Greater remuneration should be allocated for hospital doctors
(From The Japan Times Feb. 19 issue)

勤務医により多くの診療報酬を

In a report for fiscal 2010 submitted Feb. 12 to health minister Akira Nagatsuma, the Central Social Insurance Medical Council (Chuikyo) calls for greater remuneration for hospitals. This would be a step forward in the government's effort to stem the stream of resignations by hospital doctors and thus help prevent the further collapse of medical services, especially in rural regions. It will be best if hospital management uses additional income to improve hospital doctors' working conditions.

For the first time in 10 years, total remuneration to hospitals and clinics will increase 0.19 percent, adding ¥570 billion. Chuikyo proposed that nearly 80 percent of that be allocated to first-stage treatment of inpatients in the departments of emergency medicine, obstetrics, pediatrics and surgery. This proposal is reasonable since loss of doctors is especially prevalent in the first three of these fields. Remuneration to hospitals for complex operations will increase by 30 percent to 50 percent, and will also be raised for hospitals that have an emergency medicine center or a neonatal intensive care unit, or handle high-risk deliveries.

Currently, private practitioners are believed to fare better economically than hospital doctors. Chuikyo moved to rectify this situation by revising follow-up examination fees. They are to be unified at ¥690 for hospitals and clinics ? up by ¥90 for hospitals and down by ¥20 for clinics from current levels.

Chuikyo did not forget to reward medical practitioners who make special efforts to improve access to medical services. For example, clinics that advise patients via telephone outside office hours will be compensated.

Simply revising remuneration for medical institutions will not prevent the collapse of medical services. Chuikyo's proposal of a system in which remuneration is made directly to doctors deserves serious attention. The government also must consider how to rectify the uneven distribution of doctors across the nation, and how to improve cooperation between hospitals and clinics.

中医協は長妻厚労相に答申した新年度診療報酬改定案で、病院への診療報酬増を求めた。政府が勤務医不足や地方での医療制度崩壊に歯止めをかける一歩となるだろう。

改定率は病院と診療所共に0.19 % 増で10年ぶりのプラス、5700億円増額で、その8割を医師不足が深刻な救急医療、産科、小児科などの急性期入院医療に充てるよう求めた。病院での難しい手術への報酬も3〜5割引き上げる。開業医は勤務医より高収入だといわれる現状を是正するため、再診料を統一。24時間電話で応対している診療所などへの加算も新設した。

医師に直接報酬を支払う方式や、医師数の地域格差、病院と診療所の協力体制についても政府は見直すべきだ。