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2014年9月 9日 (火)

医療費適正化 ビッグデータ活用で質高めよ

The Yomiuri Shimbun
Analyze, utilize ‘big data’ to ensure appropriate medical costs, quality
医療費適正化 ビッグデータ活用で質高めよ

While continuing to enhance the quality of medical services, curbs should be placed on swelling medical expenses. This is a challenge that our super-graying society cannot avoid tackling.
 医療の質を高めつつ、費用の膨張を抑制する。超高齢社会における避けて通れない課題だ。

Utilizing vast amounts of medical service-related data has drawn attention recently as a reliable means of helping achieve cost-efficient services. The data include those contained in medical treatment expense statements or detailed breakdowns of medical bills issued to individuals by hospitals, pharmacies and related institutions.
 効率的な医療を実現する有力な手段として注目されているのが、レセプト(診療報酬明細書)などの膨大な医療データの活用である。

The Health, Labor and Welfare Ministry is in charge of administering “big data” such as those relating to medical treatment expense statements and findings in medical checkups. This amounts to 8.2 billion pieces of information.
 厚生労働省は、82億件ものレセプトや健康診断のビッグデータを管理している。

To examine specific ways of utilizing the data and methods of analyzing them, the government has set up an expert study panel under the Headquarters for the Promotion of Social Security System Reform. The panel started deliberations on the issue in August.
 その具体的な活用法や分析の手法を検討するため、政府は、社会保障制度改革推進本部の下に専門調査会を設置し、8月から議論をスタートさせた。

Analysis of the big data will make it possible to ascertain regional trends in illnesses and medical services. Based on such findings, it may also become possible to prevent illnesses from developing or keep symptoms from becoming serious, while helping rein in excess provision of medical services.
 ビッグデータを分析すれば、地域ごとの疾病や治療の傾向が把握できる。これを基に、発症や重度化を予防したり、過剰な診療を減らしたりすることもできよう。

In addition, analysis of big data will make it possible to predict future needs in health care services and the number of hospital beds necessary, through estimated demographic changes and projected morbidity rates. The studies’ findings are expected to motivate adjustments in the number of hospitals and hospital beds in different areas.
 人口推計や有病率を踏まえて、将来の医療ニーズや必要な病床数の予測も可能になる。病院数や病床数の調整を進める動機付けになるとの期待がある。

It is reasonable to use objective data to prompt medical institutions to provide appropriate medical services.
 客観的データを使って適切な医療の提供を促す狙いは妥当だ。

Based on the law enacted in June for comprehensive promotion of medical and nursing care services, prefectural governments, including those in Tokyo and Hokkaido, will prepare visions for their regional health care services, incorporating projections about needs for medical services and the number of hospitals needed as of 2025. Big data are essential for crafting adequate future visions of regional medical services.
 6月に成立した医療・介護総合推進法に基づき、都道府県は来年度から、2025年時点での医療ニーズや病床の必要数を盛り込んだ地域医療ビジョンの策定作業に入る。適切なビジョン作りにも、ビッグデータは欠かせない。

Situation differs by region

Some municipal governments and health insurance associations have already started utilizing data, including medical treatment expense statements and results of medical checkups, to slash excessive medical services and prevent lifestyle-related diseases from developing or their symptoms from becoming serious.
 すでに、一部の市町村や健康保険組合では、レセプトや健診のデータを活用して、過剰診療の削減や、生活習慣病の発症・重度化の予防に取り組んでいる。

Kure, Hiroshima Prefecture, has a system to identify patients who make particularly frequent hospital visits and are administered especially large volumes of medicine. Municipally appointed public health nurses visit their homes to give them health care guidance.
 広島県呉市では、通院回数や投薬量が多い患者を抽出し、保健師が訪問指導している。

Some health insurance associations are also assessing subscribers’ risk of lifestyle-related diseases and other illnesses, and devising measures to prevent those ailments in ways tailored to the specific stage of a subscriber’s condition. Such efforts should be encouraged to spread in other areas.
加入者ごとに生活習慣病などのリスクを判定し、各段階に応じた予防事業を展開している健保組合もある。こうした試みを広げたい。

It is concerning that the government is poised to set prefectural ceilings for medical expenses, by projecting regional needs for medical services.
 気がかりなのは、政府が医療ニーズの推計を用いて、都道府県ごとに医療費の目標値を定めようとしている点だ。

Medical bills per capita differ significantly among prefectures. Expenses in the costliest prefecture of Kochi are 1.56 times higher than those in the least expensive, Chiba Prefecture. The government appears likely to ask regions where medical expenses are high to cut back on the expenses by a large margin.
 住民1人当たりの医療費は、都道府県ごとの格差が大きい。最も高い高知県と最も低い千葉県では、1・56倍の開きがある。医療費の高い地域に、大幅な削減を求める考えなのだろう。

However, necessary medical services differ according to regional circumstances, such as local demographic makeups, geographical conditions and the number of hospitals and doctors available.
 しかし、人口構成や地理的条件、病院や医師の数など、地域事情によって、必要とされる医療は異なる。

People involved with local health care services are deeply worried that the government’s move to establish target ceilings for medical expenses could prevent them from providing residents with the medical services they need.
目標設定に対しては、地域の医療関係者の間に、「必要な医療が提供できなくなる恐れがある」という懸念が強い。

Any attempt to impose a uniform target for expense reductions, such as calling for a certain percentage of cuts, could be harmful. The government must scrupulously conduct studies on the matter.
 「何割カット」といった一律の目標を押しつけることは弊害が大きい。慎重な検討を求めたい。

(From The Yomiuri Shimbun, Sept. 8, 2014)Speech

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