Katori Teruyuki
Department of Medical Management, Graduate School of Social Sciences, University of Hyogo, Hyogo, Japan.
Future Research Institute Wolong, Tokyo, Japan.
Glob Health Med. 2024 Feb 29;6(1):6-12. doi: 10.35772/ghm.2023.01121.
Although Japan's healthcare delivery system is highly regarded internationally, the COVID-19 pandemic has exposed its structural problems. Behind these issues lies a history of medical care provisions supported mainly by an unrestricted, "free labeling" system, and independently financed private hospitals. In addition, patients have a high degree of freedom of choice under the Japanese medical insurance system, making it difficult to provide comprehensive and continuous health management from initial diagnosis and treatment (primary care), specialized treatment, to supporting a return to home, providing nursing care and lifestyle support. As Japan becomes a "super-aged" society with individuals over 65 making up over 30% of the population, the nature of medical care will have to undergo major changes. Medical care's basic function must still be the treatment and cure of patients, but the system will also have to provide support. That means conceiving of care in a way that treats a person's life with dignity and does not sacrifice life for treatment. The implementation of a family doctor function and the clarification of the functions and roles of small and medium-sized community-based hospitals that support this function, as well as the establishment of a community comprehensive care network with multidisciplinary cooperation that goes beyond medical care, should also be set forth in future regional medical care plans.
尽管日本的医疗服务体系在国际上备受赞誉，但新冠疫情暴露出其结构性问题。这些问题背后存在一段主要由不受限制的“自由标签”体系以及独立融资的私立医院所支撑的医疗服务历史。此外，在日本医疗保险体系下，患者拥有高度的选择自由，这使得从初始诊断和治疗（初级医疗）、专科治疗到支持回家、提供护理和生活方式支持等方面，都难以提供全面且持续的健康管理。随着日本成为一个“超老龄化”社会，65岁以上人口占比超过3成，医疗的性质将不得不发生重大变化。医疗的基本功能仍必须是治疗和治愈患者，但该体系还必须提供支持。这意味着要以一种尊重人的生命尊严且不将生命作为治疗牺牲品的方式来构想护理。未来的地区医疗计划还应提出实施家庭医生功能、明确支持该功能的中小型社区医院的功能和作用，以及建立超越医疗范畴的多学科合作的社区综合护理网络。
