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2014年2月14日 (金)

診療報酬改定 「病院依存」から転換できるか

The Yomiuri Shimbun February 13, 2014
Steer patients toward home-based care through revision of medical fees list
診療報酬改定 「病院依存」から転換できるか(2月13日付・読売社説)

Will the latest proposal from a key health ministry panel trigger a retreat from excessive reliance on hospital-based treatment and attach greater importance to home health-care services?

On Wednesday, the Central Social Insurance Medical Council adopted a set of recommendations for revising the list of medical treatment fees. These medical service payments constitute a portion of the income earned by medical institutions.

The advisory panel’s proposal calls for tightening requirements for medical care involving the use of beds designated as equipment for patients in the acute stage, a practice that can incur higher bills for seriously ill patients. Meanwhile, the proposal would pay higher fees for services involving beds that are used to place greater emphasis on rehabilitation so patients can leave the hospital at an early date.

The average number of days spent in hospitals by patients in this country is greater than in the United States and Europe. This has contributed to an enormous increase in national medical care expenditures.

The graying of Japanese society is expected to accelerate. A number of older people suffer from chronic diseases that can be managed with home-based treatment. In light of this situation, it was a sound decision for the advisory panel to call for a reduction in the number of beds for acute stage treatments and for efforts to encourage patients to leave the hospital at an early date.

The question is how to move forward in consolidating hospital beds that are classified by curative purpose.

Previous revisions to the schedule of medical treatment fees by the health ministry have caused significant confusion among medical institutions.

Revisions made to fees involving beds used to treat acutely ill patients in fiscal 2006 exacerbated this potential for confusion. The revisions set fees for medical services involving acute treatment beds at a higher level, which encouraged many hospitals to set up more of these beds than necessary and contributed to a surplus of them.

This resulted in medical institutions scrambling for nurses, because the use of such beds requires more nurses to provide appropriate care for acutely ill patients. The situation also fostered a tendency among nurses to prefer to work in urban areas, leading to an uneven distribution of such medical workers.

Negative impact clear

The adverse impact of the 2006 revisions was also evident in the many hospitals providing elderly people with treatments using beds designated for critically ill patients. However, the fact is that many of them are placed in such beds despite improvements in their conditions.

The ministry needs to acknowledge that it should have been more thorough in designing a new system for medical treatment fees in 2006.

There also is cause for apprehension about the latest proposed revisions. If fees for services involving beds for patients undergoing rehabilitation are set at a higher compensation level, it could create a spike in the number of hospitals seeking to take advantage of that. It seems likely that an excessive number of rehabilitation-designated beds could encourage patients to stay in the hospital, despite their ailments being treatable through home-based health services.

It is essential that the ministry take adequate measures to prevent a large surplus in beds for rehabilitation treatments.

The latest proposal would expand the pricing schedule to include fees for practicing doctors’ management of patients receiving home-based care. The plan is intended to ensure stability in the conditions of older patients receiving home-based treatment. However, because there is a perceived preference among older patients for large hospitals, it is unclear whether they would desire treatment from outpatient doctors as their regular physicians.

Consolidating purpose-classified hospital beds requires more than revisions to the fee schedule. It will also be necessary to accurately determine the number of beds needed in each region for acutely ill patients and patients in rehabilitation.

In fiscal 2015 or later, the national government intends to require Tokyo and all prefectural governments to put together new community-based health care plans that must include the number of rehabilitation beds needed by each community. The move is aimed at improving the quality of current community-based care schemes, which were prepared by the local governments. The national government is seeking to establish relevant legislation during the current Diet session.

Given the authority possessed by each municipality to supervise medical institutions in its area, Tokyo and all prefectural governments have a significant role to play in achieving a good balance in the consolidation of hospital beds.

(From The Yomiuri Shimbun, Feb. 13, 2014)
(2014年2月13日01時15分  読売新聞)


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