Kadooka Yasuhiro, Asai Atsushi, Enzo Aya, Okita Taketoshi
Department of Bioethics, Kumamoto University Faculty of Life Sciences, 1-1-1 Chuo-ku Honjo, Kumamoto City, 8608556, Japan.
Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1 Aoba-Ku Seiryomachi, Sendai, 9808575, Japan.
BMC Emerg Med. 2017 Jul 14;17(1):23. doi: 10.1186/s12873-017-0135-4.
Medical care is obviously an important public service to ensure the health of a nation; however, medical resources are not always used appropriately. 'Convenience-store consultations' and inappropriate ambulance transportation represent instances of such improper use by contemporary Japanese citizens in recent years. This article illustrates two examples of misuse and discusses potential countermeasures by considering factors contributing to these behaviours.
From both public and medical perspectives, these patient behaviours are problematic, causing potential harm to others, negative consequences to such patients themselves, exhaustion of healthcare staff, and breakdown of emergency medical services. Although citizens need to recognize the public nature and scarcity of medical care, the more immediate need may be to identify and to remove personal and social causes inducing such misuse. In addition, healthcare professionals should become more trustworthy. To combat these issues, one-sided penalties such as accusations or sanctions for patients who misuse the system cannot be justified in principle. If measures taken to prevent misuse are ineffective, imposing surcharges or restricting consultations may be considered official policy, but these are not acceptable for several reasons.
For now, we conclude that we must rely on the spontaneous motivation of patients who engage in 'convenience-store consultations' and ambulance transportation instead of taking a taxi.
医疗保健显然是保障国民健康的一项重要公共服务；然而，医疗资源并非总能得到合理利用。“便利店问诊”以及不恰当的救护车转运便是近年来当代日本民众此类不当利用医疗资源的实例。本文列举了两个滥用医疗资源的例子，并通过考量导致这些行为的因素来探讨可能的应对措施。
从公众和医疗角度来看，这些患者行为都存在问题，会对他人造成潜在伤害，给患者自身带来负面后果，使医护人员疲惫不堪，并导致急救医疗服务陷入瘫痪。尽管民众需要认识到医疗保健的公共属性和稀缺性，但或许更迫切的需求是找出并消除导致此类滥用行为的个人和社会因素。此外，医疗保健专业人员应更值得信赖。为解决这些问题而对滥用医疗系统的患者进行指责或制裁等单方面处罚原则上是不合理的。如果预防滥用行为的措施无效，收取额外费用或限制问诊可能会被视为官方政策，但出于若干原因，这些做法是不可接受的。
目前，我们得出的结论是，对于那些进行“便利店问诊”以及选择救护车转运而非乘坐出租车的患者，我们必须依靠他们的自发积极性。
