現在、地域保健医療計画で用いられている基準病床数は二次医療圏ごとの性別・年齢階級別人口、病床利用率等を利用して、全国一律の算定式によって算出されており、各二次医療圏にある病院の機能の違いを考慮していない。また、基準病床数算定式の性質上、都道府県外からの入院患者流入が多い二次医療圏では実際の必要病床数より低い病床数が算定されていると推測される。本研究は、病院の種類によって二次医療圏外からの入院患者流入割合に差があることを明らかにすることを目的とする。 平成29（2017）年度「患者調査」及び「医療施設調査」を用いて、特定機能病院及び大学医学部附属病院の本院（特定病院等）とその他の急性期病院への二次医療圏外からの入院患者流入割合について有意水準5％でKruskal-Wallis testにて群間の比較、Dunn testにて多重比較を行った。急性期医療を担う3,551病院を対象とした分析から、特定機能病院等への二次医療圏外からの入院患者流入割合は47.5％であり、その他の急性期病院と比較して有意に高かった。専門性の高い医療機能を担う特定機能病院等では二次医療圏外からも多くの患者が入院しており、病床の多くが地域住民ではない患者によって使用されている。そのため、特定機能病院等がある二次医療圏では地域住民の入院医療へのアクセスが阻害されている可能性があり、基準病床数の算定において特定機能病院等の取扱いが考慮されるべきだと考える。
The regional medical plan sets the maximum number of hospital bed, and the uniform calculation formula is used nationwide for each secondary medical area reflecting the gender and age group population, the bed utilization rate, etc. It does not consider the difference in function of hospitals. In addition, when inpatients come from outside the prefecture, the number of maximum beds may become lower than the actual required number of beds. The purpose of this study is to clarify that there is a difference in the inflow rate of inpatients from outside the secondary medical area depending on the type of hospitals. Using the “Patient Survey” in 2017 and the “Medical Facility Survey” in 2017, the inflow rate of hospitalized patients from outside the secondary medical area was compared between the academic medical centers (specially designed hospitals and university teaching hospitals) and the other acute care hospitals. Kruskal-Wallis test was used for significant difference at a significant level of 5%, and multiple comparisons were performed using the Dunn test. Based on an analysis of 3,551 acute care hospitals, the proportion of inpatients from outside the secondary medical area in the academic medical centers was 47.5%, which was significantly higher than the other acute care hospitals. In academic medical centers with highly specialized medical functions, many patients are hospitalized from outside the secondary medical area, and significant part of the beds is used for patients who are not inhabitants of that secondary medical area. Therefore, in secondary medical areas with academic medical centers, there is a possibility that access to inpatient care for local residents may be hindered, and the way to handle the academic medical center should be considered in calculating the maximum number of beds.
