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Promptly create system of support for home-based medical treatment

The Yomiuri ShimbunIn preparation for the arrival of 2025, when all baby boomers will reach the age of 75 or older, it is desirable to make steady progress in shifting to a system for providing efficient, high-quality medical services.

The details of changes in medical treatment fees for fiscal 2018 have been finalized.

The main purpose of the latest revision is to accelerate a trend in which importance is attached to home-based treatment over hospital-centered services, in accordance with the medical needs of a super-aging society. The revision seeks to reduce the number of high-cost beds for seriously ill patients by tightening the requirements involved. At the same time, it entails preferential measures to deal with beds used to help convalescent patients leave the hospital as well as for home-based treatment fees.

The graying of society has been accompanied by an increase in cases of lifestyle-related illness and dementia. Many elderly people have multiple recurrent health problems. There is a pressing need to switch from medical treatment aimed at completely curing patients through surgeries and other intensive care, to medical services intended to support the lives of patients with chronic diseases.

As circumstances stand now, there are so many beds for seriously ill patients that they have been used to accept a large number of elderly patients in less serious condition. More than a few inpatients can leave the hospital if they undergo proper rehabilitation and home-based care.

It is important to redistribute limited personnel and financial resources, and also combine improvement in the quality of medical care with curbs on the costs involved. Doing so will be in accordance with elderly people’s wishes.

Regarding hospitalization fees, the revision has introduced a performance evaluation system for such matters as the percentage of seriously sick patients and the substance of treatment and care. It is reasonable to shift to a fine-tuned fee system that fits the actual situation.

Ease congestion at hospitals

Under the current system based on the allocation of nurses, the substance of treatment given does not necessarily accord with its fees. Hospitals persist in utilizing beds for seriously ill patients that charge higher fees, a factor behind the lack of sufficient progress in reducing medical expenses. It is hoped that the revision of fees will lead to the realignment of hospital beds.

Regarding home-based treatment, the revision has placed importance on spreading the practice of receiving care from one’s regular family doctor. An extra amount will be added to the fees for an initial medical examination. A new system will be created to charge additional fees if arrangements are made for more than one medical office to cooperate in meeting a patient’s needs on a 24-hour basis. The revision has also clarified fees for remote medical care using tablets and other devices.

To promote arrangements with hospitals for the division of roles, the revision will expand the scope of hospitals eligible to charge extra from patients who have consulted doctors there without a letter of introduction. The aim of the revision is appropriate, in that it seeks to reduce the number of patients concentrated at large hospitals and who visit more than one hospital for the treatment of a single disease. To make these measures effective, it is indispensable to secure the quality and quantity of regular family doctors.

Another major theme addressed in the latest revision, made concurrently with the first change in the price list for nursing-care services in six years, is to reinforce cooperation with the provision of nursing services. The latest revision has improved the level of fees for various work. They include the sharing of information when patients enter or leave the hospital, and when they undergo rehabilitation, or when they are attended at a home or facility during their final days of life. Proactive efforts are desired at the actual scene of treatment.

There is a limit to what can be reformed through fees for medical treatment. Prefectural governments are set to go into full swing regarding their efforts to promote coordination with medical and other institutions, aiming to give shape to community-based medical care plans based on a hard look at the 2025 situation. They will also be tested over their abilities to put the basic idea of the revision into action.

(From The Yomiuri Shimbun, Feb. 12, 2018)Speech



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