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October 01, 2007

病院の倒産は蜜の味?

魚拓

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「倒産続出」病院ビジネスに明日はない
2007年9月25日(火)06:00

「病院業界は血の海、焼け野原と化す」。厚労省出身の専門家が、ただならぬ未来を警告。

医師の不足や偏在が原因で産婦人科、小児科などの診療科が閉鎖され、医療崩壊の危機が叫ばれている。これに追い討ちをかけるように病院の倒産が急増している。

信用調査会社の帝国データバンクによれば、今年に入って医療機関の倒産件数は33件(7月末現在)に及び、2001年以降で最多だった04年1年間の32件をすでに上回っている。このうち、病床数20以上の病院倒産が12件で、やはり最多の05年8件を大きく上回る。ちなみに他の医療機関別では、診療所の12件、歯科医院が9件。「明日は我が身かも」と、不安を募らせる病院関係者は少なくない。

01年から07年5月までの倒産190件の原因を帝国データが分析した結果では、「販売不振」が55件と最も多く、次いで「放漫経営」39件、「設備投資の失敗」22件と続く。販売不振は、ずばり診療報酬の減少を指す。02年から3回続いた診療報酬マイナス改定、とりわけ昨年の3.16%減が病院経営を直撃した。一方で、不足する医師の確保が人件費増につながり、医師不足が患者減少を招く、「売り上げ」減少の悪循環を引き起こしている。

看護基準の保険点数見直しも深刻な影響を与えている。看護師の労働環境改善を図る目的で、急性期一般病棟の患者7人に対し看護師1人という「7対1 看護」を実施し、夜勤時間を月平均72時間以下に軽減する病院に、手厚い入院基本料を算定する新基準の導入である。その結果、大病院のなりふり構わぬ看護師集めを、慢性的な看護師不足に悩む中小の病院は、指をくわえて見ているのが現状なのだ。

患者を奪い合う公立病院

倒産件数の増加は民間病院が冬の時代を迎えた証拠だが、地方自治体が経営する自治体病院(公立病院)も存亡の危機にある。全国982の公立病院の約 3分の2に当たる626病院が赤字経営に苦しんでいる。大阪府の南部にある公立忠岡病院は今年3月、56年の歴史に終止符を打ち、閉院となった。医師不足による外来・入院患者数の激減、診療報酬改定による減収が直接の原因だった。

その背景には04年度からスタートした新人医師の臨床研修制度がある。大学病院を希望する研修医が減ったため、全国の大学で派遣医師の引き揚げが始まった。大学病院からの医師派遣に依存していた公立忠岡病院の場合、前年度に9人いた常勤医が5人、3人と減り続け、昨年度は院長を含め2人だけになってしまった。医業収入も02年度の12億5800万円から、05年には6億4100万円と半減した。赤字も毎年膨らみ、悪化する忠岡町の財政事情では一般会計から補填できなかった。

閉院に至らないまでも、公立病院同士の統合はすでに始まっている。山形県酒田市内にある県立日本海病院と市立酒田病院は患者を奪い合い、慢性的な赤字経営に陥っていた。生き残り策として来年春、統合して独立行政法人に移行する。高知市でも一昨年、県立と市立の自治体病院が統合して高知医療センターが誕生したが、オリックスを代表とする企業グループが、設計・施工から設備管理・運営まで、診療業務を除く大半の業務を請け負うPFI方式として注目された。公共事業に民間資金とノウハウを活用した自治体病院再生のニューモデルでもある。

厚生労働省の「医療施設調査」によれば1990年に1万96もあった病院が07年には8883(5月末現在)に減った。それでも世界最多の病院数だが、最大の減少要因は倒産とされる。帝国データの分析では、かつては放漫経営がトップを占めていたが、前述したように近年は販売不振――診療報酬の減少に変わってきている。きちんと経営をしているにもかかわらず、収益が悪化し、倒産に追い込まれたケースだ。

恐怖の「改定デフレ・スパイラル」

診療報酬のマイナス改定が倒産を引き起こす構図を、病院経営戦略を専門とする工藤高(たかし)メディカル・マネジメント・オフィス代表は、改定デフレ・スパイラルと呼んでいる。「診療報酬が下がる」と「医業収入が減る」。当然「利益が少なくなる」ので「赤字幅が大きくなる」。その結果、「職員の給料を減らす」、「職員が辞める」、そして「病院倒産」に行き着く。この改定デフレ・スパイラルにより、公立、私立を問わず病院の閉院や診療所化、病院間の M&A(合併・買収)、自主廃業などの動きが加速するというのが、大方の医療制度スペシャリストの見方である。

2年に1度の診療報酬改定を来年に控え、この秋から本格的な論議がスタートする。厚労省の基本的な考え方は、医療費適正化を最重要課題の一つに据え、平均入院日数を短縮するために、一般病床数を減らして療養病床への移行を進めることだ。その布石として、いわば改定デフレ・スパイラル戦略が必要になる。旧態依然たる中小病院の退場はその延長線上にある。これは総務省の管轄になるが、自治体病院の広域統廃合、民活による独立法人化も、多すぎる病院の淘汰という射程内にある。

国立病院の統廃合にはいち早く手がつけられ、独法化や民間への払い下げなどが進んだ。国立大学病院はどうだろう。地方の国立大学の中には、臨床研修医が集まらないため、派遣業務だけでなく大学病院本体の日常診療に支障を来し始めている医局が少なくない。早晩、つぶれる医局も出るだろう。

都会の大病院も安閑としてはいられない。東京都内の社会保険中央総合病院やNTT東日本関東病院といった名門病院で、診療科によっては病床稼働率の低下現象が見られるようになった。患者が東大病院や東京医科歯科大病院などに吸引されているのだ。04年の国立大学法人化に伴い、殿様商売だった国立大学病院が「営業」に力を注ぎ始めた表れでもある。いずれ、中小病院にとどまらず、名門病院の倒産も現実味を帯びてくるかもしれない。

外科医出身で厚労省技官のキャリアを持つ長谷川敏彦・日本医大教授(医療管理学)は、講演の場で「今後3~5年間は病院業界は血の海、焼け野原」と物騒な発言をし、聴衆を驚かせた。具体的な中身を紹介する。長期ケア(慢性期)の病院が1千~2千、急性期病院が数百はつぶれ、その第1グループが自治体病院(院長に権限がなく、ビジネスセンスもない)、第2グループは地方の国立大学病院(いずれ身売りが起きる)、第3グループが私立の中小病院(7対1看護と医師不足にどれだけ耐えられるか)。

おぞましい時代が目前に迫っている。しかし、病院を弱肉強食の世界に委ねるべきではない。行政は病院倒産を政策誘導するのではなく、地域に必要な良質の病院を維持するためにも、全国の病院実態調査を早急に実施して結果を公開し、国民各層の判断を仰ぐ必要がある。

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保険診療では厚労省が医療の値段を決めている。どんなに優れた医療を提供しても値段を勝手に上げることはできない。そして,今や自治体病院の4分の3が赤字といわれている。

このことを知ってか知らずか,医師を叩きたがる人(ネット上とは限らない)がよく言うのは
「医者は医師優遇税制で保護されている」
「医療費が高いのは医者が儲けすぎているせい」

だから,こういう人たちが病院倒産や赤字の話題を耳にしたときの反応は
「ざまをみろ」「いい気味だ」だろう。

そこまでひどくはなくても
「病院のひとつやふたつつぶれたって,どうってことはない。病院は他にいくらでもある」ぐらいは口にするかもしれない。

しかし,同じセリフは勤務医が言うことだってできる。
「病院のひとつやふたつつぶれたって,どうってことはない。(医師不足なので,就職先としての)病院は他にいくらでもある」

開業医としてはどうか。近所の病院が倒産すれば重症例の紹介先に困るかも知れないが,クリニックの集客力はアップするだろう。


どちらにしても,病院経営者以外の医師は病院がなくなってもそれほど困らない。


パチンコ屋がつぶれても深刻に困る利用者はそれほどいないだろうが,病院はどうか。


病院の倒産を喜んでいる連中は,一番困るのは誰かよく考えたほうがよい。考えたところで,もうどうしようもないけど。


医師をバッシングしてきた連中ですら,「これ以上病院がつぶれたら困る」と思う時代はそう遠くないだろう。

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Comments

 病院の倒産が蜜の味というよりも、医師個人が潰されるのが蜜の味なのでしょう。要するに日本人はみんな医者が大っ嫌いなんですよ。理由は嫉妬です。
 嫉妬されるような実態があるならまだいいんですけど、国民はマスコミの偏向報道で「医者は金持ち・傲慢・先生先生とチヤホヤされ過ぎ・女にもてる・・・」などと全然事実と違うイメージを勝手に膨らませてやっかんでるんですからたまったものではありません。
 嫉妬という感情は実は歴史を動かす大きな原動力なのですが、人は自分の嫉妬心を表明するのは恥ずかしいので表にでることはなく、別のもっともらしい理屈をこじつけて要求を主張します。
 かつての受験名門であった都立高校・神奈川県立高校が凋落させられたのもこの構造だと私は見ています。これらの名門校は「学校間格差をなくすのが善である」という理屈で壊滅させられましたが、その政策の本音は学業優秀な子供に対する嫉妬でしょう。教育行政の関係者には超一流の学歴を持った者はまずいませんからね。

 医師として日々の糧を得ている人たちはこの国民感情をよく計算に入れて行動すべきでしょう。嫉妬心の破壊力は凄まじいものがありますからね。単純な善意だけで立ち向かうと地獄を見るでしょう。

Posted by: 東京メガテリウム | October 15, 2007 at 12:36 PM

東京メガテリウム様,こんにちは。

このまま医療が崩壊してアメリカ型になれば医療が高級品となり,DQNもマスコミも医師を叩きすぎたことを後悔するようになるかもしれません。それまで我慢です。

でも,やはり嫉妬は減らないでしょうね。

Posted by: 管理人 | October 15, 2007 at 08:16 PM

正直医者に嫉妬する感情を私は持っていませんが。
近年の医療の現状を見れば医者がそこまで魅力的ではないことはわかります。

医者は今は嫉妬の対象になってはいません。
単純に選択ミスを笑っているだけです。

偏差値とか年収とか一つのものにとらわれ過ぎなんですよ。医者って。変な執着がありすぎてまるで話になりません。

Posted by: pote | April 12, 2010 at 10:33 PM

しかし,同じセリフは勤務医が言うことだってできる。
「病院のひとつやふたつつぶれたって,どうってことはない。(医師不足なので,就職先としての)病院は他にいくらでもある」
>>こんな思い上がりをよく堂々と書けるものです。ちなみに就職先がいくらでもあることを威張られてもピントがずれてるとしか思えない。医者不足で患者だらけになったら医者の勤務がより過酷になりますよ。医者だからって自分が働くかどうかを自分で決められるわけではない。大部分はただのサラリーマンです。企業の技術職と何ら変わりない。

開業医としてはどうか。近所の病院が倒産すれば重症例の紹介先に困るかも知れないが,クリニックの集客力はアップするだろう。
>>

このまま医療が崩壊してアメリカ型になれば医療が高級品となり,DQNもマスコミも医師を叩きすぎたことを後悔するようになるかもしれません。それまで我慢です。
>>治療費を上げて国民に医療を供給しない医者が増えたら医者なんて言うのは一番国民に嫌われる職業になりますよ。それこそ何の存在価値もない。皆何の尊敬も払わないでしょう。日本の医者もとうとうここまで腐ったことを言うようになったのですね。
結局一番強いのは国民です。国民が安く働けと言ったら安く働くように医者はなるのです。いままで見てきてわかるでしょう。医者に状況を奪回するほどの力はないのです。さらに強い権力者の国民には太刀打ちできません。

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