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2014年6月21日 (土)

医療・介護改革 「在宅」支える体制作りを急げ

この論説はなんか変だ。
高齢者に対する医療改善政策というよりも、予算削減対策ではないでしょうか。
(スラチャイ)

The Yomiuri Shimbun
Efforts must be made swiftly to boost medical, nursing care services at home
医療・介護改革 「在宅」支える体制作りを急げ

To effectively deal with the rapidly growing demand for medical and nursing care services for the elderly using only the limited funding available, a series of needed reforms to address the challenge must be implemented steadily.
 限られた財源で、増大する高齢者の医療・介護ニーズに対応するため、必要な改革を着実に実行しなければならない。

The Diet enacted a bill on Wednesday promoting comprehensive arrangements for medical and nursing care services through blanket reviews of legal frameworks such as the Medical Service Law and the Nursing Care Insurance Law.
 医療法や介護保険法を一括して見直す医療・介護総合推進法が成立した。

The legislation is intended to provide medical and nursing care, as well as lifestyle support, to elderly citizens in an integrated manner, helping them continue living at home instead of relying on hospitals and nursing care facilities. With the envisaged arrangements, the new law aims to curb government expenditures for medical and nursing care benefits for the aged.
 高齢者が病院や施設に頼らず、在宅生活を続けられるよう、医療や介護、生活支援を一体的に提供する。そうした体制を築き、給付費を抑制するのが目的だ。

The law gives special attention to providing support for elderly patients staying in hospitals to help them return home sooner, through a strategic realignment of hospital beds and resources to promote home-based medical services.
 医療分野では、退院支援を重視して病院・病床の再編を図り、在宅医療を推進する。

The law will also raise the patient contribution level for nursing care from 10 percent to 20 percent for high-income earners, effective August 2015. Stricter requirements for admissions to elder care facilities providing around-the-clock nursing care will also be put in place.
 介護保険では、収入の多い人の自己負担割合を1割から2割に引き上げる。特別養護老人ホームの入所要件も厳しくする。

Every opposition party opposed the legislation, saying that it will lead to shrinking benefits and higher out-of-pocket payments for recipients of the services.
 全野党が、給付縮小と負担増につながる推進法に反対した。

Knowing that Japan’s postwar baby boomers will be at least 75 in 2025, we can be certain that medical and nursing care expenses for the aged will continue to balloon. The existing medical and nursing care systems will hardly be sustainable if left as they are today. It is indispensable to make more effective use of benefit payments and improve benefit allocations. There is simply no avoiding the reform measures incorporated into the comprehensive medical and nursing care promotion law.
 だが、団塊の世代が75歳以上になる2025年にかけて、医療・介護の費用は膨張し、このままでは制度の維持が困難になる。給付の効率化と重点配分は不可欠だ。推進法に盛り込まれた改革は避けて通れない。

Rethink lesser needs

One focus of Diet deliberations on the legislation was the need for a review of nursing care services for recipients who need only light or moderate degrees of care.
 国会審議では、比較的軽度の「要支援者」向け介護保険サービスの見直しが焦点となった。

The new law seeks a shift away from the current system of nursing care services, which is uniform nationwide and calls for caregivers to visit recipients’ homes, and recipients to visit nursing care facilities, on a regular basis. It would instead put in place a formula enabling municipalities to decide on specific services at their own discretion. The inclusion of volunteers and nonprofit organizations is encouraged as a cost-saving measure.
 訪問・通所介護を全国一律の保険サービスから外し、市町村が独自に内容を決めて実施する方式にするものだ。ボランティアやNPOも活用し、費用抑制を図る。

Some existing nursing care service programs include tasks that do not demand the involvement of professional caregivers, such as cleaning recipients’ homes and doing laundry, and providing recipients with recreational activities. The law is wise to focus such reviews on care for those with more significant physical or mental impediments.
 現行のサービスには、掃除や洗濯、レクリエーションなど、専門職が携わる必要のないものが含まれている。財源を重度者へ重点的に振り向けるためにも、適切な見直しと言えよう。

However, a number of problems have yet to be resolved.
 ただ、課題も多い。

For example, many cities, towns and villages are struggling to secure adequate numbers of caregivers. There is also concern over widening regional disparities in services, and degradation of services in some areas. If the elderly don’t have access to proper services, they could face worsening conditions.
 担い手の確保が難しい市町村は少なくない。サービスの地域格差の拡大や質の低下を懸念する声も根強い。高齢者が適切なサービスを受けられなければ、症状の悪化を招く恐れがある。

Some municipalities have already seen tangible results with their own initiatives, including programs to foster nursing care volunteers or help establish organizations to provide services.
 一部の市町村は既に、ボランティアの養成や、サービスを提供する団体の設立支援などに取り組み、実績を上げている。

The government should throw its support behind municipal entities, sharing expertise on the latest pioneering efforts and instruction on specific methods of service management.
 政府は、先駆的なノウハウを紹介し、事業展開に関する具体的な運営指針を示すなど、市町村を支援していく必要がある。

If regional residents actively volunteer their time for nursing-care activities, it will create new opportunities for improved neighborhood cooperation. Municipalities should take the latest legislation as a good opportunity to innovate to ensure a rebirth of communities at the initiative of residents.
 地域住民が、ボランティアとして積極的に事業に参加すれば、新たな支え合いの仕組みも生まれるだろう。市町村は、住民主体の街作りのチャンスととらえ、工夫を重ねてもらいたい。

To prevent those who are not eligible for admission to nursing care facilities or hospitals from becoming so-called nursing care refugees, every local body should do its best to support the aged living at home through the efforts of the entire community.
 施設や病院に入れない人が「介護難民」とならないよう、地域ぐるみで在宅の高齢者を支えることが求められる。

(From The Yomiuri Shimbun, June 20, 2014)

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