ASOURCE Times

"Stone" for coordinating meetings where discussions are not progressing

The Ministry of Health, Labor and Welfare issued a notice in January calling for a re-verification of the reorganization and integration of public and public hospitals at the Regional Healthcare Initiative Coordination Conference. Prior to that, in September last year, the Working Group on Community Healthcare Initiative announced the names of 424 public and public hospitals calling for a re-examination of the need for restructuring and integration (about 440 in the January notice this year). In response to this, the Ministry of Health, Labor and Welfare held discussion meetings with local governments and hospital officials at seven locations nationwide, as the local governments and hospital groups responded that they did not take into account the individual circumstances of the region. I got it.

The "Guidelines for Formulating Community Healthcare Initiatives" was presented in March 2015. It is a guideline for discussing medical demand in each region at the coordinating meeting with the aim of realizing a regional medical concept that suits the actual conditions of the region by 2025. However, I think that the discussions in each region did not proceed as a whole, and the Ministry of Health, Labor and Welfare threw a "stone" to announce the name of the hospital.

Aiming to create a new system for medical care and long-term care toward 2025, when the baby boomer generation will be over 75 years old, estimating medical needs in 2025, and creating a medical system that responds to them. Through the media, such as discussions between people and the establishment of a mechanism for division of roles and cooperation among medical institutions, it became an opportunity to widely inform the public about what the regional medical concept is like. In addition, he may have tried to use it as a trigger to activate discussions for re-verification by citing specific hospital names and showing that discussions on reorganization and integration have not progressed.

I don't know how the discussions in each region will proceed in the future. However, Masamichi Oda, Vice Chairman of the All Japan Hospital Association (hereinafter referred to as All Japan Hospital Association), has joined the working group as a member, and has expressed his opinions on the regional medical concept from the perspective of private hospitals. We hope that discussions will move forward as the necessary data have already been presented to the prefectures for private hospitals.

It is important to check the role of large public / public hospitals

What is worrisome is that regardless of the size of the scale or the difference in management body, it is about to be discussed as a group of "public / public hospitals". First of all, it makes me feel uncomfortable that some public hospitals have different personalities and roles from public hospitals because of their origins, and are the subject of discussions on reorganization and integration at the regional medical concept coordination meeting.

Furthermore, among public hospitals, many of the local public hospitals are small and medium-sized facilities and play an indispensable role in supporting community medicine, so they should be protected so that they can survive. Large-scale public and public hospitals need to be reorganized and integrated. National, prefectural, and municipal hospitals are concentrated in regional core cities, and the reality is that there are many areas with clearly many beds for the population. Naturally, the functions of the nine areas of "cancer, heart disease, stroke, emergency, pediatrics, perinatal period, disaster, remote areas, training / dispatch function", which are the selection criteria of 424 hospitals, competed, resulting in medical results. Many hospitals do not accumulate. In discussions on reorganization and integration, I think that large public / public hospitals and small and medium-sized public / public hospitals should be discussed separately.

In addition, about 800 billion yen of public funds (transfers) are poured annually into 873 public hospitals (prefectures / municipalities, local incorporated administrative agencies) nationwide, and whether they play a role as a core hospital commensurate with that, in the neighborhood. I think it is necessary to reconfirm whether the functions are shared with the large hospitals in Japan and to contribute to the harmony and stability of regional medical care.

Private hospitals are the axis of comprehensive community care

The regional medical concept is a framework for considering the medical supply system in a wide area called the secondary medical area. On the other hand, small and medium-sized private hospitals, which make up the majority of the members of the All Japan Hospital Association, are involved in the construction of a comprehensive community care system. The comprehensive community care system is based on the daily living area (junior high school district, etc.) with a population of about 20,000 to 30,000. We aim to network various stakeholders in order to provide medical and long-term care services in an integrated manner in municipalities or smaller areas, and we believe that small and medium-sized private hospitals should play an active role in that field. I am.

In the comprehensive community care system, it is required to build a system that secures medical care, long-term care, prevention, housing, and living support that suits the actual conditions of each region. Cooperation between family doctors, regional comprehensive support centers, care managers, etc. is important.

In order to support the elderly in the community, home medical care such as home-visit medical care, home-visit oral care, home-visit nursing, home-visit rehabilitation, and home-visit drug guidance is indispensable. We, private hospitals, are involved in this, and it is important to support home medical care, such as responding to hospitalization as needed and returning to home medical care. We should aim for a hospital that will continue its activities with its feet in these areas.

In constructing a community-based comprehensive care system, for example, the community-based comprehensive care ward of a large-scale hospital has many patients accepted from general wards in the same hospital and does not play the role of the original community-based comprehensive care ward. There are many challenges to be addressed. At All Japan Hospital Association, in order to tackle these issues, we will share and support various data and cases so that about 2,550 hospitals that join can continue to provide high-quality medical care that is closely related to residents and communities. ..