東京日和＠元勤務医の日々

　なんとなく、もっともらしく、イギリスナンバーワン！って報道がされると、やっぱり日本は・・・となります。

　この手の報道の裏側にあるものは簡単です。イギリスの医療が国際水準に達していないので、イギリスの国威発揚目的に発信されるわけです。

　具体的には、［EU平均以下の5年生存率］イギリス でも紹介しましたが、ヨーロッパ全体からみてもお寂しいお話なので、せめて「死の質(Quality of Death)」といった別の指標で評価してみました。というのが正直なところです。

　以前、厚生労働省の方が医療制度研究会で「英国の医療制度改革」について発表されていたとき、ある高名な先生が「とてもイギリスの医療なんてボロくて褒められたもんじゃない！」って言っておられたのを思い出しました。

イギリス：治療費が多くても、がんの生存率はヨーロッパで下位のまま

MeicalNewsJapan 2007/12/21

UK cancer spending not seen in survival rates
Telegraph紙　2007/12/18

で報道されているように、お金をかけてもちっとも生存率が改善していないと

いう報道です。

------------------------------------------------
「豊かな死」１位は英国　日本は２３位、医療費高で
共同通信　2010/7/15

　【シンガポール共同】世界で最も「豊かな死」を迎えられるのは英国―。英調査会社が１４日、終末医療の現状などを基準にした４０カ国・地域の「死の質ランキング」を発表。日本は高額な医療費と医療に従事する人員の不足がたたり、２３位と低い評価だった。
　調査したのは、ロンドンが拠点のエコノミスト・インテリジェンス・ユニット。終末医療や苦痛を和らげる緩和医療について各国の医療関係者に聞き取りを行い、普及状況や質、医療費など複数の観点から評価した。
　トップは英国で、ホスピス普及率の高さに加え、専門家養成の環境が整備されていることなどが評価された。２位以下はオーストラリア、ニュージーランドが続いた。
　高齢化が著しい日本について、調査に当たったトニー・ナッシュ氏は「医療システムは高度だが、在宅医療など患者や家族に寄り添うケアが難しいようだ」と分析した。
　施設の整備度が評価される一方、医療保険の不備が問題視された米国は９位。中国（３７位）、ブラジル（３８位）など新興国は軒並み評価が低く、人口増大に医療普及が追いつかないと指摘されたインドは最下位だった。

EIUのサイト
The UK has the highest quality of death

↓シンガポール発のAFPの報道記事・・・
Study calls for greater care to 'quality of death'

 SINGAPORE — Asian countries are failing to provide adequate care for the dying despite rising standards of living across the region, a study released Wednesday said.
 As the global population ages, the demand for end-of-life care is expected to surge, and governments and other providers are racing against time to meet these needs, a report by the Economist Intelligence Unit (EIU) said.
 Even economic powerhouse Japan was just 23rd among 40 countries ranked worldwide in a "quality of death" index, according to the study commissioned by the Lien Foundation, a Singapore philanthropic organisation.
 India scored worst in the index at number 40, with China, Malaysia and South Korea also in the bottom 10 of the global list, which measures the care that dying people receive.
 Uganda, Brazil, Mexico, Russia, Turkey, Portugal and South Africa were also among those which ranked poorly.
 Britain topped the list for the best end-of-life care, followed by Australia, New Zealand, Ireland, Austria, the Netherlands, Germany, Canada and the United States.
 Taiwan was at number 14 and Singapore was in 18th place.

 "'Quality of life' is a common phrase.... But 'quality of death' is another matter," the study said.
 "Few nations, including rich ones with cutting-edge healthcare systems, incorporate palliative care strategies into their overall healthcare policy."
 This situation has prevailed "despite the fact that in many of these countries increasing longevity and ageing populations mean demand for end-of-life care is likely to rise sharply," it added.
 According to the study, institutions specialising in palliative and end-of-life care "are not part of the national heathcare systems" and the availability of pain-killing drugs is "woefully inadequate across much of the world".
 This is mainly due to concerns about the drugs' illicit use and trafficking, and there is also a lack of training among medical personnel on how to administer them.
 "The result of this state of affairs is an incalculable surfeit of suffering, not just for those about to die but also for their loved ones," it said.
 Another challenge is overcoming perceptions of death and cultural taboos about dying in order to improve palliative care.
 By 2030, the number of people aged 65 and older is expected to reach one billion, or one in eight of the global population at that time, with the rise even sharper in developing countries, it said.
 Falling birth rates, especially in developed countries, are likely to complicate the situation and for the first time in history, the number of people over 65 will outnumber children under five years old, it added.
 While people are living longer, longevity also comes with more complex ageing diseases that are more expensive to manage, the study said, noting that people are now living with heart disease instead of dying of a coronary attack.
 "For the end-of-life care community, this presents a new and complex set of problems," the report said.
 It cited data showing that more than 100 million patients and their family care-givers need palliative support annually, but fewer than eight per cent of them actually receive it.
 "Governments and providers are in a race against time," said the study, warning that spread of ageing was rapidly outpacing efforts to provide much-needed care.
 "So while calls echo around the world for end-of-life care to become enshrined in national and international policy as a human right, the reality is that -- even if it achieves that status -- for much of the world's population, such a commitment will exist on paper only," it said.

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