臨牀透析 Vol.20 No.13(3)


特集名 透析医療費における包括化の功罪
題名 透析医療における医療費包括化と透析の質
発刊年月 2004年 12月
著者 山崎 親雄 増子記念病院則武診療所
【 要旨 】 国の経済が破綻したなかで,社会保障費の抑制は政策的にも重要な問題となっている.とくに医療費は,最近の二度の診療報酬改定で,従来は必然といわれていた自然増についても大幅な抑制が実施された.このなかでもとくに透析は,依然として増加し続ける患者およびこれに要する医療費に注目が集まり,大幅に削減された.
一方,繰り返し実施され,定型化しやすい透析治療では,標準化という目的で,定期検査や外来処置料に,部分的ではあるが定額 (包括) 払いが導入されてきた.今後,ダイアライザ一や薬剤を含むすべての包括化も示唆され,そのとき,効率的でかつ質の高い透析が選択され,これを提供する施設が経営的にも安定するシステムを提示する必要がある.
Theme Pros and Cons of DRG/PPS in Dialysis Therapy
Title PPS (prospective payment system) for hemodialysis treatment
Author Chikao Yamazaki Masuko Memorial Hospital, Noritake Branch Clinic
[ Summary ] Since the Japanese economy is on the verge of collapse, a political control mechanism on expenses for social welfare is an important subject. Though an automatic increase in medical expenses has been considered to be inevitable, a steep reduction in medical expenses has been carried out twice for a variety of expenses related to social welfare. These have been achieved through revisions of medical fee payment system as determined by the Ministry of Health, Labor and Welfare. An increase in the number of hemodialysed patients and an accompaning abrupt increase in medical expense for end-stage renal disease has attracted much attention. Based on these findings, medical expenses for hemodialysis were drastically reduced. Hemodialysis is a procedure that is done in the same manner over and over. Therefore, what is termed "a fixed payment system" has been introduced, for this type of treatment, including fees for laboratory examinations related to individual dialysis sessions for outpatients. There is the possibility that everything related to hemodialysis, such as dialysers and medicines, will covered by this system. At this point, an effective, high quality hemodialysis method should he selected from a variety of methods, to help patients, and this modality should also seen as being be beneficial for the stable management of medical institutions with a minimum of effort on the part of doctors.
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