平成24‑ 年度医療経済研究機構調査研究事業 ２０１０ ２０１２年度
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་ ⒪ ⤒ ῭ ◊ ✲ ᶵ ᵓㄪᰝ ◊ ✲ ஦ ᴗ2010-2012 ᖺᗘ2(&' ࡢ 6+$ ᡭἲ࡟ᇶ࡙ࡃ

ＯＥＣＤのＳＨＡ手法に基づく総保健医療支出の推計 報告書⥲ಖ೺་⒪ᨭฟࡢ᥎ィ
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27㈈ᅋἲே ་⒪⤒῭◊✲࣭♫఍ಖ㝤⚟♴༠఍

医療経済研究機構IHEP་⒪⤒῭◊✲ᶵᵓㄪᰝ◊✲యไ࠙ㄪᰝ◊✲ᢸᙜࠚ་⒪⤒῭◊✲ᶵᵓ‫‶ۑ‬Ṋ ᕧ⿱◊✲㒊๪㒊㛗 ᒣᒸ ῟◊✲㒊୺௵◊✲ဨ㉥⩚ 㝯ᩥ㸦๓㸧௻⏬ㄪᰝ㒊◊✲ဨబࠎᮌ ᗣ๎㸦๓㸧௻⏬ㄪᰝ㒊◊✲ဨͤ ᮏሗ࿌᭩࡟㛵ࡍࡿ㐃⤡ඛ
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i―i―OECD ࡢ SHA ᡭἲ࡟ᇶ࡙ࡃ⥲ಖ೺་⒪ᨭฟࡢ᥎ィ࠙せ⣙ࠚ
2000 ᖺࠊOECD㸦⤒῭༠ຊ㛤Ⓨᶵᵓ㸧ࡣᅜẸಖ೺ィ⟬㸦National Health Account㸧ࡢ᥎ィ᪉ἲ࡜ࡋ࡚ A System of Health Accounts㸦௨ୗࠊSHA1.0㸧ࢆබ⾲ࡋࡓࠋ௨ᚋࠊOECD ຍ┕ᅜࡣࠊSHA1.0࡟ἢࡗࡓ᥎ィࢆ⾜࠸ࠊOECD ࡟᥎ィ್㸦⥲ಖ೺་⒪ᨭฟ㸧ࢆᥦฟࡋ࡚࠸ࡿࠋ᪥ᮏ࡛ࡣࠊ་⒪⤒῭◊✲ᶵᵓࡀ SHA ࢞࢖ࢻࣛ࢖ࣥ࡟‽ᣐࡋࡓ᪥ᮏࡢ⥲ಖ೺་⒪ᨭฟ࡜ࡋ࡚ࠊ1995 ᖺᗘ࠿ࡽࡢ᥎ィ್
ࢆ OECD ࡬ᥦฟࡋ࡚ࡁࡓࠋ㏆ᖺ࡛ࡣࠊᖹᡂ 26㹼27 ᖺᗘཌ⏕ປാ⛉Ꮫ◊✲㈝⿵ຓ㔠㸦ᨻ⟇⛉Ꮫ⥲ྜ◊✲஦ᴗ㸦⤫ィ᝟ሗ⥲ྜ◊✲㸧㸧࡛࠶ࡿࠕOECD ࡢ System of Health Account2011(SHA2011)࡟‽ᣐࡢ᥎ィ᪉ἲࡢ㛤Ⓨ࡜᥎ィ㸦H26-⤫ィ-ᣦᐃ-003㸧ࠖࡢᡂᯝࢆ཯ᫎࡉࡏࡓ᥎ィࢆ⾜ࡗ࡚࠸ࡿࠋᮏሗ࿌᭩ࡣࠊࡇࢀࡲ࡛ࡢ◊✲ࡢࡶ࡜࡟ SHA1.0 ࡟‽ᣐࡋࡓ 2010㹼2012 ᖺᗘࡢ⥲ಖ೺་⒪ᨭฟࡢ᥎ィ⤖ᯝࢆ♧ࡍࠋ⥲ಖ೺་⒪ᨭฟࡣࠊയ⑓ࡢ἞⒪࡟せࡍࡿ་⒪㈝ࡢࡳ࡞ࡽࡎࠊ೺ᗣቑ㐍࣭⑌⑓ண㜵ࠊ೺ᗣ⟶⌮ࠊ࠶ࡿ࠸ࡣ་⒪ಖ㞀ࡢ㐠Ⴀ㈝ࠊタഛᩚഛ࡞࡝ࡶྵࡴࠋ୍᪉ࠊཌ⏕ປാ┬⤫ィ᝟ሗ㒊࠿ࡽබ⾲ࡉࢀࡿࠕᅜẸ་⒪㈝ࠖࡣࠊࢃࡀᅜࡢ་⒪ಖ㝤ไᗘࡢࡶ࡜࡛ࡢᨭฟࢆ᥎ィࡋࡓࡶࡢ࡛࠶ࡾࠊ⥲་⒪ಖ㝤ᨭฟ࡜ࡣ⠊ᅖࡀ␗࡞ࡿࠋ ᖺᗘࡢ⥲ಖ೺་⒪ᨭฟᅜẸ་⒪㈝ࡣ  ᖺᗘ࡟⣙  ඙෇࠿ࡽ  ᖺᗘࡢ⣙  ඙෇ࡲ࡛ቑຍࡋࡓࠋ ᖺᗘ࡟ࡣ௓ㆤಖ㝤ไᗘ࡬୍㒊ࡢ་⒪⣔ࢧ࣮ࣅࢫࡀ⛣⾜ࡋࡓᙳ㡪ࡶ࠶ࡾࠊ⣙  ඙෇࡟ῶᑡࡋࡓࡀࠊ ᖺᗘ௨㝆ࡣ෌ࡧቑຍࡀ⥆ࡁࠊ ᖺᗘࡣ⣙  ඙෇ࡲ࡛ቑຍࡋࡓ ᅗ⾲  ࠋᅗ  ࡟ࠊ
ᖺᗘࡢᅜẸ་⒪㈝࡜⥲ಖ೺་⒪ᨭฟࡢ㛵ಀࢆ♧ࡋࡓࠋ㠃✚࡜ᐇ㝿ࡢ್ࡣẚ౛ࡋ࡚࠸࡞࠸ࡀࠊᅜ
Ẹ་⒪㈝࡟ᑐࡋ࡚ࠊ⥲ಖ೺་⒪ᨭฟࡢ᥎ィ್ࡣ⣙  ඙෇࡜࡞ࡗࡓࠋࡓࡔࡋࠊ⥲ಖ೺་⒪ᨭฟ
࡟ࡣ 6+$ ࡢ඲࡚ࡢ㡯┠࡟ಀࡿ㈝⏝ࡀྵࡲࢀ࡚࠸ࡿࢃࡅ࡛ࡣ࡞࠸ࠋ✵ⓑࡢ㒊ศ࡛♧ࡋࡓ㏻ࡾࠊ
ࢹ࣮ࢱไ⣙➼ࡢ⌮⏤࡟ࡼࡾ᥎ィ್࡟ྵࡲࢀ࡞࠸ࡶࡢࡀ࠶ࡿࠋಖ㝤⤥௜እࡢ㧗ᗘ་⒪ࠊ㧗ᗘඛ㐍་⒪࡟࠾ࡅࡿᝈ⪅㈇ᢸศࠊᐊᩱᕪ㢠ࠊṑ⛉⮬⏤デ⒪࣭ṑ⛉ᮦᩱᕪ㢠ࠊ⨾ᐜᩚᙧ㈝ࠊ་ᖌࡢᣦ♧௨እ࡟ࡼࡿ࠶ࢇᦶ࣭࣐ࢵࢧ࣮ࢪ࡞࡝㸦೺ᗣಖ㝤㐺⏝እ㒊ศ㸧ࠊᨻᗓࡢಖ೺་⒪ᐇົ㈝➼ࡣྵࡲࢀ࡚࠸࡞࠸ࠋࡲࡓࠊ௓ㆤಖ㝤ࢧ࣮ࣅࢫ࡟ࡘ࠸࡚ࡣࠊ୺࡟་⒪ࡢ᭷㈨᱁⪅ࡀᥦ౪ࡍࡿࢧ࣮ࣅࢫࡢࡳࡀྵࡲࢀ࡚࠸ࡿࠋ

ii― ii ―ᅗ⾲ 1 ᅜẸ་⒪㈝࡜⥲ಖ೺་⒪ᨭฟࡢ᥎⛣≋Ϋό≌≋≉≌‧•‪…

…‧

‪‥

…•

‪․‥‧

‪‣

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․‧
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‪‣‧‣•‧‧•‣‫‫‫‣ ‫‫‣ ‫‫‣‧‫‫‬‪‣‫••․ ••․ ••․‧••․…••․‥••․․••․‣••․•••․‫‫‫‬‪․••‫․‣•․‣‣•․•‣•․‫‬࠰ࡇ‫׎‬ൟҔၲᝲዮ̬ͤҔၲૅЈ≋⁆›‷≌‫׎‬ൟҔၲᝲⅻ⁆›‷↚ҩ↰↺лӳ≋≉≌ᖺᗘᅜẸ་⒪㈝⥲ಖ೺་⒪ᨭฟ

1995
26,95833,226

1996
28,45434,745

1997
28,91535,188

1998
29,58235,916

1999
30,70237,065

2000
30,14238,409

2001
31,10039,163ᖺᗘᅜẸ་⒪㈝⥲ಖ೺་⒪ᨭฟ

2006
33,12841,5192007
34,13642,313

2008
34,80843,0992009
36,00744,824

2010
37,42046,205

2011
38,58547,4702012
39,212
48,318

2002
30,951
39,175

2003
31,53839,888

2004
32,11140,474

2005
33,12941,227

༢఩㸸10 ൨෇iii― iii ―iv― iv ―

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㸱㸬SHA ࡟ᇶ࡙ࡃ᪥ᮏࡢ⥲ಖ೺་⒪ᨭฟ᥎ィ .................................................................................. 13
㸲㸬OECD Health Data ............................................................................................................................ 14➨㸰❶ OECD Health Data ᥎ィ⤖ᯝ21
㸯㸬2012 ᖺᗘࡢ᥎ィ⤖ᯝ ...................................................................................................................... 21
㸦㸯㸧2012 ᖺᗘ⥲ಖ೺་⒪ᨭฟࡢᴫἣ .............................................................................................. 21
㸦㸰㸧1995̺2012 ᖺᗘࡢ᥎⛣ .............................................................................................................. 23㸰㸬་⒪ࢧ࣮ࣅࢫᨭฟ㸦Total expenditure on medical services㸧 ....................................................... 25㸦㸯㸧ධ㝔་⒪㈝㸦Expenditure on in-patient care㸧 ........................................................................... 26㸦㸰㸧እ᮶་⒪㈝㸦Expenditure on out-patient care㸧 ......................................................................... 27㸦㸱㸧ᅾᏯ་⒪㈝㸦Expenditure on home care㸧 ................................................................................. 29
㸱㸬㈈※ูศ㢮࡟ࡼࡿ⥲ಖ೺་⒪ᨭฟ㸦Expenditure on health by financing agents㸧 .................... 30➨㸱❶ SHA tables ᥎ィ⤖ᯝ33㸯㸬ᶵ⬟ูศ㢮ࡢᵓᡂ ........................................................................................................................... 34㸰㸬౪⤥୺యูศ㢮ࡢᵓᡂ ................................................................................................................... 35
㸱㸬㈈※ูศ㢮ࡢᵓᡂ ........................................................................................................................... 36
㸲㸬SHA tables ᵓᡂẚࡢ᥎⛣ ................................................................................................................ 37㈨ᩱ⦅
㈨ᩱ㸯㸬OECD Health Data 2012 ᥎ィ⤖ᯝ .......................................................................................... 43㈨ᩱ㸰㸬SHA tables ᥎ィ⤖ᯝ ............................................................................................................... 49㈨ᩱ㸱㸬SHA ࡟ᇶ࡙ࡃ᪥ᮏࡢ⥲ಖ೺་⒪ᨭฟࡢ᥎ィᡭἲ .............................................................. 69㈨ᩱ㸲㸬OECD Health Data 2012 ྛ㡯┠࡜ SHA ࡢᑐᛂ .................................................................. 139v
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