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2014年5月 8日 (木)

健診の基準緩和 薬剤費の削減につながるか

The Yomiuri Shimbun 11:00 pm, May 06, 2014
New health criteria should be utilized to trim spending on needless drugs
健診の基準緩和 薬剤費の削減につながるか

New criteria for the acceptable ranges of health checkup results are expected to be introduced soon. Whether the new standards will help people manage their health is an important question. We should also utilize the new criteria to trim ballooning medical expenses.
 健康診断の新基準を健康管理に役立てることが大切だ。医療費の削減にもつなげたい。

Last month, the Japan Society of Ningen Dock (comprehensive health checkups) and the National Federation of Health Insurance Societies revealed a draft recommendation of the new criteria. It is based on the two organizations’ analysis of data on those who have no chronic diseases among the 1.5 million people who underwent ningen dock examinations. The new criteria will be introduced as early as next spring.
 日本人間ドック学会と健康保険組合連合会が新しい基準案を公表した。人間ドックの受診者150万人のうち、持病がない人の測定値を使って解析したものだ。早ければ来年春から適用される。

Currently, figures suggested by academic groups are used as criteria for the acceptable ranges of health checkup results. However, which figures to use is left up to the checkup facilities and medical institutions. The new criteria will serve as the first common standard that will be used nationwide. The massive amount of data collected from people who underwent comprehensive health checkups gives weight to the criteria.
 健康診断の基準値は従来、各専門学会が推奨する数値などが基になっていたが、健診施設や病院によって採用する数値はまちまちだった。今回が初めての全国共通基準である。膨大なデータから得られた指標には重みがある。

The focus of attention on the new criteria is the easing of figures that will be judged abnormal. Under the draft, the easing will occur for more than half of the 27 health checkup indicators.
 ポイントは、27の検査項目中、半数以上で「異常なし」と判定する数値が緩和されたことだ。

The Japanese Society of Hypertension recommends that systolic blood pressure should be lower than 130, but the draft set the upper limit of the acceptable figure at 147. The acceptable ranges of indicators such as cholesterol levels and those determining obesity will also be relaxed.
 最高血圧の上限は147となり、日本高血圧学会が示している現行の数値(130未満)に比べて高くなった。肥満やコレステロールの基準も緩やかになる。

When acceptable ranges are too strict, there is a possibility that healthy people will be regarded as unhealthy, subjecting them to needless anxiety. More than 90 percent of people who underwent comprehensive health check-ups have had some sort of abnormality pointed out to them. If the new criteria come into effect, it is likely that the number of people who are judged to have abnormalities will decrease.
 基準が厳しすぎれば、健康な人まで病人扱いされ、無用な不安を与える恐れがある。人間ドックでは、9割を超える受診者が何らかの異常を指摘されてきた。新基準が適用されれば、「異常」と判定される人は減るだろう。

More flexible indicators

There is another point worth noting in the new criteria. The draft has set different values based on sex or age for many indicators—a significant change from the status quo.
 多くの検査項目で、男女別、年齢別に基準値が設けられたのも大きな変更点だ。

For example, the upper limit for LDL cholesterol, known as “bad cholesterol,” was set at 178 for men, but the upper limit will vary from 152 to 190 for women depending on their age. Values for weight and HDL cholesterol, or “good cholesterol,” will also differ based on sex.
 “悪玉”のLDLコレステロールの上限は、男性の178に対し、女性は年齢により152~190と幅を持たせた。肥満や“善玉”のHDLコレステロールの基準も、性別で差を設けた。

We believe they are appropriate changes considering the fact that the risk of heart disease and stroke vary according to sex and age.
 性別や年齢によって心臓病や脳卒中になるリスクが異なることを考えれば、適切な措置である。

Currently, the acceptable ranges for health checkups are set uniformly regardless of sex or age. As a result, despite the fact that women generally have a lower risk of heart disease, many women have been judged as having an abnormality during a health checkup, meaning they have to then take unnecessary medication. Needless treatments have been carried out, wasting money on drugs.
 従来は老若男女に一律の基準が適用されてきた。心臓病などの発症リスクが低い女性でも「異常」と判定され、多くの人が薬を服用している。過剰な治療が、薬剤費の無駄遣いを招いてきた。

Of course, the easing of the acceptable ranges does not diminish the importance of everyday efforts to manage one’s health. Even when people are within the acceptable ranges at health checkups, if their figures are close to an upper or lower limit, they should regard this to mean they have a higher risk of becoming ill in relative terms. It is important to undergo checkups periodically and watch carefully for changes in health indicators.
 基準が緩やかになったからといって、日頃の節制が大切なことに変わりはない。新基準の範囲内でも、上限や下限に近い場合は、病気のリスクが相対的に高いと受け止めるべきだ。継続的に健診を受け、数値の変化に留意したい。

We want to stress the fact that the new criteria are based on data taken only from generally healthy people, meaning they are not applicable to people dealing with lifestyle-related diseases, such as diabetes. It would be dangerous for people who have chronic diseases to prematurely conclude that they have no health problems by applying the new criteria to themselves and stop their treatments.
 健康な人だけを対象にして作成された新基準は、糖尿病など既に生活習慣病を患っていると適用されないことにも注意が要る。持病のある人が、新基準を基に「異常なし」と自己判断し、治療をやめるのは危険である。

We urge facilities and medical institutions that provide health checkup services to provide thorough explanations of the new criteria to patients to avoid confusion.
 受診者が混乱しないよう、健診を行う施設や医療機関には丁寧な説明が求められる。

(From The Yomiui Shimbun, May 6, 2014)

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