2025 Volume 74 Issue 1 Pages 53-59
Japan’s demographic structure is changing dramatically. Due to an increase in the number of older adults, there is a growing need for acute medical and long-term care services. As a result, even after completion of treatment in acute care facilities, patients who have difficulty living independently may be transferred to long-term care facilities, facing the risk of developing pneumonia and other acute illnesses that require hospitalization at an acute care facility. If a patient in a long-term facility experiences a fall or another medical safety event, they must be promptly diagnosed and treated at an acute care facility. Consequently, collaboration between acute medical and long-term care is essential, and the Japanese Ministry of Health, Labor and Welfare is promoting various initiatives to address this issue. The medical service fee, revised every two years, and the long-term care fee, revised every three years, will be used to achieve this goal. June 2024 presented a rare, once-every-six-year opportunity for these fees to be revised simultaneously, enabling the implementation of policies to promote coordination between acute medical care and long-term care. However, a significant challenge is the decline in the working-age population, which must be addressed. The details are presented in this study.
日本の人口構造は大きく変化し，高齢者の増加によって医療及び介護のニーズが高まっている．この結果，急性期医療における治療が完結しても自立した生活が困難で介護の必要な患者は介護施設に転院し，また介護施設の利用者は肺炎等の急性期疾患を容易に併発し急性期医療機関への入院が必要となる．さらに介護施設の利用者に転倒など医療安全上の出来事が起きれば，速やかに急性期医療機関において，診断と治療が必要となる．これらの結果，医療と介護の連携は必須であり，これに対応すべく日本の厚生労働省は様々な取組みを推進している．とくに取組みを実現すべく活用されるのが，2年に1回の診療報酬改定と3年に1回の介護報酬改定である．2024年度はこれらが同時に改定される6年に1度の貴重な機会であり，医療介護連携を推進するための新たな政策が実施された．一方で，これに対応すべき生産年齢人口の減少は大きな課題の一つである．これらの詳細について，当該論文で紹介する．
