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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Requests for the approval of such treatment would be examined by the planned government panel of experts and the core hospitals.

We believe the government’s involvement in that process will guarantee a certain degree of safety regarding the use of advanced treatment.

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.

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.

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.

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.

(From The Yomiuri Shimbun, June 11, 2014)


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