公立病院改革と住民生活

―宮城県登米市における無床診療所化を事例として―

抄録

This study focuses on the reorganization of public hospitals that started on a national scale following the announcement of the Public Hospital Reform Guideline by the Ministry of Internal Affairs and Communications in 2007 and examines the impact of the reorganization on residents’ lives.

Tome City in Miyagi Prefecture, which reorganized public hospitals, was selected as the study area, and this study aims to clarify the following two points: 1. the transfer (hospital change) pathways of former in-patients following the switch to outpatient clinics, and 2. the impact of patient transfers on their household lives. A survey of patient households found that following their hospital discharge, patients have been changing hospitals between two and five times. In particular since beds at the remaining municipal hospitals in the city are in short supply, many patients have to travel back and forth between the hospital and their home. Further, the “reduced accessibility of medical care opportunities” caused by the imposition of travel on patients has greatly increased the transportation burden of patient families who have to assist patients with their hospital trips and is causing economic strain. These findings suggest that the reorganization of public hospitals to improve the fiscal health of the municipalities in question is causing a decline in the quality of public services, which may lead to a worsening of residential conditions in depopulated rural areas.