なぜ僻地医療は崩壊したのか?
今日も新聞で、僻地医療崩壊の話を読んだ。
お産。車で5分のところに病院があるから安心して出産のために里帰りしたら、いざというときは車で30分の隣の県にいかなければいけない、とわかってびっくりした、という話だった。その原因は、研修制度で医者の配置が自由化されたからだと、記事にはまとめられていた。
以前から繰り返されている、論理。
なんだかなぁ。仕方がないけれど、勉強不足。
少し違う方面から話をまとめる。
医療費がなぜ高騰したか。
根本的な原因は、「生きたい!」というひとの欲望。その欲望から医療は進化し、新たな治療がつぎつぎに生まれている。技術の進歩とともに昔からの技術の値段は下がってはいるが、どうしても値段が高くなる新たな技術の出現に、値段の低下は追いつかない。
逆に、昔ながらの技術が、値段が下がったがゆえに経済的に維持できなくなり消えていく、という事態すらでてきている。昔ながらのいい薬剤が、経営効率のために消えていく、という事態などだ。
あれもこれも手に入れる。医療費は高騰し、それはできなくなってきている。そして、欲望の流れの中でいろいろなひずみも生まれている。
欲望に流されず実現可能な範囲を決断し、最善の仕組みを整える。人材も施設も限られた資源であることを認識した上で、できるかぎりの有効活用する。それが、大切。
もうひとつ、別の方面から。
今の研修制度が医者にもたらしたのは、情報改革だ。
大学卒業→出身大学の医局への入局、という、キャリアパスを医者たちが考えない時代が長く続いた。それは、医者自身はキャリアに悩む必要もなく、医局も定期的に人材を補給でき、地域も頭使わないで恩恵をうけることができた。
医者たちが、限られた情報の中にいたからだ。
しかし、研修制度ができ、医者がキャリアを考えなければいけない時代になり、かつ情報も整備され、医者たちが無知な中で仕事をしなくなった。
それは悪いことか?
医者たちは馬鹿でいろ。自分と自分の家族の人生を考えないで、きちんと僻地にいって奉仕しろ。
僻地に医者に強制的に行かせるというのは、上記を意味している。
しかし、そんな恥ずかしい欲望だと認識せず主張するひとたちは世の中けっこういて、しばしば頭にくる。
記者を通じてではほんとうの現場の意識はよくわからないし、そして記者は専門家だからしょうがないのわかるけれど、研修制度が今の僻地医療崩壊の原因とするのは、間違えている。
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