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2268 people infected in Tokyo, 3 people for 2000 consecutive days

 
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The infection situation is deteriorating at an accelerating rate, and concerns about the collapse of medical care are becoming more serious.
 

The Tokyo Metropolitan Government announced on the 9th that 2268 new cases of coronavirus infection have been reported. 2000 people ... → Continue reading

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Medical collapse

Medical collapse(Irihokai) is an excessive social demand for or an excessive expectation of medical treatment,Medical billsAgainst the background of curtailment policies,DoctorDemoralization ofDefense medicalincrease of,hospitalIt is a slang term developed by the theory that a stable and continuous medical care provision system will not be established due to deterioration of management.[1][2].

2020,New coronavirusIn countries where the disease was rapidly spreading, there was a shortage of medical personnel and medical equipment, making it difficult to treat severely ill people. Such a state came to be called medical collapse[3]..Originally, according to OECD data, the number of hospital beds per 1,000 people is the highest in Japan compared to other countries, but the internal situation is that the number of psychiatric beds per 1,000 people included in the statistics is also outstanding. In Japan, the number of beds (capacity) in nursing homes is small compared to the aging rate, and hospitals play the role of nursing homes.[4][5].

Medical collapse in Japan

Background and overview

Health policy/medical administration issues

In Japan, suspicions about medical policy and administration began to emerge among healthcare workers in the late 1990s.[6].. Specifically, the policy of controlling the number of doctors since the middle of 1980,Medical billsHospitals suffering from doctor shortages due to restraint policiesWorking doctorHowever, there is a mythical theory that it was forced to work hard due to the deterioration of hospital management due to the policy of curbing medical expenses (as of 2006, more than 7% of hospitals in the nation were in the red. Is)[7].. Former financial bureaucratMasayasu MurakamiAccording to the report, the biggest cause of "healthcare collapse" is the policy of curbing medical expenses so far. "The medical policy so far is based on the bad financial reconstruction supreme principle that prioritizes the reduction of medical expenses. Has been established.”[8].

However, contrary to the above myth, public data show that Japan's healthcare spending in 2012 accounted for 10.3% of GDP, one point higher than the OECD average of 9.3%. In most OECD countries, the majority of healthcare spending comes from the public sector, but in 1 2012% of Japan's healthcare spending was public spending, even more than the OECD average of 82%. It's expensive.Therefore, even if the medical cost restraint policy is implemented as in the above myth, the actual medical cost is not restrained, and it is spent a little higher than GDP compared to other countries, such as France, Germany, and Sweden. It is almost the same level.In terms of the number of doctors per 72 people, Japan has 2.4 people, which is the sixth from the bottom of the 35 target countries, and belongs to the category of a small number of countries.In terms of the number of nurses, Japan has 6 people, which is 11.0th out of 35 countries, which is almost the middle level.[9].

Excessive social demands for medical safety

Furthermore, since around 2002, medical accidents have been targeted by police investigations, and well-meaning nurses and doctors are often treated as suspected criminals.In addition, mass media coverage increases, The social demands on the country have risen excessively. In this social situation, a movement called “escape-type sabotage” among local doctors (working doctors) (Defense medical) Has been seen, Komatsu said[10].

The word "escape-type sabotage" was createdToranomon HospitalUrologyWas the managerHideki KomatsuIs. In 2004, KomatsuJikei University Aoto Hospital Case The structure of medical practice and practical ethics” (2004), and the one-sided attitude of the media, police, and prosecutors who ignored the uncertainty of medical care amplified the conflict between patients and doctors, and eventually Japan. Komatsu said it would disrupt medical care.

Even ordinary doctors are afraid of the police and the media. I am beginning to think that I could be a criminal for ambiguous reasons. This has begun to cast a shadow on the medical practice of doctors. The relationship of trust between doctors and patients has also collapsed. Doctors are reluctant to take dangerous treatment methods. If this situation continues, it may happen that in the future there will be no human resources who will become surgeons. Komatsu said that criminal penalties for doctors could undermine medical care without a clear definition of crime in medical care.[11]

Although the book did not receive public attention, it was "the position of the pivot of society."[12]In 2005, he decided to speak at the Supreme Public Prosecutor's Office. Based on the opinion submitted at that time, Komatsu wrote "What is "Medical Disintegration-Leaving-type Sabotage"" (2006), and the situation facing the Japanese medical system, especiallyCriminal lawBased on the police and public opinion as a background to alert the doctor how to hunt down doctors, the book temporarily called the word "medical collapse".

Komatsu is a doctor at a high-risk hospital.Working doctorResigning from the hospital and moving to a less burdensome hospital or becoming a practitioner is called an "escape-type sabotage." As Komatsu pointed out, the medical litigation rate was originally high and the amount of compensation was also high.Obstetrics and gynecologyThe number of doctors in charge is remarkably decreasing, and many medical students who will be the future bearers refuse to become obstetricians, and the collapse is progressing. Furthermore,Pediatrics,Internal medicine,surgicalAdvanced medical services such as have reached the same situation.

However, the medical level in Japan isWorld Health OrganizationFor many years, it has been number one in the world, as seen in various indexes by (WHO). For example, by the agencyWorld Health Report(2000), Japan has the highest healthy life expectancy and the third highest level of equality, and has the highest overall health achievement in the world.[13].. In addition, the 2009 OECDHealth DataBut it still stays number one overall[14].

Social disintegration of medical collapse

Such institutional "distortion" has emerged as a concrete social problem in the so-called emergency transport from around 2007.Turning aroundThe number of cases is increasing[15].. However, the expression “turning around” in the mass media is not too sensational and does not accurately capture the actual situation.[16]Actually, the ambulance was stopped and the hospitals were making inquiries, and when the number of inquiries was high, the mass media called it "turning around."[17].. Moreover, there are many reasons why the recipient cannot be found, such as "under treatment", "absence of doctor", "no bed", "non-specialty", "no specialist", etc. It was against an administrative background[18].

In addition, the high priceMedical equipmentThe burden of introduction, debts for the construction of new hospitals, repeatedMedical system reformbyMedical feeDue to the decrease in medical income due to the decrease, there are cases in which hospitals are being forced into financial crisis, bankruptcy, and voluntary closure. The closure of the hospital is closely related to the problem of lack of doctors as well as the management problem. For example, see belowMandatory initial clinical trainingTriggered by a university that sent doctors to local hospitalsMedical officeUnder the initiative of, the number of doctors is increasing and the number of doctors is responding to the doctor shortage by increasing the number of doctors from hospitals that examine one department by themselves for the purpose of medical safety and reducing the burden on doctors working.[19].. However, even if the hospitals were consolidated, doctors did not always gather as planned or doctors retired one after another.[20], The provision of medical services in that area is no longer possible, and depending on the area and department, there are no more clinics/hospitals that can provide medical treatment nearby.[21].

Among these cases, there were cases in which local medical care collapsed because doctors were forced to retire due to the slander of local residents and the hard work caused by media reports.[22].. The number of cases such as internists and anesthesiologists who have to retire in large numbers is increasing due to the heavy burden of specific specialized departments.[23], There are occasional cases where the outcome of an abandoned hospital is taken.

Against the backdrop of these social phenomena, mass media reports have begun to change in the tone of unilateral criticism of medical staff and hospitals.

HyogoWill be integrated and newly establishedKitaharima General Medical Center(Ono CityThe number of predecessor doctors in the market was 2012 in December 12, but is expected to decrease to 33 in April 2013. Regarding internal medicine, the number has decreased from 4 to 18, making it difficult to accept new hospitalized patients.[24].

Health policy/medical administration issues and responses

Medical cost control policy

The policy of curbing medical costs from the mid-1980s has not changed even in the 2000s when the collapse of medical care became a reality.Koizumi administrationBelow, the natural increase in social security costs was reduced by about 5 trillion yen over five years. During this time,Medical feeHas continued to be revised, and in 2006Postal elections-3.16%, the biggest negative revision in history[25].. The restraint policy continued after the Koizumi administration, but due to the change of government in 2009 due to the change of government to the Democratic Party, the revision of medical fees in 2010 was only +0.19%, but it was positive for the first time in 10 years. It will be revised and the specific allocation will be decidedChuikyoIn order to reduce the burden on doctors working in acute care hospitals and improve management, it was decided to allocate most of the financial resources to hospital treatment.
However, medical care, which was supported by drug price margins with low technical fees, has lost the drug price margins due to the beliefs of the Ministry of Health, Labor and Welfare, the Ministry of Finance, and the media, and many procedures have been left without becoming economical. Due to the financial situation, the number of surgical doctors is decreasing year by year.[26] Although the consumption tax will increase from 5% to 8%, the medical treatment fee will be basically left unchanged or reduced, and it will be dealt with by raising the initial consultation fee and the re-examination fee (originally, the consumption tax will be levied and the consumption tax for the purchase Should be refunded, but to raise tax revenueMinistry of Finance-Ministry of Health, Labor and WelfareDid not revise[27].

Lack of doctors

The beginning of the doctor control policy wasSecond extraordinary administrative survey meetingIn the "Third Report on Administrative Reform-Basic Report" compiled in July 1982[29].. Establishing a rational doctor training plan to prevent excessive medical doctors in the second section of “Rationalization of medical supply” in the section “Adjustment of medical expenses and rationalization of medical insurance system” in the same statement “Social security” It will be done”. Behind this, there was concern that medical expenses would increase due to an excessive number of doctors. In response to the report, the government decided in September of the same year to consider a training plan for doctors and dentists, and since 2,Faculty of medicineQuorums will be reduced by 7% compared to the maximum.

Eventually, the shortage of doctors became a social problem, but the Ministry of Health, Labor and Welfare did not admit the shortage of absolute numbers based on the theory of uneven distribution of doctors. However, in June 2008,Yoichi MasuzoeUnder the Minister of HealthReliable and hopeful medical care visionWas announced, and the policy was changed to increase the number of doctors to be trained, as well as reviewing the Cabinet decision to reduce the number of medical staff.

Even so, since it takes at least 10 years to train doctors, the working environment for working doctors has not been improved, and it hasDeath from overworkThere are some cases where doctors are adapting to doctors[30].. In addition, cases such as doctors resigning collectively have come to be caught in the context of medical collapse, "because hospitals make excessive demands that violate the Labor Standards Law".[31].

On the other hand, there is a cautious opinion that excessive supply of doctors may lead to economic collapse, which is a prerequisite for the insurance system. Among the OECD countries, Greece has the highest doctor rate (6.3 people per XNUMX people), but it is said to contribute to the collapse of the Greek economy. Regarding the proper number of doctors per population, there are very few studies that support it, and there are various debates.

Mandatory initial clinical training

Conventionally, doctors who have passed the national doctor examination often belong to university medical offices as trainees. Then, after educating the trainees who gathered, the medical department semi-forcedly dispatched them to a regional central hospital that is aware of personnel rights, and the doctors who were unwillingly dispatched often supported regional medical care. . This management of the medical office was effective in maintaining regional medical care, but the administrative side said that the university medical office was doing what it liked with the personnel right of the hospital as a shield. There is a strong opinion that "the medical office needs to be dismantled."

1998 years,Kansai Medical University Resident Overkill CaseFrom the beginning, the theory of reviewing the position of the trainee emerged and was examined by the doctor clinical training review subcommittee of the Ministry of Health, Labor and Welfare.2004From the beginning, mandatory initial clinical training was implemented, and it became possible to provide initial training for residents at general hospitals in the city. At the university hospital, the number of residents was drastically reduced because the hospital was originally a chore and badly treated. The university medical office where the number of doctors has decreased has been forced to raise the number of doctors who have been dispatched to affiliated regional hospitals, and it has also become impossible to newly forcibly dispatch doctors to regional hospitals. In rural areas, there was a shortage of doctors, which led to consolidation, and some hospitals had no choice but to close certain medical departments.

In addition, in order to be able to choose the training destination freely, the number of trainees is concentrated in hospitals with a well-developed training system in urban areas, and aspirants are no longer going to hospitals with a poor educational environment. From the above, the initial clinical training system was a drag of medical collapse.[32][33][34][35][36][37][38].. In other words, an era in which trainees, who were conventionally dispatched in a relationship with medical offices regardless of the improvement of the training system, compared various hospitals and their education/training systems to select a hospital that the trainee thinks was good Became.

In addition, until then, when deciding which medical department to specialize in, medical students rarely saw the actual working environment in the medical field, and chose a medical department with an interest, longing and a sense of mission. With the compulsory initial clinical training, we will enter various clinical departments and experience the reality of those sites.QOMLI can avoid the low department.

Originally, this system had the merit of improving the treatment of trainees, improving the training system, and increasing the degree of freedom that allows doctors to freely choose their destinations, but hospitals, medical schools, and private medical associations opposed it as accelerating the collapse of medical care. Had[39], Was initiated by the government. This system was effective in the United States, but in Japan, where medical resources were originally scarce, the system was launched without taking measures such as increasing the number of doctors.

Insufficient support system for women returning to work

FemaleThe number of excellent women has started to work in the world of doctors[4].. However, at the time of marriage, childbirth, and childcare, it is difficult to be compatible with working in the medical field, and there is a situation in which it is necessary to leave the medical field. It is said that this is also one of the causes of the shortage of doctors in medical practice.[40].. Another reason is that it is difficult to return to work once they leave the medical field.[41].. Some medical institutions have adopted work systems that make it easier for women to work, such as part-time work and no shifts, but the number is still small and further measures are required.

Excessive demand for medical safety and deepening doctor-patient conflict structure

In recent years, factors such as crimes by doctors and excessive demands from patients have been increasing. for that reason"QOLEfforts have been made to tackle new issues such as “improvement of health care”, but medical distrust has not been dispelled.Medical civil litigationThe number of people who have strong distrust and dissatisfaction with the doctors also begins to increase, leaving the high risk workplace,Defense medicalYou can also see the movement to do.

Criminal cases and lawsuits by investigations and judicial institutions

Some doctors and medical institutionsMedical errorIs called up by the mass media, and on the other hand,Oyodo Municipal Oyodo Hospital Case,Kyorin University Hospital split death case,Fukushima Prefectural Ono Hospital Obstetrician Arrest CaseFor many healthcare professionals, the bereaved family wants to distract the unfocused anger and sadness of losing their family by passing on responsibility to doctors and the like, which is not considered a malpractice or crime.[42]However, it has been pointed out that it is one of the causes of the collapse of medical care that media criticism has been made that it is a malpractice/crime, and that it has been criminalized.[43].. In fact, the obstetrician arrest case at Fukushima Prefectural Ono Hospital was confirmed not guilty in August 2008, and the Japanese Society of Surgeons expresses condolences and issued the following statement regarding the Ono Hospital case.

``Fear of escape'' despite the fact that the investigative committee has prepared a report for the doctor who was conducting sincere medical treatment as the only obstetrician and gynecologist in this district, and the prefecture has finished disposing of it. We arrest and detain because of the fear of destroying evidence, and protest the prosecution's authorities on the goodwill of doctors who seek better medical care and the prosecution's authorities who tramples free medical care for patients. This in turn leads to a decrease in the number of risky physicians in surgical departments, a shift from true medical care for patients to medical care for self-defense, and a fair distribution of regional medical care nationwide. We would like to give a warning that it could make the impossible and bring about the devastation of Japan's medical care.[44]

Criminal justice for individual doctors is not found in other developed countries. This is to investigate the cause and prevent atrophy medical treatment. According to Komatsu, rationality in the field of natural science, including medical care, develops autonomously at the global level and is formed inductively in each field (induction), while politics, law, morality, etc. Local rationality in the system is formed normatively and deductively, and trying to bring Japanese domestic justice into the global medical world solves the medical problem, despite the fact that they operate in different systems. Point out that it is an obstacle to[45].. Furthermore, after establishing autonomy with the self-cleaning action of medical personnel, Komatsu organizes a national conference such as "medical care", concludes an agreement on what medical treatment is, and takes concrete measures. Proposes that “mutual distrust” between vertical patients and the medical side should be resolved[46].

Medical civil litigation

In case of unfortunate outcome, bereaved family demands result responsibility from hospital or doctor in chargeMedical litigationAlso showed a marked increase from the latter half of the 1990s, but since 2005 it has been on a downward trend.[47].

Some medical litigation involves a medically wrong medical act, and one does not necessarily make a mistake. Basically, the number of the former is overwhelmingly large, so many timesMedical errorIt is said that there are repeater doctors who repeat the above, but in recent years, the latter example has become more popular. For example, because the clerical worker apologized to the patient's side without medical consideration mainly at the public hospital, it was judged that "the hospital had recognized that there was a failure", and a criminal case was filed. Develop (Fukushima Prefectural Ono Hospital Obstetrician Arrest CaseIn some cases, it is difficult to maintain a theoretical trial, and there is a very rare case where a disadvantageous settlement condition must be imposed.

In addition, since civil trials inevitably take a confrontational structure, both sides will assume that they are correct and will hate the other party's lawsuit thoroughly, and if the lawsuit is prolonged, it will be prolonged. The more hate increases. Patients who have sought mutual understanding also cannot get a real solution, even if they win, by being caught up in this conflict amplification structure. As a result, medical professionals and patients have begun to try to avoid civil trials. In particular,Out-of-court dispute resolution means(ADR) is attracting attention and is expected as a place to promote mutual understanding between the parties while realizing the rights of patients aiming to find out the truth.[48].

Movement of patient, civic group

Decrease in patient morality

MidnightEmergency medical care"I'm working in the daytime, so I want to see a specialist right now." "I have a stomachache for three months." "I want the medicine I usually get from the hospital." "I can't sleep." , There are conspicuous cases where many patients who are not suitable for critical care visits the hospital.These consultation formats areVisit a convenience storeCalled. In addition, cases where ambulances are called easily and used instead of taxis and cases where unnecessary transportation requests are made many times to become regular customers are becoming more prominent. Therefore, there are cases where necessary emergency transportation becomes difficult.[49].

またMonster patient,Dive birthIs also exhausting doctors and healthcare professionals[50].

Breaking away from the conflict structure

On the other hand, moving away from the doctor-patient conflict structure,Hyogo OfPrefectural Kashiwara Hospital Pediatrics AssociationBy urging residents to symptom-seeking the hospital to identify symptoms and reducing the number of emergency users in half, pediatricians from other prefectures wish to be transferred, and pediatrics will continue. It has become possible to see cases that show a certain attitude and have achieved certain results[51].

Similar phenomena in other countries

America

It is also a problem that high-priced medical lawsuits occur frequently in the United States[52].. In New York State, 10 in 1 doctors are sued by patients every year, but only in obstetrics and gynecology, 4 in 1 doctors are sued each year.[53].. 73% of obstetricians have litigation experience on average across the United States[53].. Lawyers' offices and insurance companies are rich in huge liability insurance, but the executive director of the New York Court of Justice Bargaining Law is only the tip of the iceberg because of many treatment mistakes and misdiagnosis. Emphasize the responsibility of the doctor. On the other hand, the insurance premiums for doctor's liability insurance have skyrocketed, and there are some cases where doctors withdraw from medical care. In Long Island, New York, one brain surgeon averaged $1 in doctor liability insurance annually[53].

Due to soaring insurance premiums, 1/3 of the maternity costs paid by pregnant women will be appropriated for insurance for doctors' liability insurance, resulting in soaring maternity costs.[53].. In addition, there is also the adverse effect of reluctance to carry out natural delivery, which has a high risk of lawsuits, and unnecessary cesarean section is performed.[53].. According to the nationwide consumer protection group Citizen Health Research Group, half of the cesarean operations performed in the United States in 1986 were not medically necessary Caesarean sections, but cesarean sections aimed at litigation risk. Criticized that[53].. As a result, doctors who were confused in Florida collectively refused medical treatment, which caused a big problem.[53]In Georgia, a group of obstetricians and gynecologists has been accused of refusing to deliver their family to their lawyers because they are "lawyers swearing at patients."[53]In California, examines litigation history of patients who see it and refuses to see patients who have a history of litigating with a doctor[53].

The United Kingdom

Margaret ThatcherThe administration isWelfare stateWith the dismantling ofNational Health Service(NHS, National Health Service) adopted a spending restraint policy.

There were no financial problems at the beginning of the NHS system (1948),British diseaseSince the latter half of the 1970s, when the impact of the government became stronger, it has been suffering from a chronic shortage of funds due to severe financial difficulties. Also, because the salaries of medical staff are low, morale is generally low, and it takes time to respond to patients.[54], Referred to a specialist[55]I have to wait for a long time before undergoing an examination or surgery[5].. In addition, the treatment is cheap and can be completed in a short time.[56]Tends to be. Since the situation has not improved further, health care workers have beenカナダ-Australia-Singapore) Is increasing, and laterTony BlairUnder the administration, a major reform was implemented to increase the total medical cost by 1.5 times.

According to an external survey conducted in 2004, patients are very satisfied with NHS medical services.

New Zealand

Junichiro KoizumiIn the cabinetStructural reform without sanctuaryOften cited as a model forNew ZealandThe public medical expenses budget has been curbed and reduced, and public hospitals are independently profitable.[57]Was asked. As a result, not only did the medical services of public hospitals deteriorate (increased waiting time, hospitalization in the same room for men and women), but most of the local public hospitals that could not be profitable were closed, and public hospitals exist only in large cities. became. To fill this gap, many private-sector hospitals that offer free medical care (expensive non-insurance medical care) have been opened.

フィリピン

Since the salaries of nurses working overseas are higher than those of doctors working in Japan, doctors have acquired a nurse qualification and are leaking overseas as nurses.フィリピンOriginally, nearly 1% of national finance was overseasMigrantAlthough it is a large exporter of workers that is covered by remittances from workers, this tendency is strong for nurses as well, and because English is the official language, many migrant workers to the UK suffer from a shortage of medical workers.[6].

As a result, there was a shortage of medical personnel in Japan.[58].

footnote

  1. ^ Komatsu (2006)
  2. ^ Honda (2007: 213-4)
  3. ^ "The future of the new corona pandemic you want to avoid, Italy in medical collapse”. Nikkei Business (March 2020, 3). 2020/4/3Browse.
  4. ^ Yumiko Maeda, Japan Medical Association Policy Research Organization (December 2009, 12).International Comparison of Healthcare Data-From "OECD Health Data 2009"”. JMA Research Essay No.55. 2021/1/31Browse.
  5. ^ "Hospital beds”. OECD (July 2009, 12). 2021/1/31Browse.
  6. ^ Honda (2007: 213-4)
  7. ^ Honda (2007: 22)
  8. ^ Murakami (2009: 197-8)
  9. ^ OECD (2014)
  10. ^ Komatsu (2006: 4)
  11. ^ Komatsu (2004)
  12. ^ Komatsu (2006: iv)
  13. ^ Honda (2007: 178)
  14. ^ Kayama (2009)
  15. ^ 19 Refused by the hospital...,30 Visit to the hospital "Turn-around" emergency transportation
  16. ^ Despite not accepting and refusing, "Turning aroundSome people are critical of using the phrase.[1][2][3]
  17. ^ Murakami (2009: 22)
  18. ^ Murakami (2009: 24-5)
  19. ^ As a successful example, Yamagata PrefectureNihonkai General Hospital("Tomorrow's medical records: Part XNUMX: Road to solving doctor shortage/XNUMX hospital integration, reluctant municipalities""Mainichi Shimbun, August 2010, 8). In addition, as a pioneering example of Yamagata PrefecturePublic Okitama General HospitalCan be mentioned ("Medical change bold "functional reorganization" was successful""San'in Chuo Shinpo" June 2007, 6).
  20. ^ "Tome City Hospital Go to Self-Goal""Yomiuri Shimbun," September 2010, 9,
  21. ^ "Statement of position for securing doctors"Iwate Prefecture Oshu City Council (June 18, 6)
  22. ^ "In the case of XNUMX million, an assistant professor of a university hospital will come. The reward is too high." The danger of disappearing obstetrician and gynecologist in Owase City... Actually because of slander... Mie Owase
  23. ^ "Retirement as a group of ICU doctors / National Cardiovascular Center""Shikoku Shimbun" March 2007, 3,"Major Resignation of Doctors at Maizuru Municipal Hospital"Nikkei Medical March 2004 Issue
  24. ^ Ono Municipal Hospital Half of 15 doctors voluntarily retiredYomiuri Shimbun June 2013, 2
  25. ^ Murakami (2009: 134)
  26. ^ http://bizboard.nikkeibp.co.jp/kijiken/summary/20090417/NM0497H_1435765a.html
  27. ^ http://medical.nikkeibp.co.jp/leaf/mem/pub/report/201401/534874.html
  28. ^ OECD Health Data 2013 (Report). OECD. (2013-06). Doctors consultations, Number per capita. http://www.oecd.org/health/healthdata. 
  29. ^ Futaki (2009: 166)
  30. ^ "Statement Regarding Toshiro Nakahara's Liability Complaint (Pediatrician Overwork Death Case)" National Doctor Union Steering Committee (July 2010, 7)
  31. ^ "Direct talk-resignation without request"West Japan Shimbun January 2003, 1
  32. ^ Murakami (2009: 58-61)
  33. ^ [Human documents / seasonal people] / 31 The collapse of local medical care.Hospital director's mourning = Ken Mori September 2019, 09 Sunday Daily Page 1 Volume 98 No. 44 Volume 5556 Page 44 Photographs and tables available (1,367 characters in total)
  34. ^ Forum / Current status of community medicine from the perspective of emergency and its reconstruction / Matsue's search for solutions to the shortage of doctors February 2014, 02 Sanin Chuo Shimpo Morning edition page 15 Izumo PR page Photographed (4,840 characters in total)
  35. ^ Make a hole in the internet for medical problems! Talk/Kaido×Daisuke Tsuda December 2013, 12 Weekly Asahi 06 pages with drawings (36 characters in total)
  36. ^ Mt. Yoneyama Age of medical inequality Chikuma Shobo ISBN 9784480064370
  37. ^ (Future of medical care) 2008.03.14% shortage of required number of doctors First survey of prefectural hospitals/working doctors / Nagano Prefecture Asahi Shimbun 31 Tokyo region edition / Page 1,196 Nagano Nagano Tohoku Shin Copies (all XNUMX characters)
  38. ^ Commentary / Kenji Yanagisawa / Business world and government dealing with people / Destruction of "labor" and "medical care" is highlighted Red flag February 2007, 02 Daily newspaper 28 pages General (9 characters in total)
  39. ^ "Proposals by the private medical associations to improve post-graduate training for Japanese doctors-we oppose mandatory post-graduate training and internships for medical insurance to reduce the number of doctors and medical costs." All Japan Democratic Medical Organisation, March 1998
  40. ^ "Introductory opportunity for the Japan Women's Medical Association to work""Journal of the Japan Women's Medical Association" 189
  41. ^ Because the medical knowledge and technology we have is old, it may not be applicable in the medical field, and the training system for returning is not established ("Introductory opportunity for the Japan Women's Medical Association to work""Journal of the Japan Women's Medical Association" 189)
  42. ^ For example, regarding the death of the chopstick chopsticks, "The coverage of the "Chopstick case" is penal violence" "Nikkei Medical Online" June 2009, 6
  43. ^ Komatsu (2004, 2006)
  44. ^ "Statement of the Japanese Surgical Society (Fukushima Prefectural Ono Hospital's doctor arrest and prosecution)" December 2006, 12
  45. ^ Komatsu (2006: 73-95)
  46. ^ Komatsu (2006: 279-80)
  47. ^ "The number of medical litigation cases first decreased in 05, 999 cases nationwide" Online Med News (August 2006, 8)
  48. ^ Komatsu (2006: 255-8), Murakami (2009: 46-7)
  49. ^ "Do you need more ambulance dispatch/payment?""Shikoku Shimbun" July 2005, 7
  50. ^ "Looking at life and the future of community medicine: Part 6: Face medical treatment 29 Contracting sites-some patients waste medical care""Nipponkai Shimbun" article, November 2007, 11, read March 18, 2009
  51. ^ Besides, Hirai and Akiyama (2007)
  52. ^ In New York State, there are also trials certifying compensation of over 8 million yen
  53. ^ a b c d e f g h i Medical error litigation surges in the United States Rejection of medical treatment due to “self-defense” skyrocketing insurance premiums for patients, “Yomiuri Shimbun” November 1987, 11 Tokyo morning edition, 17 pages, copy (all 4 characters)
  54. ^ Medical System Study Group “Medical Ethics and Medical Accident Prevention Measures”
  55. ^ Due to the system, it is not possible to apply directly to a specialist.
  56. ^ Extraction of all cases with small tooth decay
  57. ^ JapaneseIndependent administrative agencyOperation form close to.
  58. ^ Japan andフィリピンFree trade agreementThis issue was raised on the agenda when concluding theJapanThere was a lot of controversy from the Nursing Association.

References

Related item

外部 リンク

Acceleration

Acceleration(Velocity,British: acceleration) IsUnit timePer hitspeed OfRate of change(SpeedTime derivative [1]).Acceleration is defined as a vector that indicates the temporal change of the velocity vector.[2].

Overview

Acceleration as a vectorparallelogram OflawIt is possible to synthesize and decompose with, as in the case of force and speed,NormalAcceleration,TangentAccelerationOften decomposed into.Normal acceleration changes direction, tangential accelerationSpeedchange.

Minute timeΔtThe

Defined as speed differenceΔvThe definition of

So thisΔtAfter dividing byΔt → 0As accelerationa The

Defined as[2].

ThePolar coordinatesWhen expressed in (r, θ), the radial and angular components are respectively.

Becomes

In general"Deceleration(Gensokudo) "is saidnegativeIt is the acceleration (opposite the direction of travel).Also, changing (turning) the direction of travel means receiving acceleration in a direction different from the direction of travel.

Centrifugal forceAcceleration byCentrifugal accelerationThat.

objectAcceleration is applied toPowerIs equivalent to adding. (Second law of movement

The rate of change of acceleration per unit time is jerk orJerkIs called.

Constant acceleration motion

Constant acceleration

When the velocity v (t) and displacement x (t) after the elapsed time t are

V speed at0, Position coordinates x0If

Required by[3].

Also, if the position coordinates are x (0) = 0, the following equation with t eliminated can be obtained by transforming the above two equations.[4].

unit

Of accelerationunitTo m / s2(Meters per second squared) Is used,EarthquakeFor the acceleration of shakingGal The unit (Gal) is used (100 Gal = 1 m / s)2). Standard gravityThere is a unit called G (G) based on 1.0 G = 9.806 65 m / s2.

footnote

[How to use footnotes]

References

  • Shoichiro Koide "Physics" Shokabo, November 1997, 11, 10rd edition.ISBN 4-7853-2074-5.

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