On January 17, 2020, the Ministry of Health, Labor and Welfare sent a notice to each prefectural governor in the name of the director of the medical affairs bureau, "Regarding re-verification of specific response policies of public and public medical institutions." By the fall of 2020, we are requesting re-verification of the reorganization and integration of public and public hospitals at the regional medical concept coordination meeting, and discussions on optimizing the medical care provision system based on the current situation and future image of the region. Expected to be activated.
公立・公的病院の再編・統合の再検証を求めた今回の通知は、2017年から始まった「地域医療構想」の調整会議が停滞していた事態を踏まえ、新たな方策を提示し、議論を進めさせようという厚労省の意図が反映されている。
The regional medical concept is an initiative in which local medical personnel discuss and voluntarily reconstruct an appropriate medical care provision system toward 2025, when the so-called baby boomer generation will be over 75 years old. A coordinating meeting was set up in each concept area (in principle, the secondary medical area), and discussions began in 2017. Although there were reports on the required number of beds and bed functions for each region in the future, the hospital was reorganized. It did not lead to concrete movements such as integration.
Next, the Ministry of Health, Labor and Welfare will present the "New Public Hospital Reform Plan" and "Public Medical Institutions 2025 Plan" to public and public hospitals, and adjust the appropriateness of the plan in consideration of future medical demand. We decided to have them discuss at the meeting. Check whether it plays the role expected of public / public hospitals such as remote medical care, emergency, pediatric, perinatal, disaster, mental and other unprofitable / special sector medical care, and advanced / advanced medical care that is limited in the private sector. I let you. Nevertheless, the working group on the regional medical plan of the Ministry of Health, Labor and Welfare pointed out that the discussion was sluggish, saying that "there are few opinions on the plan."
Therefore, on September 26, last year, the Working Group announced 424 public and public hospitals calling for a re-examination of the need for reorganization and integration (including bed reduction and functional conversion) as a means of activating discussions. Immediately after this announcement, newspapers and television reported it, and there was an article that seemed to encourage the consolidation and abolition of the hospital, which spread the turmoil to the heads of local governments, hospital groups, hospital staff, and residents.
The National Governors'Association, the National Association of City Mayors, and the National Association of Towns and Villages said, "The fact that the hospital name was announced only by analysis based on uniform national standards without considering the individual circumstances of the region is the last fort to protect the lives and health of the people. It is extremely regrettable that it may lead to the mechanical reorganization and integration of hospitals. "
In response to this situation, the Ministry of Health, Labor and Welfare held "opinion exchange meetings with local governments regarding regional medical plans" for local governments and hospital officials at seven locations nationwide, and also to hospital groups and prefectural medical associations. On the other hand, after repeated briefing sessions and somehow understanding the purpose, the notification for this January was reached.
Of the 1,652 public hospitals nationwide, 1,455 hospitals that can grasp data have medical records in 9 areas such as cancer, heart disease, emergency, pediatrics, perinatal period, remote areas, and training / dispatch functions. Hospitals with particularly few hospitals or hospitals with similar medical records in the six areas of cancer, heart disease, stroke, emergency, pediatrics, and perinatal period were selected.
The working group emphasized, "It is not a mechanical decision on the direction of reorganization and integration, but only to stimulate discussions at the coordinating meeting." In response, the Onshi Foundation Saiseikai and the Japanese Red Cross Society said, "The intention of the announcement was not known, and suddenly" "The director and staff of the hospital were shocked." It is a fact that there are few achievements, and I would like to consider what to do in the future in the community and in the hospital. "
The majority of the doctors in the field said that the hospital names announced as requiring re-verification of the reorganization and integration were "valid" and "convinced".
For example, in a survey conducted by "m3.com", a website for doctors and medical professionals, targeting doctor members, out of the 7,259 respondents, the reorganized and integrated hospitals were "valid" and "generally valid". The majority of doctors who think about it were 53.1%, which greatly exceeded the responses (35.6%) that were "not very valid" or "not valid" (Fig. 1). In addition, regarding the medical care provision system by 2025, "review is necessary" (29.9%) and "somewhat review is necessary" (54.7%), and 84.6% answered that some kind of review is necessary.
In a survey conducted by Nikkei Medical Online, a website for doctors and healthcare professionals, targeting hospital owners and hospital workers, 60.9 out of 1,419 people who answered that they "know" about the publication of 424 hospitals. % Positively accepted the announcement as "convinced" or "generally convinced". Regarding the reasons, "it was a good stimulus for discussing the regional medical care provision system for the future" (42.8%), and "the hospitals that certainly need to be verified for reorganization and integration have been announced" (42.8%). 30.6%) was the most common answer (Fig. 2).
It can be said that the announcement of the hospital name, which needs to be re-verified for reorganization and integration, has thrown a stone in the discussion of the regional medical concept, which tended to be stagnant, as the Ministry of Health, Labor and Welfare aimed.
Figure 1 Validity of the published 424 public / public medical institution hospital names
Source: m3.com
Figure 2 424 Evaluation of hospital publication
Source: Nikkei Medical Online
However, it is unclear whether the debate will be lively toward the realization of the regional medical concept. The fact that the recognition that the current medical care provision system needs to be reviewed is shared in the field emerges from the above two surveys. However, even if you agree with the general consensus, if the hospital where you work is the target, there is data that it seems that there are not a few people involved in the discussions in each theory.
According to the "m3.com" survey, half of the doctors (493) working at the hospitals subject to re-verification answered that the published hospital names were "not very valid" or "not valid" at 53.4%. Was over. This is in contrast to the majority (56.4%) of doctors (2,371) in non-target hospitals who answered "reasonable" or "generally valid" (Fig. 3). It seems that the real intention of the site is that even if reorganization and integration are necessary, it is not convincing if it falls on oneself.
In fact, when it comes to consolidating and abolishing hospitals, it is necessary to consolidate and convert the functions of each hospital and reduce the number of beds. It is painful to relocate or reduce the number of staff, including not only medical staff such as doctors and nurses, but also staff in the back office, so there are many obstacles for management to make decisions. In the case of public hospitals, the head of the local government may have stated in the election pledge that the hospital will continue to exist or be expanded or remodeled, and political issues will also be involved.
Dissatisfaction with the use of data from the "Bed Function Report" to make an assessment that re-verification is necessary is also smoldering. The reason is that the bed function report reports the medical function of each hospital and does not reflect the medical demand of how the population composition of the area changes and what kind of patients increase or decrease. It will be necessary for the Ministry of Health, Labor and Welfare to respond properly to these voices.
Currently, the Ministry of Health, Labor and Welfare is confirming the progress and future schedule of each regional medical concept coordination meeting. Based on those answers, it is also considering extending the deadline for re-verification of reorganization and integration, which is to decide the policy by September 2020.
Figure 3 Differences in answers depending on whether the place of employment is "yes" or "no" at the target hospital
Source: m3.com
About the aim of publicizing the hospital name
The analysis of medical care performance data from public and public medical institutions is based on the functional differentiation of beds in order to build a high-quality, efficient, and complete medical care provision system toward 2025, when medical demand increases.・ This was done as an initiative to realize the "community medical care concept" that promotes cooperation.
The regional medical concept is formulated by prefectures, and all prefectures are required to formulate it in FY2016, and from FY2017 to FY2018, as an effort to realize it, we have been mainly responsible for the acute phase function. We have asked public and public medical institutions to consider future medical functions from the viewpoint that we should focus on policy medical care that cannot be carried out by the private sector.
However, it has been pointed out that the results of the study have not progressed from the acute phase, and as a further effort toward the realization of the concept, this time, the acute phase functions of public and public medical institutions, etc. We analyzed the objective data that we focused on, and based on the results, we asked each region and medical institution to reconsider the future medical care provision system.
The analysis results do not mechanically determine the direction of hospital consolidation, but are shown as materials for revitalizing regional discussions. When discussing in the region, I would like you to do your best to build a future-oriented medical care provision system while taking into account the analysis results and supplementing the knowledge about the actual situation in the region that cannot be reflected in this analysis. We are doing it.
About the reaction from each direction after the announcement
In response to this initiative, local governments have pointed out that "it was suddenly announced" and "anxiety is spreading to local residents". We have held an opinion exchange meeting in which local governments and medical personnel participate.
While the people who attended the exchange of opinions received harsh opinions about this initiative, such as "The analysis is based on uniform standards nationwide and does not reflect the actual situation in the region" and "Request for withdrawal of analysis results". We also received the opinion that "in order to receive medical care with peace of mind in the future, efforts for reorganization and integration are indispensable."
We are still holding individual exchanges of opinions with local governments that have hoped for it, and we will continue to carefully listen to the opinions of local governments and medical personnel, etc., and proceed with efforts toward the realization of the regional medical concept. I will come.
About policies to promote bed reduction / reorganization integration
In advancing discussions on the medical care provision system that includes the functional reorganization and consolidation of medical institutions in the region, how to build consensus in the region, including residents, and how to deal with the costs associated with the reorganization and integration. I think it will be important. For this reason, the Ministry of Health, Labor and Welfare has also selected "priority support areas" where the national government intensively supports data analysis and coordination of related parties, expanded the conventional comprehensive community medical care and long-term care fund, and reorganized and integrated the fund. We will implement new bed downsizing support to subsidize the expenses associated with this.
Through these efforts, the national government will provide maximum support so that discussions on building a future-oriented medical care provision system will steadily proceed in each region.
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