ASOURCE Navi

With the spread of COVID-19, various discussions have been held on how the medical care delivery system should be. Regarding the regional medical concept, which was institutionalized by the "Act on Promotion of Comprehensive Security of Medical and Nursing Care" enacted in 2014 and aims to build a medical care provision system in 2025, discussions are being held to revise the contents assuming response to pandemics of infectious diseases. is in progress.

Ministry of Health, Labor and Welfare 11. [Reference Material 4] Quoted from Japanese Population Related Materials.

By 2025, all the baby boomers (born between 1947 and 1949), who have a large population, will be over 75 years old, and the late-stage elderly population is expected to reach approximately 21.8 million (18% of the total population). As the proportion of elderly people increases further, it is expected that there will be a greater impact on medical and nursing care than at present. Specifically, (1) a decrease in the number of hospitals and a shortage of doctors, (2) an increase in demand for nursing care and medical care due to an increase in the elderly (increase in bedridden elderly and dementia patients), and (3) medical expenses due to an increase in the late-stage elderly. and (4) an increase in the burden of social security costs due to a decrease in the working-age population and labor force.

Under these circumstances, a regional medical concept is being promoted to consider building a regional medical provision system with a view to 2025. Based on future population projections, the number of hospital beds required in 2025 is estimated for each of the four medical functions of advanced acute phase, acute phase, convalescent phase, and chronic phase. This is an initiative to promote functional differentiation and collaboration to realize an efficient medical care delivery system. Among them, it is required to reduce the number of advanced acute stage beds and acute stage beds, increase the number of convalescent stage beds, reduce the number of chronic stage beds, and enhance home medical care. In addition, we will analyze the results of medical care for advanced acute phase and acute phase functions, and downsize and convert functions at 424 hospitals, including public and public medical institutions, that will request re-verification of the roles they will play in 2025 and the number of beds by function. Consideration is being given to reorganization and integration including

Due to the corona crisis, the consolidation work of public hospitals is currently temporarily frozen, but about 200 institutions on the reorganization list are accepting corona patients, and there are opinions that the reorganization policy should be reviewed. . In addition, in order to expand the number of beds for new corona patients at private medical institutions, prefectures will contract with private hospitals, and from the perspective of "securing the public nature of private medical institutions", if there is a deficit, the prefecture will There is also a proposal that it is possible to have a mechanism to compensate for

At the Ministry of Health, Labor and Welfare's review of medical plans since last year, based on the discussions at the Infectious Diseases Committee of the Health Sciences Council and the working group on regional medical concept, future plans based on the response to the new coronavirus infectious disease. As an issue of the regional medical concept, a policy is shown to position responses to emerging infectious diseases in the medical plan so that administrative and medical personnel can smoothly respond when an emerging infectious disease occurs. In addition, because it is similar to disaster medical care, it is appropriate to add it to the "five projects (emergency medical care, disaster medical care, remote medical care, perinatal medical care, and pediatric medical care)."

On top of that, the policy is to encourage each prefecture to discuss and prepare in advance in each region based on the actual situation of the region, divided into normal times and outbreaks. As a result, it will be possible to respond flexibly and efficiently in emergencies while minimizing the burden during normal times.

■ Efforts during normal times
(1) Development of hospital beds and vacant spaces other than beds that are easy to use during the spread of infection (including development assuming severe cases and suspected cases)
(2) Developing and securing human resources (nurses with expertise in infection control, medical staff who can handle ECMO and ventilator management)
(3) Stockpile of protective equipment for infection, etc.
④Thorough measures against nosocomial infections
(5) Sharing of response policies when clusters occur within medical institutions
(6) Describe the establishment of systems such as PCR tests at medical institutions.

■ Efforts during the spread of infection
(1) Securing candidate medical institutions (including candidate medical institutions for severe cases and suspected cases)
(2) Efforts to secure manpower to deal with infectious disease patients (response including non-infectious disease specialists, priority placement within the hospital, etc.)
③ Cooperation between medical institutions (dispatching support staff such as doctors and nurses to medical institutions accepting patients with infectious diseases and medical institutions where clusters have occurred) and division of roles (medical institutions accepting patients with infectious diseases and responding to patients other than infectious disease patients) medical institutions)

In addition, in view of the actual situation of population decline and aging, we will work to ensure a high-quality and efficient system for both inpatient and outpatient medical care, while paying attention to the impact of an outbreak of an emerging infectious disease. I am proposing that we need to take action.