ケアサポート９／ケアマネージャー（介護支援専門員）試験／ＴＯＰへ

介護予防事業、予算縮減も「額は判定不能」―事業仕分け

厚生労働省などの事業の「仕分け」を行っている行政刷新会議の第2ワーキンググループ(WG)は11月17日、市町村が介護保険事業計画に基づいて実施する地域支援事業中の「介護予防事業」について、「予算を縮減する」としたが、その金額については厚労省側の説明が不十分として「判定不能」と結論付けた。

　介護予防事業は2006年度から開始。要介護認定で非該当と判定された高齢者のうち、要介護や要支援になるおそれがある「特定高齢者」の生活機能の維持や向上のための事業を実施することなどを市町村に義務付けており、市町村は介護保険事業計画の中で介護予防事業の計画を策定する。来年度予算の概算要求には、200億8700万円が計上されている。

　財務省側は介護予防事業について、▽実施主体の自治体から「効果はそれほどない」という意見がある▽予防効果を実証できる十分な結論は得られていない▽予算の執行では、毎年度多くの不要額が出ている(昨年度当初予算258億円に対し、執行実績は171億円)―などと指摘。このため、▽執行実績に合わせて予算額を削減すべき▽将来の制度の在り方としては、補助事業としてではなく保険者(市町村)が自ら地域の実情やニーズに合った事業を創意工夫により行うべき―などと主張した。
　WGの評価者からは、介護予防事業によって圧縮できた介護給付費の具体的な金額をただす指摘あったほか、介護予防事業での改善効果のデータを示すべきとの意見が相次いだ。一方で厚労省側は、介護予防に参加した特定高齢者のうち、改善した人の割合が全体の50%を超えたとの統計を紹介するなど、介護予防事業の意義を強調した。

　評価結果では、評価者8人のうち、「自治体や民間に移管する」が1人、「要求通り」が1人、「予算を縮減する」が6人だった。予算縮減とした6人のうち、5人が「その他」とし、うち3人が「説明不十分」と評価した。これを受けて取りまとめ役の尾立源幸参院議員は、「介護予防事業は今後さらに重要になっていく大事な施策という認識は、全員に共通している」と述べる一方、厚労省側の説明が不十分と指摘。「予算を縮減する」としたが、「具体的な見直し額は判定不能」との評価を下した。また、科学的根拠に基づく調査により、事業の費用対効果を検証すべきとした。

　仕分け終了後、厚労省の宮島俊彦老健局長は記者団に対し、WGから「説明不十分」と評価された理由について、「まだ始まって3年間なので、きちんとした推計はできない。そこで(議論が)かみ合っていなかったと思っている」との見解を示した。また、「予算縮減」との評価については、「縮減しようということになっても、市町村が実質的に事業費を決めているので、国が一方的に縮減することは構造的にできない」と述べた上で、「合理化できることがあれば考えていく」とした。

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