grounds it might foster treatments not grounded in science.
　厚労省は一貫して混合診療を原則禁止としてきた。科学的根拠のない治療を助長する恐れがあるという理由からだ。

The Supreme Court upheld the ministry's policy in 2011. In a lawsuit filed against the state by a cancer patient who received new, yet-to-be-approved treatment, the top court judged that the policy was "legitimate from the viewpoint of ensuring the quality of medical treatment and in light of fiscal constraints."
　最高裁も２０１１年、この政策を追認した。未承認の新治療を受けていたがん患者が国を相手取った訴訟の判決で、「医療の質の確保や財源面の制約を考えると適法」との判断を示した。

The top court also pointed out that the policy was meant "to deter medical practices that threaten to undermine the safety and effectiveness" of medical treatment.
　「安全性や有効性を脅かす医療行為を抑止する意味がある」とも指摘している。

It is true that if mixed treatment is approved without restriction, expensive, dangerous drugs and medical treatments whose safety has not been confirmed may become widespread.
　確かに、混合診療を無制限に認めると、高額なうえに効果が実証されていない危険な薬や治療が横行することが懸念される。

In light of what the top court pointed out, a certain amount of restraint will be necessary.
　最高裁判決の趣旨からも、何らかの歯止めは必要である。

As an effective way of applying mixed treatment, we suggest it be limited to medical techniques approved by domestic medical societies, as well as to drugs and therapies confirmed to be effective overseas.
　混合診療の対象は、海外で効果が確認された薬や治療法のほか、国内の医学会などが認めた医療技術に限定するのも有効な方法ではないだろうか。

(From The Yomiuri Shimbun, Feb. 22, 2013)
（2013年2月22日01時14分  読売新聞）