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2013年9月20日 (金)

医療・介護費 5兆円抑制を「画餅」とするな

The Yomiuri Shimbun September 20, 2013
Ministry must make ¥5 tril. cut in medical costs real to save social security
医療・介護費 5兆円抑制を「画餅」とするな(9月19日付・読売社説)

The Health, Labor and Welfare Ministry has set a new goal of curbing the expected increase in the nation’s medical and nursing care expenses.
 厚生労働省が、医療・介護費用の伸びを抑える新たな目標を掲げた。

Medical and nursing care costs of Japanese are estimated to rise by ¥35 trillion in fiscal 2025 from the current ¥48 trillion due to the rapidly aging population. The ministry plans to reduce the estimated increase by ¥5 trillion.
 急速な高齢化で、国民の医療・介護費は、2025年度には現在の48兆円より約35兆円増える見通しだ。この伸びを5兆円程度圧縮することを目論(もくろ)む。

The envisaged restriction of medical and nursing care expenditures must become real if the nation’s social security system is to be maintained.
 社会保障制度を維持していくには、医療・介護費の抑制を絵に描いた餅にしてはなるまい。

Health insurance societies, to which corporate employees belong, have been in the red for five straight years due to the massive amount of contributions to the medical care system necessary for elderly people. As a result, the finances of health insurance societies have been driven to the verge of bankruptcy.
 サラリーマンが加入する健康保険組合は、高齢者医療への巨額の負担金により、5年連続で赤字に陥っている。健保財政は破綻寸前まで追い込まれている。

Bringing medical expenses under control is an urgent task for the government. As part of its effort to achieve this goal, the health ministry has set up a task force to promote public health. In the past, however, the ministry came up with measures to restrict medical and nursing care expenses but failed to produce sufficient results. We expect the ministry to reflect on past mistakes and to carry out effective measures this time around.
 医療費の抑制は急務である。
 厚労省は目標達成に向け、「健康づくり推進本部」を発足させた。これまでも医療・介護費削減を打ち出しながら、十分な成果を上げられなかった経緯がある。その反省を踏まえ、今度こそ、実効性のある対策を進めてもらいたい。

As a pillar of the cost-cutting plan, the ministry is focusing on the prevention of lifestyle-related diseases among adults by improving the percentage of people actually taking metabolic syndrome exams. The ministry expects this measure to have the effect of reducing medical expenses by ¥2.4 trillion. However, it is unclear how much can actually be reduced. We wonder if the reduction will be as high as projected.
 対策の柱として、厚労省はメタボ健診の受診率を向上させ、生活習慣病の予防を掲げる。2・4兆円の医療費削減効果を見込んでいるが、現時点では医療費の抑制効果は明らかになっていない。見込み通りの削減は可能なのか。

Practical cost-cutting

Meanwhile, the prevention of pneumonia is expected to be a more practical measure. Pneumonia is the third-leading cause of death among elderly people, following cancer and heart disease. It can also cause elderly people to become bedridden.
 現実的な対策として期待されるのが、肺炎の予防だ。高齢者の死因の中で、がん、心臓病に次ぎ多い。寝たきりの原因ともなる。

It is believed that pneumonia vaccinations can lower the incidence of the condition by about two-thirds. By promoting the vaccinations, the ministry estimates that costs for treatment of the disease could be reduced by about ¥600 billion.
 ワクチンを接種すると、肺炎の発症率が約3分の1に減るとされ、厚労省は接種の普及によって、肺炎の医療費を6000億円程度削減できると試算している。

Expenses for pneumonia vaccinations are currently paid out of pocket. However, if it is covered by public funds, prevention of the disease could be more effective.
 現在は自己負担となっている接種を公費で受けられるようにすれば、予防効果は高まろう。

An increase in the number of people with diabetes is also a problem. Preventive measures should be considered to reduce the number of patients that require dialysis, an expensive treatment, due to kidney failure caused by severe diabetes.
 急増する糖尿病についても、高額な医療費がかかる人工透析を減らす予防策の検討が必要だ。

Wasteful spending on medical services must be investigated as well. Japanese see doctors more often than people in other developed countries. Senior citizens with more than one condition tend to go from one doctor to another.
 医療費の無駄遣いにも切り込まねばならない。
 日本人は、他の先進国と比べ、医師にかかる回数が多い。複数の病気を持つ高齢者が“はしご受診”をしがちだからだ。

The municipal government of Kure, Hiroshima Prefecture, scrutinized statements of medical expense claims by hospitals and clinics, and identified senior citizens who saw doctors 15 times or more in a month. Public health workers then visited them to offer advice. As a result, duplicate visits to multiple doctors and an overlap in drug administration were curbed, leading to a decrease in medical care costs.
 広島県呉市では、医療機関が診療報酬を請求する際の明細書であるレセプトを調べ、月に15回以上受診した高齢者に、保健師が訪問指導を実施した。この結果、重複した受診や投薬が減り、医療費を削減できたという。

The health ministry should introduce such initiatives to other local governments around the country.
 厚労省は、こうした取り組みを全国の自治体に周知すべきだ。

The use of information technology such as digitizing statements of medical expenses will be essential to improving the efficiency of medical services. Taking advantage of the My Number system to be introduced in 2016, it is also important to make use of patients’ medical information to reduce the number of redundant visits to doctors.
 レセプトの電子化など情報通信技術の活用も、医療の効率化の鍵になる。2016年に導入される共通番号制度を利用し、患者の診療情報を重複受診の抑制などにつなげることも重要である。

(From The Yomiuri Shimbun, Sept. 19, 2013)
(2013年9月19日01時32分  読売新聞)

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