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2013年12月22日 (日)

診療報酬改定 制度維持へ実質下げは妥当だ

The Yomiuri Shimbun December 21, 2013
Govt acted reasonably in cutting medical treatment fees for FY14
診療報酬改定 制度維持へ実質下げは妥当だ(12月21日付・読売社説)

To maintain the social security system, it is indispensable to hold down medical expenses, which have continued to increase.
 社会保障制度を維持するには、増え続ける医療費の伸びを抑えることが欠かせない。

The government has thus decided to substantially decrease medical treatment fees, which go to medical institutions as income, by 1.26 percent for next fiscal year. This is the first reduction of such costs in six years.
 医療機関の収入となる診療報酬について、政府は来年度、実質的に1・26%引き下げることを決めた。6年ぶりのマイナス改定だ。

When medical treatment costs increase, health insurance premiums and payments at medical institutions also rise. When coupled with next spring’s increase in the consumption tax rate, the increases in medical treatment costs will put a double strain on household finances.
 診療報酬が引き上げられれば、保険料や医療機関の窓口での支払いも増える。来春の消費税率引き上げと重なれば、家計には二重の負担増になる。

Although the extent of the cut is not sufficient, we believe the government has acted reasonably in having settled the matter by substantially decreasing the medical treatment fees. The cut will likely curb negative effects on spending and business sentiment.
 下げ幅は物足りないが、診療報酬を実質引き下げで決着させたことは妥当だ。消費や景気への悪影響を避けることにもつながる。

In terms of the medical fee structure, the main portion that includes a doctor’s technical fee was raised by 0.1 percent, while the “charge for medicine” category was lowered by 1.36 percent. The latter move reflected the actual trading prices of medicine.
 医師の技術料など「本体」部分は0・1%増にとどめ、医薬品など「薬価」を1・36%引き下げるとした。医薬品の実勢価格を反映させたものだ。

Private hospitals last year posted a ¥76 million surplus on average, up from the previous year. Salaries of doctors working at hospitals have also increased. The government must have judged that it is increasingly unnecessary to raise medical treatment fees.
 民間病院の収支は昨年、平均7600万円の黒字で、前年より改善した。病院勤務医の給与も上昇している。政府は、診療報酬を引き上げる必要性は乏しいと判断したのだろう。

However, costs including the fee charged for a patient’s first visit were raised to supplement the greater financial burden medical institutions are expected to face due to the scheduled increase in the consumption tax rate. As a result, the medical treatment fee was raised by 0.1 percent in this main category, which should be considered inevitable.
 ただし、消費税率引き上げで医療機関の負担が増える分を補填(ほてん)するため、初診料などが加算された。結果的に0・1%の増となったのはやむを得まい。

Various efforts needed

The Liberal Democratic Party proposed increasing the medical treatment fees at the request of parties concerned, including the Japan Medical Association, which has called for improving labor conditions of doctors and mitigating the shortage of doctors. However, the Prime Minister’s Office and the Finance Ministry, both of which aim at keeping medical costs from rising, largely brushed off the request.
 自民党は、医師の待遇改善や医師不足の解消を求める日本医師会などの要望を受け、診療報酬の引き上げを主張した。しかし、医療費抑制を目指す首相官邸と財務省に押し切られた。

Indeed, labor conditions of doctors working at hospitals remain serious. At many hospitals, doctors routinely work long hours, including overnight, and conduct surgeries after their night duties.
 確かに病院勤務医の労働実態は依然厳しく、夜間当直を挟んだ長時間勤務や、当直明けの手術は常態化している。

However, the main cause of the lack of doctors is the uneven distribution of doctors, depending on treatment department and region. A major improvement in labor conditions of doctors cannot be expected by simply increasing the total amount of medical treatment fees.
 だが、医師不足は診療科や地域による医師の偏在が主因だ。単に診療報酬の総額を増やしても、大きな改善は見込めないだろう。

The Central Social Insurance Medical Council, an advisory panel to the health minister, will discuss how to distribute medical treatment fees among various fields in the New Year.
 診療報酬をどの分野に配分するかは、年明けに中央社会保険医療協議会で議論される。

It is important to intensively distribute health care reimbursements to the busiest departments, such as emergency medical service, pediatrics, obstetrics and surgery. It is also necessary to enhance treatment fees at hospitals, which face a more serious doctor shortage, rather than at small clinics.
 大切なのは、激務の救急、小児科、産科、外科などに診療報酬を重点配分することである。診療所より人手不足が著しい病院に報酬を手厚くする必要もある。

Efforts must also be taken to cut wasteful medical expenses. There is a large margin for cuts in drug costs in particular.
 医療費の無駄をなくす工夫もしなければならない。特に圧縮の余地が大きいのは薬剤費だ。

Regarding drugs prescribed by doctors, the percentage of lower-priced generic medicine has been kept at about 40 percent. The use of generic drugs should be further promoted.
 医師が処方する薬の中で、価格の安い後発医薬品の割合は4割程度にとどまっている。さらに使用を促進すべきだ。

Also, the compounding fee for drugs available at pharmacies outside medical institutions is higher than that of the same drugs available at in-hospital pharmacies. This is one reason for the increase in the cost of prescription drugs. We hope this point is also swiftly addressed.
 薬を医療機関外の薬局で受け取る院外処方の調剤料は、院内処方に比べて高い。薬局の調剤医療費が膨張する一因だ。この点も早急に是正してもらいたい。

(From The Yomiuri Shimbun, Dec. 21, 2013)
(2013年12月21日01時33分  読売新聞)

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