日本の保険医療が疲弊する、本当の理由
「1時間40分待たされて、診察は2分だった」
患者さんから見れば、腹が立つのも無理はありません。
しかし医師は、その1時間40分を休憩していたわけではない。
別の患者さんを診察し、検査結果を読み、処方を決め、説明をし、カルテを書き続けています。
医療者側から見れば、1時間40分、ほぼ休みなく診療し続けた末の「2分」なのです。
欧州のプライベート医療では、医師の診察だけで100ユーロ前後、日本円で約2万円かかることもあります。
医師の時間、知識、判断、そして結果に対する責任に対価が支払われる。
ところが日本では、安く、早く、いつでも診てもらえることが当然になりました。
その結果、患者さんは長く待ち、医師は一人ひとりを短時間で診ざるを得なくなる。
そして、この制度を設計する側にも問題があります。
かつて厚生労働省の医系技官採用には、若いうちに入省することを前提とするような運用がありました。
現在は、医師免許取得後の経験年数や年齢による応募制限はありません。
臨床経験を積んだ医師の中途採用も可能です。
これは以前より改善された点でしょう。
しかし、厚労省は現在も「医系技官として多彩な行政経験を積むため、早期の入省をおすすめする」と明記しています。
実際、初期臨床研修を終え、専門研修を始めたばかりの医師が、医師4年目前後で入省する例も紹介されています。
現在の専門医制度では、多くの診療科で初期研修修了後、さらに数年間の専門研修が必要です。
つまり早期に厚労省へ入れば、一人の主治医として患者を継続的に診療し、治療の結果や合併症まで背負う経験を十分に積まないまま、行政官としてのキャリアへ進む可能性があります。
もちろん、医師免許を持っていれば政策を作れるわけではありません。法律、予算、統計、国会対応、各団体との調整には、行政官としての高度な専門性が必要です。
しかし逆もまた真です。
医師免許を持っているだけでは、医療現場を知っていることにはならない。
深夜の救急外来を経験したか。
患者家族への厳しい説明をしたか。
治療がうまくいかなかった夜を知っているか。
診療報酬改定によって、病院や診療所の経営がどう揺れるかを体感したか。
スタッフを雇用し、医療事故の責任を負いながら、毎日患者を診たことがあるか。
そうした経験は、統計表の数字からは見えません。
厚労省が掲げる医系技官の仕事は、地域医療構想、医師の働き方改革、医療安全、医師偏在対策、診療体制の整備など、まさに現場そのものに関わります。
それならば必要なのは、単に医師免許を持つ行政官ではない。
十分な臨床経験を持ち、そのうえで行政を学んだ医師です。
若くして行政に入る道を否定する必要はありません。
ただし、政策を作る医系技官には、一定期間の臨床復帰や病院・診療所への出向を制度化する。
逆に、専門医や指導医として現場を経験した医師が、年齢や処遇で不利にならず行政へ移れる道を太くする。
行政と臨床を、行き来できる制度にすべきなのだと思います。
「1時間40分待って、診察は2分」
この言葉は、病院だけへの苦情ではありません。
現場を知らずに作られた制度と、制度の限界を知らずに医療へ無限のサービスを求める社会。
その双方が生み出した、日本の保険医療の縮図なのです。
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Why Japan’s Public Healthcare System Is Under Strain
“I waited one hour and forty minutes, only to see the doctor for two.”
From a patient’s perspective, that frustration is entirely understandable.
But during those one hour and forty minutes, the physician was not taking a break. They were seeing other patients, reviewing test results, making treatment decisions, explaining diagnoses, and documenting every consultation. From the doctor’s perspective, those one hour and forty minutes were spent working almost without interruption—and the “two-minute consultation” came only after that continuous effort.
In many private healthcare systems across Europe, a physician’s consultation alone may cost around €100—or roughly ¥20,000. Patients pay not only for the doctor’s time, but also for their knowledge, clinical judgment, and the responsibility they bear for the outcome.
In Japan, however, people have come to regard inexpensive, rapid, and virtually unlimited access to medical care as a given. The inevitable result is that patients wait longer, while physicians are forced to spend less time with each individual.
Yet the problem extends beyond the consulting room.
It also lies in the way the system itself is designed.
For many years, physicians entering Japan’s Ministry of Health, Labour and Welfare (MHLW) as medical officers were, in practice, expected to join relatively early in their careers. Today, formal restrictions based on age or years of clinical experience have been removed, making it possible for experienced physicians to enter government service mid-career. That represents a welcome improvement.
Even so, the Ministry continues to state that it recommends early entry so that medical officers can gain a broad range of administrative experience. Indeed, official recruitment materials introduce examples of physicians joining the Ministry only a few years after obtaining their medical license, shortly after completing their initial residency and beginning specialty training.
Under Japan’s current specialist training system, physicians in most fields require several additional years of postgraduate training before becoming fully qualified specialists. A doctor who enters government service early may therefore move into policymaking before having accumulated sufficient experience as a primary physician—following patients over time, managing complications, and taking responsibility for the outcomes of treatment.
Of course, holding a medical license alone does not qualify someone to design healthcare policy. Drafting legislation, managing budgets, interpreting statistics, responding to parliament, and coordinating with professional organizations all require highly specialized administrative expertise.
But the reverse is equally true.
Simply holding a medical license does not necessarily mean one truly understands frontline medicine.
Have you worked overnight in a busy emergency department? Have you delivered devastating news to anxious families? Have you experienced the sleepless nights that follow an unsuccessful treatment? Have you witnessed firsthand how revisions to the reimbursement system affect the financial stability of hospitals and private clinics? Have you hired staff, managed a medical practice, and accepted responsibility for both patient care and medical errors?
These realities cannot be captured in statistical reports.
The responsibilities of medical officers at the MHLW include regional healthcare planning, physician workforce reform, patient safety, addressing physician shortages and geographic maldistribution, and strengthening healthcare delivery systems. In other words, they are shaping policies that directly affect everyday clinical practice.
What Japan needs, therefore, is not simply administrators who happen to possess medical licenses.
It needs physicians with substantial clinical experience who then acquire expertise in public administration.
There is no reason to discourage young physicians from entering government service. At the same time, policymakers with medical backgrounds could benefit from periodic returns to clinical practice or structured secondments to hospitals and clinics. Likewise, experienced specialists and senior clinicians should be able to transition into government without being disadvantaged by age or career stage.
The ideal system is one in which clinicians and policymakers can move back and forth between medicine and government throughout their careers.
“I waited one hour and forty minutes, only to see the doctor for two.”
That sentence is not merely a complaint about hospitals.
It reflects two realities at once: a healthcare system shaped by policies that may become increasingly disconnected from frontline practice, and a society that often expects unlimited medical services without fully recognizing the constraints of the system.
Together, they form a revealing portrait of the challenges facing Japan’s public healthcare system today.
