Top > ご連絡など > ケアマネジャーの介護保険NEWS > 【介護支援専門員 NEWS】新高齢者医療制度、国保のあり方など地方と協議へ―厚労省方針
【介護支援専門員 NEWS】新高齢者医療制度、国保のあり方など地方と協議へ―厚労省方針
最終取りまとめによると、新制度では被用者である高齢者や被扶養者は被用者保険に、それ以外の自営業者や退職者など地域で生活している人は国保に加入する。国保の財政運営については、第1段階(2013年予定)で暫定的に75歳以上について都道府県単位化し、環境整備を進めて第2段階(18年目標)で全国一律に、全年齢での都道府県単位化を図る。都道府県単位の運営主体については、「市町村による広域連合ではなく、都道府県が担うことが適当であるとの意見が大勢」と明記し、都道府県をはじめとする地方関係者の理解と納得を得る努力を重ねることが必要としている。
一方、医療サービスについては、▽病院・病床の機能分化の推進▽急性期医療から慢性期医療、在宅医療までの切れ目のないサービス▽地域医療のネットワーク化―などが求められるとし、地域ごとに医療・介護・福祉サービスが継続的・包括的に提供される体制づくりを進める必要性を指摘している。
議論では、複数の委員から同案を了承する旨の発言が出る一方、「現役世代の支援が限界に達している現状が認識されていない。不本意な内容だ」(白川修二・健康保険組合連合会専務理事)、「全国知事会の基本的な考え方は反対の方向だ」(神田真秋・愛知県知事)などの声も上がった。
神田委員は、「知事会として求めてきたことが十分反映されなかったことは誠に遺憾だ」と述べた上で、財源論が見えないため、国保の運営主体を担うことについてほとんどの都道府県が反対していると説明した。今後についても、「野党は否定的で、まして与党の中にも反対論がある。通常国会に向けて法案のすり合わせが本当にできるのか」と疑問視した。
一方、細川厚労相は冒頭のあいさつで、「(国保の)運営について、知事会あるいは地方団体の皆様に今後お願いをしなければならない」と述べ、国と地方が協議する場を設ける方針を示した。
同省によると、協議には厚労相をはじめ政務三役と知事、市町村長、広域連合長の代表者が参加。法案提出に向けて、国保の抱える構造的な問題への対応や、新制度での国保運営の具体的なあり方などについて検討する。同省は来年1月にも協議を開始したい考えだ。
これについて神田委員は会合で、「国保の構造的な問題などについて、なぜこれまで(協議を)していただけなかったのか。法制化のための協議であれば、全国知事会として到底、直ちに参加できるものではない」と述べた。
最後に藤村修副大臣は、「知事会にもぜひご理解いただき、ご参加いただきたい」と要請。「政府として法案を提出していく以上は、責任を持って国費と地方分担の増加に必要な財源を確保するという方針を打ち立てて臨みたい」と述べた。
■通常国会への法案提出見送り「一切ない」
細川厚労相はまた、法案の提出時期について、「通常国会に出すのを見送る検討をしているというような報道もあったが、そういうことは一切ない」と述べ、次期通常国会への提出を目指す考えを改めて強調した。
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【介護支援専門員 NEWS】新高齢者医療制度、国保のあり方など地方と協議へ―厚労省方針
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