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2014年6月12日 (木)

混合診療拡大へ 患者の利益優先で制度設計を

The Yomiuri Shimbun
Patients’ interests must come first under mixed medical care plan
混合診療拡大へ 患者の利益優先で制度設計を

It is important that a planned reform of health-care services should provide patients with greater options, thus giving them swift access to advanced medical services at lower cost.
 患者の選択肢を広げ、先端医療を迅速に、少ない負担で受けられるようにすることが重要だ。

Prime Minister Shinzo Abe has announced a plan to establish a system to offer patients greater access to so-called mixed medical care—that is, a combination of medical treatments covered by health insurance with treatments that are not covered. The system would permit patients to receive both types of medical care at the same time, though this would be limited to scenarios in which patients ask for treatments not covered by insurance after determining that their doctors’ explanations about such medical care are convincing.
 安倍首相が、混合診療の拡大へ向けて、「患者申出療養制度」の創設を表明した。患者が医師の説明を受け、納得した上で申し出た治療法であれば、保険が利く治療との併用を認める制度である。

The prime minister explained the purpose of the new system, saying, “[The government] wants to create a mechanism for implementing flexible measures to ensure patients receive advanced treatment at nearby medical facilities.” We hope Abe will make good on his promise to promptly design a system in which the interests of patients come first.
 首相は「身近な医療機関でも先進医療を受けられる、柔軟に対応していくような仕組みを作りたい」と述べた。その言葉通り、患者の利益を最優先する制度設計を急いでもらいたい。

The mixed medical care plan would enable the simultaneous use of services covered by public health insurance programs and those to which such insurance plans do not apply.
 混合診療は、公的医療保険が適用される医療と対象外の医療を併用するものだ。

Medical services of that nature have been banned, as a general rule, over fears of enabling the spread of treatments whose safety and efficacy are open to doubt.
安全性や有効性が不確かな治療法が広がりかねないとして、原則禁止されてきた。

As circumstances stand today, patients are required to pay all expenses—even for treatments that would otherwise be covered—if they receive mixed medical care. This means, for example, that patients must shoulder exorbitant financial burdens if they choose to receive anticancer drugs that have not yet been approved in this country. Such a situation must be rectified.
 併用した場合には、本来は保険が適用される治療費も全額自己負担となってしまう。国内で未承認の抗がん剤などを使う場合、患者が過大な負担を強いられる現状は、改善しなければならない。

The few exceptions to the ban on mixed medical care include some cutting-edge treatments. This applies to new methods of treatment for which approval for coverage under health insurance has been sought. Requests for the use of such advanced treatments is examined by a planned panel of experts, and approved by the Health, Labor and Welfare Ministry.
 現在、先進医療の一部では例外的に混合診療が認められている。保険適用を目指す新しい治療法を対象に、専門家会議が審査し、厚生労働省が承認する。

The problem is that limits have been placed on the scope of medical institutions authorized to provide advanced medical care and the range of patients eligible for such treatment. It also takes six to seven months for each request to be examined. Given this, it is impossible to respond to patients’ compelling cases requiring advanced treatment.
 問題は、実施する医療機関や対象患者の範囲が限定され、審査に6~7か月を要している点だ。新たな治療法を求める患者の切実な思いに応えられていない。

Flexibility, but not without risk

The planned new system entails a large increase in the number of medical facilities authorized to offer advanced services. It will also promote cooperation between what are called clinical research core hospitals, designated by the ministry, and medical institutions in each community, so they can seek consultations with doctors at faculties close to their homes.
 新制度では、実施する医療機関を大幅に増やす。厚労省指定の「臨床研究中核病院」と地域の医療機関が連携し、患者が身近な場所で受診できる体制を作る。

The system would also shorten the length of time required for approval of new advanced treatment. For instance, the time to reach a decision on a request for a new method of treatment that has not yet been applied in Japan would be reduced to six weeks, and only two weeks if there is a precedent for its use.
 承認期間も短縮する。国内で初めて行う治療法は6週間、前例があれば2週間で結論を出す。

Requests for the approval of such treatment would be examined by the planned government panel of experts and the core hospitals.
新設される政府の専門家会議と中核病院がそれぞれ審査を担当する。

We believe the government’s involvement in that process will guarantee a certain degree of safety regarding the use of advanced treatment.
 政府がチェックに関わることで一定の安全性が確保されよう。

Meanwhile, there still are some problems to be addressed in this respect. Some patient advocacy groups have expressed apprehension that patients could be treated with new advanced methods whose effectiveness is not yet fully clear. Few patients have good medical knowledge. With this in mind, doctors should take care to provide scrupulous explanations to patients so they can make appropriate decisions about whether to receive advanced care.
 一方で、課題も残る。患者団体からは、効果のあいまいな治療を押しつけられるのではないかとの声も上がっている。患者には医療の専門知識が乏しい。患者が適切に判断できるよう、医師には丁寧な説明が求められる。

Another pertinent issue concerns the application of health insurance to methods of advanced medical care provided under the new system. If the safety and efficacy of such treatment is established, such treatments should be included in the list of insurance-covered medical services.
 新制度の対象となった治療法も、安全性や有効性が確認されれば、保険を適用するのが本来の姿である。

If methods of advanced treatment are only used under the new system for an indefinite time, it means such medical care will be provided outside the health insurance system, naturally forcing patients to pay substantial bills. That would be contrary to their interests.
いつまでも新制度の枠内にとどまり、保険外のまま高額で提供されるようでは、患者の利益に反する。

With all this in mind, it is necessary to create a structure by which records on each method of advanced treatment provided under the new system will be utilized to examine whether the treatment should be covered by health insurance, while also removing treatments from the list of insurance-covered care if their efficacy is not confirmed.
 新制度の治療実績を保険適用の判断に活用し、効果が確認できないものは対象から除外する仕組みを確立することが大切だ。

(From The Yomiuri Shimbun, June 11, 2014)

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