福岡県の某健康保険組合における外来老人医療レセプトの解析 : 診療行為および医療費の集中に注目して  [in Japanese] An Analysis of Medical Expenses of Outpatient Service for the Elderly at One Health Insurance Society in Fukuoka Prefecture : Focused on Medical Service and Concentration of Medical Expenses  [in Japanese]

老人外来医療費を高くする要因を明らかにするため, 福岡県某健保組合の平成9年7月分レセプトを1件単位で分析した.医療機関と調剤薬局のレセプトを1件単位で結合し312件の新たなデータベースを作成し解析した結果, 診療行為別頻度%は投薬87.7, 検査45.8, 処置26.3で, 費用割合%は投薬39.3, 診察20.0, 検査12.1であった.重回帰分析にて診療実日数, 尿路生殖器疾患, 疾患数、在宅医療, 検査, 処方場所が医療費への影響大であった.院内処方より院外処方で医療費は高額で, 医薬分業は医療費抑制に貢献していないと思われた.上位1割の高額群に医療費の4割が集中した.高額群は非高額群に比較し診療実日数や疾患数が多く, 処置や在宅医療の割合が高かった.在宅医療の半数以上が高額群に含まれたが, 改めて入院医療と比較すべきと考えられた.レセプト有効利用のため, 医療機関と調剤薬局の請求を統一する電算フォーマット開発を提言する.

To determine the best way to reduce medical expenses of the elderly, we analyzed the aged outpatients'receipts covered by the Health and Medical Service Law for the Aged at one health insurance society in Fukuoka prefecture. We used 312 medical receipts during July, 1997. The proportion of frequency of each medical service was 89.7% for medications, 45.8% for laboratory tests and 26.3% for procedures. The proportion of expenses of each medical service was 38.3% for medications, 20.0% for examinations and 12.1% for laboratory tests. Medication is considered as one of the main causes of increasing medical expenses. As a result of multiple regression analysis, the number of consulting days, urinary and genital disorder, the number of diseases, home care, laboratory tests and prescriptions for outside pharmacies were detected as statistically significant factors associated with medical expenses. There was a concentration of medical expenses, i.e.about 10% of higher rank receipts consumed around 40% of total outpatients'expenses and included 6 of 10 home medical care receipts. One of the causes of expensive outpatients'medical expenses was medication. The separation of dispensary and prescription of drugs does not contribute to the reduction of medical expenses. In the higher rank of the expenses group, compared with the lower rank of the expenses group, the consulation days were longer, the number of diseases was greater and the proportions of expenses for procedures and home care were larger. Medical expenditures for patients receiving home medical care were higher than those of others, but home care should be compared with admissions. Beacause the insurance societies are now facing financial difficulties in Japan, analyzing the data of medical receipts is very important. During our analysis, we had to make an enormous effort to combine two data sources, because the receipts were made separately by clinics and pharmacies. It is strongly suggested that a computerized information system with a standardized format for clinics and pharmacies be developed.