臨牀透析 Vol.17 No.13(2-1)


特集名 介護保険と透析医療
題名 各論:中核病院における透析医療と介護保険の問題点
発刊年月 2001年 12月
著者 中本 雅彦 済生会八幡総合病院腎センター
著者 菅 朗 介護老人保健施設「しんわ苑」
著者 阿部 哲哉 阿部クリニック
著者 田中 孝夫 王子病院
【 要旨 】 近年,透析患者の高齢化は患者の家族や医療施設にとって大きな問題になってきている.2000年4月に高齢者の生活支援のため,介護保険制度が導入され,介護が必要な透析患者と医療施設にとって福音かと思われたが,現在の制度では,(1) 介護老人保健施設(老健)に入所の血液透析患者の診療報酬は,従来の診療報酬に比較して,透析施設にとっては月におよそ4,600点マイナスになる,(2) 老健での血液透析患者の送迎は時間的に困難である,(3) 老健に入所の腹膜透析患者の指導管理料が請求できないといった問題をかかえている.現行の介護保険制度は,高齢の透析患者と透析施設にとってなんらの利益ももたらしていない.早急なる改定が望まれる.
Theme Curent Status and Problem of Long Term Care Insurance System for Dialyzed Patients
Title Problems between dialysis therapy and social insurance system for elderly care in center hospital
Author Masahiko Nakamoto Saiseikai Yahata Hospital
Author Akira Suga Sinwaen
Author Tetsuya Abe Abe Clinic
Author Takao Tanaka Ouji Hospital
[ Summary ] It has been a big problem for both the families and medical institutes involved to take long-term care of the elderly patients. In April, 2000, Social insurance system for elderly care was introduced in Japan, seemingly a good news for these elderly patients necessitating cares as well as for the dialysis centers. However, the following problems appeared; (1) Dialysis fee for the patients in health care facilities for the elderly is 4,600 points lower than that for the ordinary patients. (2) It seems difficult for these patients in facilities to maintain dialysis regularly mainly because of some problems related to the patients-transportation system between their facilities and dialysis centers. (3) Additional doctor's fee is not allowed for the dialysis patients admitted to these health care facilities for the elderly. From these reasons, the authors conclude that the current social insurance system still include some problems to be solved for both patients and medical institutes. The system should be revised as soon as possible.
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