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和歌山県の医療提供体制について
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Yohei Ogawa
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全国に先駆けて医療需要のピークアウトを迎える和歌山県の医療提供体制に関する考察
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和歌山県の医療提供体制について
1.
全国に先駆けて 医療需要のピークアウトを迎える和歌山県の 医療提供体制に関する考察
2.
背景
3.
団塊・団塊ジュニアの高齢化と 出生率の低下により少子高齢化が進行 年齢階級別の人口数・人口推計(全国) ※国立人口問題研究所:将来推計人口 出生中位・死亡中位(加工) グラフの補足説明:グラフ内の数字は2015年の値を100とした指数
4.
高齢者は罹患リスクが高いため 高齢者数のピーク≒医療需要のピーク 人口10万人あたり入院患者数(総数) ※厚生労働省:患者調査(年齢階級別人口10万対入院受療率)
5.
全国的に患者数は増えているが 入院日数短縮が進み延べ患者数は減少 患者数・平均入院日数・延べ患者数(全国) ※厚生労働省:医療費の動向調査 グラフの補足説明:グラフ内の数字は2011年の値を100とした指数
6.
和歌山県は既に高齢者数の伸びが鈍化 全国より20年早くピークアウトする 高齢者(65歳以上)人口数の推移(全国・和歌山県) ※国立人口問題研究所:将来推計人口(出生中位・死亡中位)
7.
和歌山県の延べ患者数は 全国よりも速いペースで減少している 患者数・平均入院日数・延べ患者数(和歌山県) ※厚生労働省:医療費の動向調査 グラフの補足説明:グラフ内の数字は2011年の値を100とした指数
8.
先にピークを迎える和歌山県の知見を 先行事例として他の都道府県に活かす 2020年から2025年にピークアウトを迎える7都道府県 秋田県・富山県・和歌山県・島根県・山口県・徳島県・高知県 2025年から2030年にピークアウトを迎える13都道府県 青森県・岩手県・山形県・新潟県・鳥取県・香川県・愛媛県・ 佐賀県・長崎県・熊本県・大分県・宮崎県・鹿児島県 2030年以降にピークアウトを迎える27都道府県 (2030年~35年)福島県(2040年~45年)北海道・ 宮城県・茨城県・栃木県・群馬県・石川県・福井県・山梨県・長野県・ 岐阜県・静岡県・三重県・京都府・兵庫県・奈良県・岡山県・広島県 (2045年~50年)埼玉県・千葉県・東京都・神奈川県・愛知県・ 滋賀県・大阪府・福岡県・沖縄県 ※国立人口問題研究所:将来推計人口(出生中位・死亡中位)
9.
方法
10.
2016年度データ 2016年度・2017年度の 厚労省公開データをダウンロード ※厚生労働省:DPC導入の影響評価に関する調査 施設概要表(抜粋) 2016年度データ 2017年度データ 2016年度ファイルダウンロード用URL: https://www.mhlw.go.jp/stf/shingi2/0000196043_00001.html 2017年度ファイルダウンロード用URL: https://www.mhlw.go.jp/stf/shingi2/0000196043_00001.html DPC導入の影響評価に関する調査 公開年度別リンク掲載URL: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000049343.html
11.
2016年度、2017年度共に 1年分のデータを提出した病院を抽出 ※厚生労働省:DPC導入の影響評価に関する調査 施設概要表(加工) 厚生労働省公開データ(2017年度)
12.
患者数・日数・延べ患者数の前年比を 都道府県・医療圏別などの単位で計算 ※厚生労働省:DPC導入の影響評価に関する調査 在院日数の状況 その他病棟の入院含(加工) 厚生労働省公開データ(2017年度)
13.
結果
14.
和歌山県の36病院 7568病床分のデータを抽出 病院数ベース 全病院数 43.4% 病床数ベース 全病床数 56.5% ※厚生労働省:医療施設調査 都道府県別の病院数・病床数により総数把握
15.
47都道府県の3221病院 777,209病床分のデータを抽出 病院数ベース 全病院数 38.5% 病床数ベース 全病床数 50.3% ※厚生労働省:医療施設調査 都道府県別の病院数・病床数により総数把握
16.
都道府県別の患者数前年比率は 和歌山県が全国で最も高い結果だった 都道府県別前年比率(2017年実績÷2016年実績) ※厚生労働省:DPC導入の影響評価に関する調査 在院日数の状況 その他病棟の入院含(加工)
17.
和歌山県にある二次医療圏は 患者数が増加していた 二次医療圏別前年比率(2017年実績÷2016年実績)※和歌山県 ※厚生労働省:DPC導入の影響評価に関する調査 在院日数の状況 その他病棟の入院含(加工)
18.
和歌山県は他の都道府県に比べ 病院を集約する取り組みが進んでいた 都道府県別前期比率(2014年実績÷2011年実績) ※厚生労働省:医療施設調査 都道府県別 病院数・病床数
年次推移 →今回の検証方法は、医療圏全体の患者数が増えていなくても 1病院あたりの患者数が増えていれば増加傾向と判定される
19.
和歌山県を除く6都道府県には 患者数が減少している医療圏があった 患者数増加・減少二次医療圏(2017年実績ー2016年実績) ※厚生労働省:DPC導入の影響評価に関する調査 在院日数の状況 その他病棟の入院含(加工) グラフの補足説明:都道府県名の横にあるカッコ内の数字は都道府県毎の二次医療圏数を示す 面積の広い都道府県は 集約が難しい可能性
20.
和歌山医療圏の病院別実績(2017年実績ー2016年実績) 二次医療圏のトレンドが患者増でも 患者数が減っている病院が複数あった ※厚生労働省:DPC導入の影響評価に関する調査 在院日数の状況 その他病棟の入院含(加工) 症例数が多い病院の患者数が増えている↗ ↙症例数が少ない病院の患者数が減っている
21.
結論
22.
地域のトレンドと各病院の傾向は必ずしも一致しておら ず、更なる集約化を要求される病院がでる可能性もある。 →現時点で最適な提供体制は将来的に過剰となる 全ての二次医療圏で 患者数が増えていた 和歌山県がしていたこと 高齢者人口数が ピークアウトを迎える 7都道府県の状況 5年以内にピークアウトを迎える7都道府県のうち6都 道府県には既に患者数が減少している医療圏があった。 →患者増を前提とした病院運営は見直しが必要 まとめ ピークアウトを 迎えるにあたって 留意すべきこと 和歌山県では、2011年から2014年にかけて全国 で最も病院の集約が進んでいた。 →需要減少への対応が患者数の増加に繋がった ※課題①:2017年から2016年にかけての傾向を見ただけなので中長期的にみて同じ傾向を示すかどうか裏付けが必要 ※課題②:病院数ベースで約4割、病床数ベースで約半数の病院情報しか利用できていないため他の病院も含めた分析が必要
23.
全国に先駆けて 医療需要のピークアウトを迎える和歌山県の 医療提供体制に関する考察 完
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