EDITORIAL: Revisions to medical treatment fees should improve community health care

TOKYO (The Japan News/ANN) - Details of the fiscal 2020 revisions to medical treatment fees have been decided. The revisions feature a focus on work style reform for doctors.

There is a serious shortage of doctors in regional areas. Currently, their long working hours keep the medical system going. It is reasonable to try to correct the situation by using medical treatment fees paid to medical institutions.
 The latest revisions create a scheme in which significant fees will be paid to hospitals that make efforts to improve work environments for doctors. This is intended to lead the hospitals to use the revenue increase to boost the number of doctors.
 Under the new system, an additional payment of ¥5,200 will be made each time a patient is hospitalized. About 900 hospitals with more than 2,000 emergency admissions a year are planned to be included in the system.
 To receive this additional medical treatment fee, hospitals will be required to draw up plans to secure personnel and improve their working conditions.
 It is expected that the hospitals will plan to create a system that will make it easier for doctors to work in shifts, such as by allowing multiple doctors to serve as the doctors in charge of a certain patient. Other envisaged plans would aim to have doctors focus on work that only they can do. Online meetings also can be utilized. It is essential to change the mind-set in the medical care field and improve the efficiency of operations.
 The Health, Labor and Welfare Ministry intends to check whether hospitals are properly implementing their plans and verify the plans’ effectiveness. The ministry should thoroughly instruct medical institutions that have not made improvements.
 From fiscal 2024, an upper limit will be introduced for overtime work by doctors. The annual limit will be set at 1,860 hours for doctors such as those at hospitals providing emergency medical care. Efforts are urged to secure sufficient doctors and prevent a vacuum in community emergency medical care.

Respond to aging society
 Raising medical treatment fees alone would naturally have its limits.
 There will be no alternative but to concentrate doctors at key hospitals by promoting the division of roles among hospitals that are scattered in communities. It is important to pursue the reorganization and integration of hospitals and protect local medical services.
 The prefectural governments must take the lead in quickly considering the ways to provide medical services to local communities.
 It is also necessary to improve medical services in a manner suited to people’s increased longevity.
 In the latest revisions, the government has tightened the requirements for acute care beds, for which higher fees are paid. The move is aimed at reducing the excessive number of such beds, which are meant to be for patients with severe symptoms.
 With the aging of society progressing, the number of chronic disease patients has increased. It is desirable to shift them to recovery-phase beds for rehabilitation and other care. The curbing of medical costs also can be expected.
 An extra fee paid to hospitals when examining pregnant women is being abolished. The move came following public criticism that the scheme increased the burden on pregnant women even when they received medical treatment unrelated to their pregnancy. The ministry intends to change the current system to encourage cooperation between primary care doctors and medical specialists regardless of whether the treatment is for pregnant women.
 It is crucial for the government to encourage medical institutions to provide services that take into account the safety of fetuses and mothers.

(From The Yomiuri Shimbun, Feb. 12, 2020)

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