東北農村の医療再編と家族行動

宮城県登米市における公立病院改革を事例として

抄録

　　　In recent years, public services are being made more efficient at an accelerating pace. Public hospital reforms are part of that effort. Medical services cannot be supplied profitably in farming and mountain areas, where public hospitals are the core suppliers of medical care. This paper, which clarifies the effects of medical reorganization in farming and mountain areas, elucidates problems of hospital transfer arrangements associated with reorganization, with emphasis on family behavior. The study area is Tome city, Miyagi Prefecture, where municipal hospitals were reorganized as clinics without beds. Results revealed that, after leaving the hospital, patients changed hospitals several times to continue their access to medical care. Repeated movements were observed frequently between homes and hospitals. Patients were compelled to leave hospitals before they had recovered from symptoms. Furthermore, transferring patients to distant hospitals affected patients’family caregivers by increasing the burdens of transportation, and by affecting or cancelling employment. These effects were recognized even in large families, which had been perceived traditionally as having high life-security functions.