医療保険制度の崩壊ーその1 [エコノミスト記事]
皆保険制度導入から５０年の日本ーその現状と今後の課題
イギリスの経済誌エコノミストが「日本の医療制度」を取り上げ、今後日本が直面するであろう様々な問題点を指摘しています。
日本が世界に誇る「皆保険制度」ーこの制度が出来てから今年で５０年になる。これを受けてイギリスの医療ジャーナルLancetが「日本の医療」を特集。
この記事をもとにエコノミストが、日本の医療制度が抱えている様々な問題点を取り上げ、その解決策を提示しています。
日本の医療、海外からはどのように見られているのか、海外からの意見に少し耳を傾けてもいいのでは。
エコノミストの記事の内容は次の通りです。
海外から見た日本の医療制度の優秀性のあれこれ
◆医療費ー日本人はアメリカ人の半分
◆平均寿命ー日本人はアメリカ人より長生き
◆診察回数ー日本人はヨーロッパ人の２倍 薬の摂取量も日本人の方が多い
、、、そして日本人の平均寿命は、１９４５年の５２歳から今日では８３歳にまで伸び、長寿世界一の国となった。幼児死亡率も世界一低い。
他の諸外国と比べてみても、日本の医療制度は優れた面が多いにも関わらず、医療費はGDPの８．５パーセントにしか過ぎない。
、、、とこのようにいいことずくめのように見える日本の医療制度だが、実は様々な困難な問題を抱えているのであるとこの記事は指摘する。
最大の問題は人口問題
人口の高齢化と出生率の低下により、皆保険を支える現役の労働力が不足していることだ。
皆保険制度が始まってから５０年になるが、６５歳以上の高齢者は今現在、総人口の２３パーセントを占めている。そして2050年までには４０パーセントに達し、日本の人口は3000万人減少し、1億人以下になると見られている。
東京大学の渋谷健司教授は語る。
「日本の医療制度はこれまではちゃんと機能してきたのだが、50年が経過してほころびが見え始めてきた。今まで医療制度に非効率的なところがあっても、高度経済成長の時代には何とか持ちこたえてきたのだが、今日の経済の低迷時代にはちゃんと機能を果たすことが出来なくなってきている。」
GDPに占める医療費の割合が倍になる
コンサルタント会社のマッキンゼーの調べによると、2035年までには、GDPに占める医療費の割合は今の2倍にまで膨らむと予想されているが、そのつけは医療費の3分の2を負担する国にかかってくるのである。
政治家たちは増税には消極的な態度をとり、かえって医療供給側の規模を縮小している。そのため効率病院の4分の3以上は赤字経営となっている。
日本の医療制度は、他のサービス産業のように厄介な規則がある。医療制度に絡んだ関係機関が多すぎて、医療制度を改善する気運がほとんど見られないのだ。
医者の絶対数が少なすぎだ
医者の数は国の割り当て制度により、人口の割に、先進国の平均の３分の１と、少なすぎだ。地方での医者不足は特に深刻で、外科、小児科、産科などの専門医が不足している。
小児科医と産科医の不足は出生率の低下と関係があるが、医者の収入は、診察する患者の数と処方する薬の数によってある程度決まってくるので、そうした医者の不足は起きてくるのだという。それで子供診る医者や妊婦を診る医者が不足するのである。
医者稼業はもうからない
医者は低賃金であくせく働かされている(中堅の医者では年収が１２万５０００ドルぐらい)。ある３０代の医者は１週間に１００時間以上働いているという。
関連記事はこちら
長寿王国日本の終末
長寿世界一は木村次郎右衛門さんー１１４歳
Lancetの特集記事はこちら
Japan: universal health care at 50 years
Health care in Japan
Not all smiles
Japan’s health-care system is the envy of the world. It is also in crisis
THE Japanese spend half as much on health care as do Americans, but still they live longer. Many give credit to their cheap and universal health insurance system, called kaihoken, which celebrates its 50th anniversary this year. Its virtues are legion. Japanese people see doctors twice as often as Europeans and take more life-prolonging and life-enhancing drugs. Rather than being pushed roughly out of hospital beds, they stay three times as long as the rich-world average. Life expectancy has risen from 52 in 1945 to 83 today. The country boasts one of the lowest infant-mortality rates in the world. Yet Japanese health-care costs are a mere 8.5% of GDP.
Even so, the country’s medical system is embattled. Although it needs a growing workforce to pay the bills, Japan is ageing and its population is shrinking. Since kaihoken was established in 1961, the proportion of people over 65 has quadrupled, to 23%; by 2050 it will be two-fifths of a population that will have fallen by 30m, to under 100m. “The Japanese health system that had worked in the past has begun to fail,” Kenji Shibuya of the University of Tokyo and other experts write in a new issue of the Lancet, a British medical journal, devoted to kaihoken. “The system’s inefficiencies could be tolerated in a period of high growth, but not in today’s climate of economic stagnation.”
By 2035 health care’s share of GDP will roughly double, according to McKinsey, a consultancy. The burden falls on the state, which foots two-thirds of the bills. Politicians are unwilling to raise taxes, so they squeeze suppliers instead: more than three-quarters of public hospitals operate at a loss.
Like other service industries in Japan, there are cumbersome rules, too many small players and few incentives to improve. Doctors are too few—one-third less than the rich-world average, relative to the population—because of state quotas. Shortages of doctors are severe in rural areas and in certain specialities, such as surgery, paediatrics and obstetrics. The latter two shortages are blamed on the country’s low birth rate, but practitioners say that they really arise because income is partly determined by numbers of tests and drugs prescribed, and there are fewer of these for children and pregnant women. Doctors are worked to the bone for relatively low pay (around $125,000 a year at mid-career). One doctor in his 30s says he works more than 100 hours a week. “How can I find time to do research? Write an article? Check back on patients?” he asks.
On the positive side, patients can nearly always see a doctor within a day. But they must often wait hours for a three-minute consultation. Complicated cases get too little attention. The Japanese are only a quarter as likely as the Americans or French to suffer a heart attack, but twice as likely to die if they do.
Some doctors see as many as 100 patients a day. Because their salaries are low, they tend to overprescribe tests and drugs. (Clinics often own their own pharmacies.) They also earn money, hotel-like, by keeping patients in bed. Simple surgery that in the West would involve no overnight stay, such as a hernia operation, entails a five-day hospital stay in Japan.
Emergency care is often poor. In lesser cities it is not uncommon for ambulances to cruise the streets calling a succession of emergency rooms to find one that can cram in a patient. In a few cases people have died because of this. One reason for a shortage of emergency care is an abundance of small clinics instead of big hospitals. Doctors prefer them because they can work less and earn more.
The system is slow to adopt cutting-edge (and therefore costly) treatments. New drugs are approved faster in Indonesia or Turkey, according to the OECD. Few data are collected on how patients respond to treatments. As the Lancet says, prices are heavily regulated but quality is not. This will make it hard for Japan to make medical tourism a pillar of future economic growth, as the government plans.
The Japanese are justly proud of their health-care system. People get good basic care and are never bankrupted by medical bills. But kaihoken cannot take all the credit for the longevity of a people who eat less and stay trimmer than the citizens of any other rich country. And without deep cost-cutting and reform, the system will struggle to cope with the coming incredible shrinking of Japan.
(Economist 2011/09/10)
イギリスの経済誌エコノミストが「日本の医療制度」を取り上げ、今後日本が直面するであろう様々な問題点を指摘しています。
日本が世界に誇る「皆保険制度」ーこの制度が出来てから今年で５０年になる。これを受けてイギリスの医療ジャーナルLancetが「日本の医療」を特集。
この記事をもとにエコノミストが、日本の医療制度が抱えている様々な問題点を取り上げ、その解決策を提示しています。
日本の医療、海外からはどのように見られているのか、海外からの意見に少し耳を傾けてもいいのでは。
エコノミストの記事の内容は次の通りです。
海外から見た日本の医療制度の優秀性のあれこれ
◆医療費ー日本人はアメリカ人の半分
◆平均寿命ー日本人はアメリカ人より長生き
◆診察回数ー日本人はヨーロッパ人の２倍 薬の摂取量も日本人の方が多い
、、、そして日本人の平均寿命は、１９４５年の５２歳から今日では８３歳にまで伸び、長寿世界一の国となった。幼児死亡率も世界一低い。
他の諸外国と比べてみても、日本の医療制度は優れた面が多いにも関わらず、医療費はGDPの８．５パーセントにしか過ぎない。
、、、とこのようにいいことずくめのように見える日本の医療制度だが、実は様々な困難な問題を抱えているのであるとこの記事は指摘する。
最大の問題は人口問題
人口の高齢化と出生率の低下により、皆保険を支える現役の労働力が不足していることだ。
皆保険制度が始まってから５０年になるが、６５歳以上の高齢者は今現在、総人口の２３パーセントを占めている。そして2050年までには４０パーセントに達し、日本の人口は3000万人減少し、1億人以下になると見られている。
東京大学の渋谷健司教授は語る。
「日本の医療制度はこれまではちゃんと機能してきたのだが、50年が経過してほころびが見え始めてきた。今まで医療制度に非効率的なところがあっても、高度経済成長の時代には何とか持ちこたえてきたのだが、今日の経済の低迷時代にはちゃんと機能を果たすことが出来なくなってきている。」
GDPに占める医療費の割合が倍になる
コンサルタント会社のマッキンゼーの調べによると、2035年までには、GDPに占める医療費の割合は今の2倍にまで膨らむと予想されているが、そのつけは医療費の3分の2を負担する国にかかってくるのである。
政治家たちは増税には消極的な態度をとり、かえって医療供給側の規模を縮小している。そのため効率病院の4分の3以上は赤字経営となっている。
日本の医療制度は、他のサービス産業のように厄介な規則がある。医療制度に絡んだ関係機関が多すぎて、医療制度を改善する気運がほとんど見られないのだ。
医者の絶対数が少なすぎだ
医者の数は国の割り当て制度により、人口の割に、先進国の平均の３分の１と、少なすぎだ。地方での医者不足は特に深刻で、外科、小児科、産科などの専門医が不足している。
小児科医と産科医の不足は出生率の低下と関係があるが、医者の収入は、診察する患者の数と処方する薬の数によってある程度決まってくるので、そうした医者の不足は起きてくるのだという。それで子供診る医者や妊婦を診る医者が不足するのである。
医者稼業はもうからない
医者は低賃金であくせく働かされている(中堅の医者では年収が１２万５０００ドルぐらい)。ある３０代の医者は１週間に１００時間以上働いているという。
関連記事はこちら
長寿王国日本の終末
長寿世界一は木村次郎右衛門さんー１１４歳
Lancetの特集記事はこちら
Japan: universal health care at 50 years
Health care in Japan
Not all smiles
Japan’s health-care system is the envy of the world. It is also in crisis
THE Japanese spend half as much on health care as do Americans, but still they live longer. Many give credit to their cheap and universal health insurance system, called kaihoken, which celebrates its 50th anniversary this year. Its virtues are legion. Japanese people see doctors twice as often as Europeans and take more life-prolonging and life-enhancing drugs. Rather than being pushed roughly out of hospital beds, they stay three times as long as the rich-world average. Life expectancy has risen from 52 in 1945 to 83 today. The country boasts one of the lowest infant-mortality rates in the world. Yet Japanese health-care costs are a mere 8.5% of GDP.
Even so, the country’s medical system is embattled. Although it needs a growing workforce to pay the bills, Japan is ageing and its population is shrinking. Since kaihoken was established in 1961, the proportion of people over 65 has quadrupled, to 23%; by 2050 it will be two-fifths of a population that will have fallen by 30m, to under 100m. “The Japanese health system that had worked in the past has begun to fail,” Kenji Shibuya of the University of Tokyo and other experts write in a new issue of the Lancet, a British medical journal, devoted to kaihoken. “The system’s inefficiencies could be tolerated in a period of high growth, but not in today’s climate of economic stagnation.”
By 2035 health care’s share of GDP will roughly double, according to McKinsey, a consultancy. The burden falls on the state, which foots two-thirds of the bills. Politicians are unwilling to raise taxes, so they squeeze suppliers instead: more than three-quarters of public hospitals operate at a loss.
Like other service industries in Japan, there are cumbersome rules, too many small players and few incentives to improve. Doctors are too few—one-third less than the rich-world average, relative to the population—because of state quotas. Shortages of doctors are severe in rural areas and in certain specialities, such as surgery, paediatrics and obstetrics. The latter two shortages are blamed on the country’s low birth rate, but practitioners say that they really arise because income is partly determined by numbers of tests and drugs prescribed, and there are fewer of these for children and pregnant women. Doctors are worked to the bone for relatively low pay (around $125,000 a year at mid-career). One doctor in his 30s says he works more than 100 hours a week. “How can I find time to do research? Write an article? Check back on patients?” he asks.
On the positive side, patients can nearly always see a doctor within a day. But they must often wait hours for a three-minute consultation. Complicated cases get too little attention. The Japanese are only a quarter as likely as the Americans or French to suffer a heart attack, but twice as likely to die if they do.
Some doctors see as many as 100 patients a day. Because their salaries are low, they tend to overprescribe tests and drugs. (Clinics often own their own pharmacies.) They also earn money, hotel-like, by keeping patients in bed. Simple surgery that in the West would involve no overnight stay, such as a hernia operation, entails a five-day hospital stay in Japan.
Emergency care is often poor. In lesser cities it is not uncommon for ambulances to cruise the streets calling a succession of emergency rooms to find one that can cram in a patient. In a few cases people have died because of this. One reason for a shortage of emergency care is an abundance of small clinics instead of big hospitals. Doctors prefer them because they can work less and earn more.
The system is slow to adopt cutting-edge (and therefore costly) treatments. New drugs are approved faster in Indonesia or Turkey, according to the OECD. Few data are collected on how patients respond to treatments. As the Lancet says, prices are heavily regulated but quality is not. This will make it hard for Japan to make medical tourism a pillar of future economic growth, as the government plans.
The Japanese are justly proud of their health-care system. People get good basic care and are never bankrupted by medical bills. But kaihoken cannot take all the credit for the longevity of a people who eat less and stay trimmer than the citizens of any other rich country. And without deep cost-cutting and reform, the system will struggle to cope with the coming incredible shrinking of Japan.
(Economist 2011/09/10)
タグ：長寿国 皆保険
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