Medical institutions that have secured beds to accept inpatients with the new coronavirus are paid subsidies to support their management.
Regarding hospitals that receive this subsidy, which is also called "empty bed compensation," the Board of Audit pointed out, "The bed occupancy rate was about 60% on average even when the infection spread."
This is the second time, following November last year, and we are asking the Ministry of Health, Labor and Welfare to review the system.
On the other hand, some experts point out that ``whether the utilization rate is high or low should be considered based on the sense of the medical field.''
We have summarized in detail in the Q&A.
Q1.
what kind of grant?
"Empty bed compensation" is a grant called "bed security fee" in the official name.
It started in April 2020 with the aim of supporting the management of medical institutions that accept COVID-19 patients, keeping in mind that the income that should have been earned by admitting patients would be reduced.
In these medical institutions, nurses and other medical workers are gathered in the corona ward and general beds are closed, or a room that was originally used by multiple patients is used by a single patient. Sometimes we have no choice but to vacate other beds.
For this reason, subsidies are paid on a daily basis from the national government through prefectures for medical institutions with the following beds.
▽ Beds that were suspended due to the acceptance of corona patients ▽ Beds that
were
not filled with patients while securing
It is said that up to 51,000 beds have been secured as of January 10.
Q2.
What are the findings of the Board of Audit?
There are two main points to point out.
One is the occupancy rate of hospital beds at medical institutions that receive subsidies.
Regarding the "occupation rate of hospital beds," the Board of Audit points out that "it turned out that it was about 60% on average even when the infection spread."
The Board of Audit announced that the 496 hospitals nationwide, which are the bases of the new corona countermeasures, were declared in a state of emergency in January and August 2021, and in February 2022, when the infection with the Omicron strain spread. I checked usage.
Although there were some hospitals with a bed utilization rate of over 80% or 90%, the average was as follows.
▽January 2021: 54.5%
▽August 2021: 61.2%
▽February 2022
: 61.2 %
I answered.
These hospitals specialized in treating severely ill patients, pregnant women, children, etc., and the fact that the number of corona patients themselves was small in some regions, suggesting the possibility that mismatches occurred depending on the patient's symptoms and region. It means that
On the other hand, about 10% of the hospitals answered that they had vacant beds, but they declined the request for admission due to circumstances, and some cited a shortage of doctors and nurses as the reason.
The Board of Audit said, ``It is a challenge to secure the necessary hospital beds and provide sufficient medical care to COVID-19 patients.'' I requested that we consider reviewing the system, such as making it a target for
Q3.
Another point?
The other is whether the amount paid per hospital bed is appropriate.
Subsidies range from 16,000 yen to 436,000 yen per day per bed, depending on the role of the medical institution and the type of bed.
The Board of Audit compared the maximum amount of subsidies and the medical fees obtained when accepting patients for 426 "priority medical institutions" nationwide as follows.
▽ICU of a general hospital = Intensive care unit (amount per day per bed)
・Maximum amount of
grant: 301,000 yen
・Average medical fee: 363,821 yen
It is less than about 60,000 yen, and for this reason, there is a possibility that sufficient compensation may not be received depending on the medical institution.
On the other hand, it also points to the opposite case.
▽ In the case of an ICU such as a "specific function hospital" that provides advanced medical care (amount per day per bed)
・Maximum grant amount 436,000 yen
・Average medical fee 369,130 yen
Maximum grant amount exceeds the average medical fee by more than 66,000 yen, and there is a possibility that the subsidy exceeding the amount to be compensated is paid.
Based on these actual conditions, the Board of Audit is requesting that consideration be given to reviewing the method of calculating the amount of subsidies and setting the maximum amount.
Q4.
Has the coronavirus crisis changed hospital management?
Of the hospitals subject to this inspection, the Board of Audit investigated the management status of 269 hospitals operated by nationally funded independent administrative agencies and national university corporations, and found that management had been worse than before the spread of the new corona infection. I know it's going up.
According to the Board of Audit, when we examined the management status of 269 hospitals in 2019, which is said to be less affected by the new corona, and in 2020 and 2021, when the infection spread, the results were as follows.
Average medical practice balance
▽FY2019 deficit of more than 386 million yen
▽FY2020 surplus of more than 290 million yen
▽FY2021 surplus of more than 705 million yen
Subsidies related to COVID-19 paid to these hospitals , averaged over 1.12 billion yen per hospital in 2020 and over 1.41 billion yen in 2021, and many hospitals would have been in the red without subsidies.
The Board of Audit said, ``It seems that receiving subsidies for securing hospital beds for the new corona tends to lead to improved hospital management compared to keeping conventional beds.''
Q5.
what do the experts think?
Professor Takero Doi of Keio University, who specializes in finance, said that he played a role in helping to secure beds even at hospitals where income was greatly reduced due to refraining from visiting hospitals in the early stages of the spread of infection. pointing out.
"It should be verified whether it was good to spend so much money to secure a hospital bed. If there is a situation where it is not possible to secure a corona hospital bed even if you provide money, we will immediately change the way you spend the money. "
I understand that it is difficult to deal with the novel coronavirus on the ground, but medical care is made up of the money entrusted to us by the people, so the government should make sure that the money is used appropriately." It is necessary to verify that,"
he pointed out, and now that three years have passed since the spread of the new coronavirus infection began, the time has come for the government to verify financial support for corona policies, including compensation for vacant beds. I'm doing it.
On the other hand, Professor Tomonobu Iseki of Josai University, who is familiar with community medicine, points out as follows.
"Whether 60% of the utilization rate is high or low should be considered from the point of view of the medical field, and if it is 100%, the hospital will be overwhelmed.Because we will secure enough room in case the infection explodes, we will not fill up the hospital beds. Accepting COVID-19 patients comes with risks such as hospital-acquired infections, so the subsidies are meant to compensate for that."
On top of that, about the review of the system.
"We are currently in the middle of the 8th wave, and in terms of fire, we are in the process of extinguishing the fire. It is premature to ask that the water in the pump that extinguishes the fire be closed at that time, and we will wait until the infection has really calmed down. The system should be reconsidered based on this, and I would like the hospitals to use the surplus to improve the medical system and develop human resources so that they can respond to the next infectious disease that will replace the new coronavirus."
Q6.
What is the response of the Ministry of Health, Labor and Welfare?
What about future revisions?
The "bed security fee" is the largest amount of corona-related grants paid to medical institutions, and the Ministry of Health, Labor and Welfare has reviewed the system so far.
In January last year, the amount paid to hospitals that did not accept enough patients was reduced, and in October last year, the amount of subsidies greatly exceeded the income obtained when accepting patients before the spread of infection. We reviewed the situation, such as setting an upper limit so that it does not occur.
On the other hand, the Board of Audit also pointed out this subsidy in November last year before this point.
In the inspection report for the fiscal 2021 budget, we investigated 106 medical institutions in 13 prefectures, and found that 32 hospitals in 9 prefectures applied for excessive number of days to be eligible for benefits, or were paid at a higher bed price. It was pointed out that a total of more than 5.5 billion yen was spent inappropriately.
In response to this, the Ministry of Health, Labor and Welfare has asked prefectures to verify whether or not they were properly granted to the approximately 3,500 medical institutions that received payments in the two years of 2020 and 2021. If it is confirmed, we will ask the country to return it.
Medical institutions that are expected to return large sums of money, and medical institutions that have significantly lower bed occupancy rates than other medical institutions, are requested to consider conducting on-site surveys.
The deadline for vacant floor compensation has been extended so far, with no prospects for the convergence of the corona virus, and the current deadline is the end of March.
In response to this remark, the Ministry of Health, Labor and Welfare said, "In the future, we will ask prefectures to investigate and report again whether there are any cases where they refused to accept patients on the grounds that the necessary nurses were not secured." I am commenting.
After that, we will consider how the system should be after April based on the infection situation and the findings of the Board of Audit.