わが国における歯科受診状況および診療内容の推移 : 1994年以降における診療行為別診療報酬額の分析を中心として Trends in Dental Utilization and Dental Practice in Japan, Focusing on the Analysis of Dental Fees by Clinical Types Since 1994

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著者

    • 南郷 里奈 NANGO Rina
    • 東京医科歯科大学大学院医歯学総合研究科環境社会医歯学系専攻国際健康開発学講座健康推進歯学分野 Oral Health Promotion, Department of International Health Development, Division of Public Health, Graduate School, Tokyo Medical and Dental University

抄録

今後の歯科医療の方向を探るための基礎資料を得る目的で, 歯科受診状況および診療内容の推移について診療報酬額を中心に分析を行った.歯科疾患の有病者率に比べて有訴者率や通院者率は低く, 自覚症状がなければ受診行動には結びつきにくいと推察された.受診状況をみると, う蝕や歯髄炎などが減少して歯周疾患が増加していた.患者の大半が治療目的で受診しており, 歯科健診を目的とした受診は総数の1%に満たなかった.ただし, 約2割の者は過去1年間に健診を受けた経験があった.診療報酬額は, 1990年代後半から, 修復・補綴がほぼ横ばい, 処置・手術や検査・画像診断などが減少傾向にあったが, 指導管理料は, 保健指導や予防管理に重点を置いた近年の診療報酬改定を反映し, 顕著な伸びを示していた.回帰モデルを用いた分析の結果, 指導管理料は, 前年の診療報酬総額よりも前年の指導管理料の影響を強く受けて着実に増加してきたことが示された.療養の給付を主たる対象とする現行の医療保険制度において, 診療報酬改定を通じて予防的診療行為の増加が誘導されてきたことから, こうした政策が定期受診による口腔保健の向上を促進する可能性が示唆された.また, 歯科疾患の有病者率と有訴者率には依然格差があり, 歯科を受診した患者に対しては通院の機会を捉えて定期歯科健診を勧め, 自覚症状のない人々に対してはさまざまな機会に早期の歯科受診を促すことが必要と考えられた.

Since the current national health insurance in Japan only covers treatments for existing diseases and injuries, there is little incentive for regular preventive dental visits or preventive interventions in dental practice. In order to provide basic data to evaluate these preventive activities for future dental practices, the trends in dental utilization and dental practice were investigated using some national surveys. 1. In adults, the prevalence of dental caries was more than 40 percent, and from 20 to 30 percent of people consulted a dentist for dental caries in the past year. As for periodontal diseases, the prevalence was more than 80 percent, and the dental visit rate was just a few percent. The number of outpatients was comparatively close to that for people with oral symptoms. It seems that people mainly consult a dentist only after they realize the symptoms. 2. During the past 15 years, the dental visit rate for people aged 54 and under decreased, but increased among those aged 70 and over. Visits for dental caries or pulpitis decreased and those for periodontal diseases increased. However, most dental visits were for treatments of dental caries or prosthodontics. Visits for dental check-ups were less than 1% of total visits. 3. The transition of fees per dental claim from 1985 through 2002, excluding the influence of the revision on dental treatment fee points, revealed that the "Restoration and Prosthodontics fee" had plateaued and the "Treatment and Surgery fee" and the "Diagnostic Test and Radiology fee" had decreased since the second half of the 1990's. On the contrary, the "Instruction fee", mostly consisring of fees for oral health instructions and disease preventions, has increased remarkably. 4. According to a regression model analysis using panel data by age groups from 1994 to 2002, I estimated that 1% of the "Total fee" and the "Instruction fee" change in the previous year affected the "Instruction fee" in the following year by 0.04% and 0.98%, respectively. Therefore the "Instruction fee" has been promoted by the increase of the "Instruction fee" in the previous year, rather than by the change of the "Total fee" in the previous year. This implies that receiving and giving preventive instruction has been established and become accustomed to over the same period. I also found that the raise of the co-payment rate of the employed in September 1997 caused a 27.5% reduction of the "Instruction fee". These findings show that the instructions for prevention, mainly for periodontal diseases, have been provided for more in dental practice. This means that the recent remuneration policy has induced more preventive interventions, even under the current health insurance system. Meanwhile, there is a disparity between the number of people with oral diseases and that of people who realize their symptoms. I conclude that dental practitioners should encourage their patients to have routine dental check-ups, and consultations at an early stage should be recommended for those who have not yet realized their symptoms.

収録刊行物

  • 口腔衛生学会雑誌

    口腔衛生学会雑誌 55(5), 586-599, 2005

    一般社団法人 口腔衛生学会

参考文献:  42件中 1-42件 を表示

被引用文献:  3件中 1-3件 を表示

各種コード

  • NII論文ID(NAID)
    110004062124
  • NII書誌ID(NCID)
    AN00081407
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    0023-2831
  • NDL 記事登録ID
    7725631
  • NDL 雑誌分類
    ZS44(科学技術--医学--歯科学・口腔外科学)
  • NDL 請求記号
    Z19-144
  • データ提供元
    CJP書誌  CJP引用  NDL  NII-ELS  J-STAGE 
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