41)「存亡の危機に立つ有床診」

41)「存亡の危機に立つ有床診」


　　厚労省の社会保障審議会医療部会は、やっと今年度から有床診についての論議に着手し、マスコミにもとりあげられてきたが、まだ残念ながら大きな声になっているとは言い難い。

　　部会の委員のなかに当事者たる有床診の代表は皆無で、委員に配られた資料には「有床診に配置が義務付かれているのは、管理者たる医師一名のみで医師の宿直義務も無い」などと書かれていて「有床診は何の規制もないままにやりたい放題だ」と言わんばかりの委員の発言もみられるが、現実を見ていない暴論といわざるをえない。「人員や設備に明文化された規制が無いから、最低限の人員や設備でやっているにちがいない」という意見が出てくること自体が悲しい。

　　ほとんどの有床診は、同一の敷地内に医師の住居を構え、看護師の当直制をひき放射線診断装置や心電図や超音波診断装置、胃や大腸の内視鏡位までは装備しているし又、そうでなけりゃ存続していけないというある種の使命感を持って日々精進しているのである。病棟の廊下幅や病室面積などの施設基準をクリアすることを義務付けられたし放射能漏れのチェックも定期的に行う義務を負い、酸素配管すれば検査を受け、厨房も設備や衛生防火対策が適正かのチェックを受けさせられたりと行政からの監視は枚挙にいとまがない。

　　この他いろんな規制があるのに、入院基本料だけをみても、病院の入院基本料Ｉは１日１６６１点、入院基本料５でも１日１２３３点なのに比べ有床診で一番多いＩ群入院基本料２は１日６７９点で２週間を過ぎると１日５４１点となり３食看護師付きでも、検査や医療行為のない介護施設や素泊まりのビジネスホテルより安いというので毎年約千箇所づつ有床診が減ってきているのである。（ちなみに無床診療所は毎年約２千箇所増えているが。）いまのままでは有床診を新設すること自体無謀なことでありまた、診療報酬が十数年もほとんど据え置きであるので有床診のベッド部門は「社会奉仕だ」と揶揄される所以である。
外国には無い「日本独自の文化」たる有床診の火を消さないためにも声を大にして主張していくべき時期にきているのではないでしょうか。

41) I "examine an existence floor rising for the crisis of the life and death"
* floor rising means Japanese 19beds having small hospital


　　At last I start a discussion that I arrive to examine an existence floor and it has been against the mass communication, but, as for council for social security medical care sectional meeting of Ministry of Health, Labour and Welfare, this year is hard to say to an unfortunately still big voice that it is it.

　　I examine an existence floor as the person concerned in the committee of the sectional meeting, and there is no representative の, and the remark of the "duty committee where that it is accompanied is written that there is not the night duty duty of the doctor only with one doctor as the manager, and "an existence floor says to almost that examining it does what examine it wants to do as there is not what regulation" is watched, but placement cannot but say to a document distributed to the committee with the irrational opinion that does not watch reality to examine an existence floor". That the opinion "that I must study with the minimum staff and facilities because there is not regulation stipulated by the staff and facilities" comes out to is sad.

　　Examining it sets up the house of the doctor in the same site, and most existence floors are devoted with certain sense of duty that they pull the duty system of the nurse and equip it to the endoscope rank of a radiographic examination device and an electrocardiogram and somascope, a stomach and the large intestine and otherwise cannot retain again every day. I carry the duty that it was obliged to clearing the institution standards such as corridor width or the sickroom area of the ward, and the check of the radiation leak performs regularly on my back and am examined if oxygen lays pipes, and and it is equipped with the kitchen, and hygiene fire prevention measures are made to receive the check that is appropriateness monitor from administration is numerous to mention.

　　In addition, an existence floor examines by about 1,000 places a year in every what is cheaper than a nursing facility without inspection and the medical act and the budget hotel of the room without meals, and が decrease comes to appearing with 541 points of three meals of neighbor nurses on 1st even if I watch only basic hospitalization charges to have various regulation when hospitalization basics charges I of the hospital compares even 1,661 points, hospitalization basics charges 5 on 1st on 1st though it is 1,233 points and examines an existence floor, and で first much I group hospitalization basics charges 2 is over between two weeks by 679 points on 1st. （By the way, the no floor medical offices increase by about 2,000 places every year.） Appearing examines an existence floor as now, and を is the reason that to found is a reckless thing, and, in addition, medical examination and treatment reward 10 examine an existence floor for several years because it is almost deferment, and is made fun of when the の bed section "is social service".
Will not you come in the time when you make a voice a size you examine an existence floor as "the Japanese original culture" that the foreign country does not have it, and not to put out の fire and should insist?