混合診療 適用拡大の流れを変えるな

The Yomiuri Shimbun(Oct. 1, 2009)
Give more thought to mixed treatment issue
混合診療　適用拡大の流れを変えるな（10月1日付・読売社説）

The nation's courts have adopted different stances on the government's ban on mixing medical treatments that are covered by health insurance with treatments that are not.
In 2006, a male cancer patient filed a lawsuit with the Tokyo District Court, claiming the government was in the wrong to deny him the right to receive two types of treatment--one covered by his health insurance and the other paid for out of his own pocket.
Though the district court ruled in favor of the patient, the Tokyo High Court on Tuesday reversed the lower court's decision, saying the ban on mixed treatment was valid.
　保険医療の在り方をめぐって司法判断が揺れている。
　がん患者の男性が国を相手取り、「混合診療」を禁じている現状は不当だと訴えた裁判で、東京高裁は、男性の主張を認めた１審・東京地裁判決を取り消し、混合診療禁止は妥当との判断を示した。
　混合診療とは、公的保険で認められた投薬や治療とともに、まだ保険が適用されていない治療法を併用することだ。

Under the current health insurance system, patients are only supposed to pay 30 percent of medical fees when their treatment is covered by health insurance. However, in the case of mixed treatments, people are expected to stump up the full amount for all the medicines and therapies they receive.
　現行制度では、保険診療の範囲内なら患者の負担は原則３割で済むが、混合診療を行うと医療費全額が自己負担になってしまう。

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Ability to pay

The man who filed the lawsuit wants to receive interferon treatment, which is covered by health insurance, and another form of treatment, which is not. However, if he decides to go ahead with both courses of treatment, he must pay 100 percent of all costs, including the full fees associated with the interferon treatment. The man's lawsuit was based on the premise that the government line is unfair, as it reduces his medical options.
　提訴した男性は保険がきくインターフェロン療法に加え、保険外の新療法を希望した。併用するとインターフェロンまで全額自己負担になり、結果的に医療の選択肢が狭められるため、現行制度は不当だと訴えた。

Many people likely sympathize with the man's predicament.
　共感する人は多いだろう。

However, the Health, Labor and Welfare Ministry has certain reasons for prohibiting mixed treatments.
　ただ、厚生労働省が禁止措置をとってきたことには、それなりの理由がある。

If such a practice was allowed, medication and therapies that have not been proven safe or effective might become widespread. Furthermore, it is possible that patients could be saddled with heavier financial burdens if unscrupulous doctors were to casually conduct expensive medical tests or administer costly medicines that are not covered by the health insurance scheme.
　混合診療を認めると、効果や安全性が疑わしい医療が横行しかねない。不心得者の医師が、保険外の高価な検査や投薬を安易に行えば、患者の負担増を招く。

If self-funded treatments become mainstream and treatment covered by health insurance becomes marginalized, the quality of medical care that patients can receive might hinge on the amount of money they are able to pay.
　自由診療が主で保険診療が従になってしまうと、患者の経済力によって受ける医療の質に差が生じかねないとの議論もある。

Many people oppose the full deregulation of mixed treatments.
　混合診療を全面的に自由化することには反対論も多い。

However, we believe that exceptions should be made in cases involving certain serious diseases, such as cancer. More than a few patients pin their hopes on new drugs or therapies after treatments covered by health insurance have proved ineffective.
　だが、がんのように深刻な病気は、保険が認められた医療を尽くしても効果がなく、適用外の新しい薬や治療法に望みを託す場合が少なくない。

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More exceptions

Responding to calls for deregulation, the health ministry has been working on a system to allow for more exceptions.
　解禁を望む声に対して、厚労省も混合診療を例外的に認める制度を拡大してきた。

For example, under the current system, a patient could combine health insurance treatments and new therapies if the patient's medical institution successfully applies to the health ministry to use the new therapy as an advanced treatment.
　例えば、今でも新たな治療法を医療機関が届け出て「先進療法」に認められれば保険診療と併用できる。

The ministry has already developed a system that speeds up decisions on whether to approve the use of unapproved drugs in certain cases of mixed treatment.
未承認薬も以前より早く、混合診療の適用を検討する仕組みができてはいる。

However, we are still not fully satisfied with all facets of the system, including the speed of the approval process. The system should be further improved to allow new drugs to be approved for mixed treatments more quickly in necessary cases, and pave the way for adoption under the insurance scheme.
　それでも審査のスピードが遅いなどの不満は残る。混合診療を、必要な場合には迅速に認める仕組みをさらに整備し、保険適用につなげていくべきだ。

The lawsuit will now go to the Supreme Court. Regardless of the top court's ruling, however, the ministry should improve the system so it can better meet the needs of patients.
　今回の訴訟は最高裁に持ち込まれる見通しだ。だが裁判の行方にかかわらず、患者の要望に十分応え切れていない所は改善を進めていく必要があろう。

In the face of demand for full deregulation, the ministry has been approving mixed treatment in an increasing number of cases. The high court ruling should not be used as an excuse to stop this trend.
　混合診療の適用拡大は、全面解禁論に背を押される形で進んできた。その流れを、高裁判決を口実に止めてはならない。

(From The Yomiuri Shimbun, Oct. 1, 2009)
（2009年10月1日01時04分 読売新聞）