保護費詐取、２億円を全職員穴埋め？「連帯責任」に異論も（2月8日22時50分配信 読売新聞 ウェブ魚拓）
自治労北海道本部の幹部は、「業務上生じた損害を、職員の給与で補填することがパターン化しかねない。行政上の責任の所在をあいまいにすることが恒常化してしまわないか」と他自治体への影響を懸念する。青山学院大の鈴木豊教授（公監査論）も、「直接関係ない職員にまで負担させるのは、責任の分散化で、職員の無責任体質を強めることになる」と職員が連帯責任をとるやり方に否定的だ。
たしかに、事件に全く関係のない職員もかなりいると思いますが、この事件は、市の上から下まで、変だなと思っていたのに何も言わない人間がたくさんいたから被害が拡大したものと思われます。
それなのに、そのような職員が誰も責任を負わないということになりますと、それこそ「責任の分散化で、職員の無責任体質を強めることになる」と思います。
「業務上生じた損害を、職員の給与で補填すること」をパターン化させないためには、本件のような事件の発生をパターン化させないことが何より重要です。
そしてそのためには、おかしいと気づいた人間がおかしいと声を上げ、その上司はその声を無視できない、無視すれば責任を問われる、という空気をパターン化させる必要があると思います。
ただし、事件と全く無関係な職員と不正を知り得る立場にいた職員とは負担額または負担率を区別していいようには思います。
生活保護費の不正取得は、元暴力団員という肩書きの方がなさったようですが、他の地域でも準構成員とか、そういう方々もされているようです。就業できない理由として挙げられて、調査すると、人権侵害だと、地方紙や特定の政党の市議会議員が問題にしてしまうからです。
障害年金をとるために、子供に熱傷を負わせたのも、生活保護を受けていた世帯でした。
そして、その一方で、本当に仕事をすることができない方が、生活保護を受けることができないままに、孤独死することが起こっています。ところが、そんな事件があったからと、他の県や地方から、生活保護をもらうためにやってきて、病気でもないのに、あそこが痛い、ここが痛い、と、救急車を不正利用し、入院して生活保護をもらおうとする人間もいました。
生活保護の在り方を、現物支給にでも換えない限り必要なところに行き着かないままではないかと思います。
【情報提供です】
この件については、滝川市の現役市役所職員の下記ブログが詳しいです。
「アナーキー小池の反体制日記」
http://blog.goo.ne.jp/1000496/m/200812
小池氏は、この生活保護搾取事件を「２.３８事件」（被害額が2.38億円）と呼んでいます。オススメの記事は下記の通りです。他にも関連記事は沢山ありますが、このモトケンブログでのエントリーに一番近いのは、冒頭の＃89 2.38事件続報 2008年02月17日の記事でしょうか。
ま、取り敢えず読んでみてください。
＃89 2.38事件続報 2008年02月17日
＃186 被恐喝被害金穴埋之件 2008年11月23日
＃187 寄付？ しますってば！ 2008年11月24日
＃195 2.38事件総括①詐欺か恐喝か 2008年12月09日
＃196 2.38事件総括②猛々しい盗人 2008年12月11日
＃197 2.38事件総括③犯罪を生む土壌 2008年12月13日
＃201 市職員労働組合① 2008年12月22日
＃212 2.38事件 市長の直感と洞察力 2009年01月16日
>生活保護の在り方を、現物支給にでも換えない限り必要なところに行き着かないままではないかと思います。
賛成です。
私の住んでいるところでは「子育て応援券」なるものがあるのですが、使用できるものが限られています。
（予防接種だとインフルエンザのみとか）
だから、「生活支援券」なるものを創設すればいいのではないでしょうか。
いえ、単に個人的な不満から出た意見です。
人の納めた税金でタバコを吸うな、と言う愚痴ですけど。
＞生活保護の在り方を、現物支給に･･･
生活保護が現金で被保護者に直接支払われるのは、「生活扶助」です。「医療扶助」は元々現物支給です。
法律上は生活保護制度は次の８週類あり、金銭での給付が原則の扶助と、現金での給付が原則の扶助とあります。
・生活扶助→原則現金給付（世帯構成や地域ごとに基準の額あり）
・教育扶助→原則現金給付（義務教育が対象、高校大学は対象外）
・住宅扶助→原則現金給付（公営住宅など一部は現物給付もあり）
・医療扶助→原則現物給付（被保護者ではなく、医療機関に直接支払）
・介護扶助→原則現物給付（被保護者ではなく、介護施設に直接支払）
・出産扶助→原則現金給付（健保の出産育児一時金も現金給付です）
・生業扶助→原則現金給付（技能講習など現物給付もあり）
・葬祭扶助→原則現金給付（健保の埋葬料も現金給付です）
今回の滝川市の事件は、上記の内で医療扶助に属する移送費の支給であり、当該給付は現物給付であって、被保護者が移送タクシーの会社に支払った金額を滝川市が後日補填給付として被保護者に現金が支給されるのではありません。被保護者が利用した移送タクシー会社が直接滝川市へ請求し、市からタクシー会社に移送費が振り込まれます。
ところが滝川市事件での詐欺を働いた夫婦の犯行は、この移送タクシー会社ぐるみの搾取であり、滝川市からタクシー会社の銀行口座（実際はタクシー会社の法人名義の銀行口座ではなく、架空名義の個人普通口座）に振り込まれた移送費が、直ちに詐欺犯夫婦によって引き出され環流していたという事件です。
いくら現物給付の制度にしてみても、現物の給付を実際に行う事業者（医療機関や移送タクシー会社）が、詐欺行為を企む被保護者グルであって、それを支給者（本件の場合は滝川市）が見抜けない杜撰さでは、全くの尻抜けであり意味がありません。
以上のように、「生活保護を現物支給に改変せよ」というご意見は、こうした詐欺行為の本質的解決策には為り得ないと思われます。
的確なご指摘だと思います。
その意味で、本件は、一般的な不正受給事案とは少し性格が異なるように思っています。
金銭での給付が原則の扶助と、現金での給付が原則の扶助？現物ではなくて、現金なのでしょうか？となると、すいませんが違いがわからないのですが、もう少しわかりやすくご説明いただけませんでしょうか？
それと、医療扶助が直接医療機関に振り込まれるのは以前からでしょうか？10年近く前に、生活保護の患者さんが、病院に払う予定の医療費を使い込んだために、まるまる損したことがあります。
それと、就業できない理由を聞いただけで、地方紙や議会が問題にするような状況がある場合は、支給する側が見抜くための調査をするのかなり大変なのではないでしょうか？
官公署が犯罪による金銭被害を受けた場合の損失を誰が負担するかという問題ですよね。２億は現場担当者個人にとっては大きすぎますし、税金で補填も全くあずかり知らない市民からみれば不当支出でしょう。今回の解決がどうなるかはともかく、今後を考えると、保険制度を作るとか、銀行のように担当者を短期間で交代させるとかいろいろ制度を考えていかなければなりませんね。半裁者から犯罪者から間接的に利益を得た人間を訴える手もありそうですが、法律家からみると無理でしょうか？
＞医療扶助が直接医療機関に振り込まれるのは以前からでしょうか？
以前からと言うより、医療扶助を実施した医療機関は、その被扶助者には窓口負担を請求することなく、その診療報酬の全額を「診療報酬支払基金」に請求します。
また生活扶助を受給している世帯には、国保であれ健保であれ健康保険証が発行されません。健保の被扶養者にもなれません。（健保の被扶養者ということは、生活の面倒を見てくれる＝扶養してくれる近親者が存在するということです。近親者に扶養されている者には、生活保護の受給資格はありません）
生活保護受給者は、健康保険証が使えない（持っていない）為、予め市町村の福祉担当窓口より「医療券」という証明書を発行してもらいます。医療を受ける場合にはその「医療券」を医療機関窓口に提出し、医療を受けます。（保険医療機関は医療券での受診を拒否できません）その医療券での診療分については、レセプト全額を支払基金に請求し、窓口負担はゼロ円です。
以上が生活保護法における「医療扶助」です。
参考として埼玉県福祉課のＨＰが、大変良くまとめた解説図を掲載しているので、そちらを参照してください。なおこのＨＰ中の解説本文にある「医療券」などの用語をクリックすると、リンクページで「医療券」の現物書式が見ることが出来ます。
http://www.pref.saitama.lg.jp/A03/BB00/seikatuhogo/iryoufujyonojissihousiki.html
＞10年近く前に、生活保護の患者さんが、病院に払う予定の医療費を･･･
このご記憶の事例は、生活保護法の医療扶助ではなく、市町村などの自治体独自の「低所得者の為の窓口負担の助成」制度ではありませんか？
先に解説したとおり、生活保護の受給世帯には健康保険証がありませんので、「病院に払う予定の医療費」という何らかの病院窓口での負担金支払が生じることはありません。病院が生活保護受給者に対して請求できるのは、病室のテレビ使用料など医療扶助適用外の自費負担分だけです。医療費そのものについて窓口負担を求めると、保険医療機関の取消処分の対象になります。
＞就業できない理由を聞いただけで、地方紙や議会が問題にするような状況がある場合
議会でトンデモ議員さんに質問で苛められようと、トンチンカンな不勉強マスコミ記者に事実誤認の記事を書かれようと、行政の担当公務員としては法令に要求された職務を果たさなければなりません。法令によって要求された事務処理を行うことを躊躇し、法令手順を手抜きしたのであれば、その公務員は処罰を受けなければなりません。
今回モトケンさんがこのエントリで取り上げた北海道滝川市の事件などは、まさしくこうした行政職員の不作為と言うか、好き嫌いに関わらずやらねばならない職務、いや義務を果たさなかった結果でしょう。死刑執行が新聞記事やテレビのワイドショーで非難されるから、死刑執行の実行者になるのは心情的にイヤだからといって、法務省の公務員が、法令に基づいた死刑執行の職務を放棄することは許されません。
滝川市の職務執行が適正であれば、2億3800万円も不正に搾取されることは無かったはずです。その意味でマスコミや議員などの「外圧」を嫌がって、易きに流れた行政（滝川市）の責任は、この事件に限って言えば非常に大きいと思います。決して詐欺を働いた夫婦の責任が低いと言うつもりではありませんが、滝川市が毅然として生活保護の職務執行を行っていれば、こんなアホな事件は起きていないはずです。
マスコミや議員などの「外圧」があるから、完全な職務執行を要求すべきでない、と受け取れるご主張には全く同意できません。そのようなご意見は、事の本質を取り違えた議論だと思います。
公務員が法律の条文通りに仕事をして、血も涙もない行政などと言う人たちは違法行為を教唆しているのかも知れませんね。法律通りに実行して世の中で不都合があれば法律の方を改正すべきなのにそうしないで、現場の裁量をよしとする風潮は危険だと思います。
> タカ派の麻酔科医 様
> 法務業の末席 様
生活保護法による医療扶助の実務については、法務業の末席様の仰るとおりだと思います。
故に、当事者が生活扶助の支給を受けていたが、何等かの事情によって「医療扶助の支給決定を受けていなかった」に一票。
thx-1138 さま、フォローありがとうございます。
＞当事者が生活扶助の支給を受けていたが、何等かの事情によって「医療扶助の支給決定を受けていなかった」
このような例外的実例も無いわけではない。でもそこまで解説すると「生活保護法の事務取扱の事例別解説」という本が書けてしまう。私が先に解説したのは、あくまでも生活保護法での医療扶助の一般的原則の解説です。
特に名宛人を指定しない感想として。
外圧があるから、不適切執行を免責すべきでないのは、当然だと思います。一方、不適切執行を責めるなら、同じ舌で妙な外圧をかけるんじゃない！という見解には賛成。
いつも思うのは、「法令そのものに起因する、自己の希望と異なる行政の対処」と「法令の不適切執行に起因する、自己の希望と異なる行政の対処」の区別が出来ない人が、思いの外多いと言うこと。
前者の場合には立法に訴えて法律を変えるのが正道なのに、行政に訴えて法律を破る（曲げる）事を考える人＆票欲しさに無茶な外圧をかける人が、思いの外多いと言うこと。言い換えれば「行政は立法を無視してけしからん」と言いつつ「一方で行政に、立法を無視するような対応を迫る」という矛盾した人が、思いの外多いのも事実。
むろん、不適正執行は責められて然るべきだけれど、同じように適性執行を不当に萎縮させるような不当な外圧も、同じように責められる必要があると思いまふ。
って言うか、適正執行の結果が批判されてる時ぐらい、毅然として現場を守ってやれよ＞執行組織の責任者。でないと、末端は適正執行を貫くことが難しい局面もあるんだよ。。。
加えて、「担当者を頻繁に後退させて不正の余地を排除すべき」といいつつ「頻繁な人事ローテーションが責任軽視・先送りの風潮を招き、望ましくない。」と言われても、「両立は難しいのでわ？」と思ったりもしまふ。
> No.11 法務業の末席 様
一般論を申し述べておられる点について、そうなんだろうとは思ってました。あと、説明し始めたら解説本が出来るというご見解について賛成です。茶々入れしたみたいで申し訳ないでふ。m(__)m
あくまでも、投稿された個別事例に対する局所的な個別具体論としてお願いします。
------ 以下名宛人を限定しない一般的感想として。
というか、こうしたニュースで「生活保護」と聞いて、８種類の扶助から構成されて個別事案毎に単独又は複数の組み合わせで、現物給付と現金給付を使い分けて実施されるという事が案外知られてないのでしょうね。
白状すると、かくいう私も縁あって生活保護法を読むまでは、「生活保護＝生活扶助」と恥ずかしながら思いこんでました。こういう勘違いは私だけじゃないと思いたい。。。（恥
窓口負担の助成だったのでしょう。疑問はほぼ解決しました。
若干の誤解があるようなのですが、公務員が果たすべき義務を果たさないでいいと思っている訳ではありません。私の住んでいる所では、暴力団員の不正受給と思われる話が、よくありますし、先に疑問に思っていたような例で、その筋の人間であったということは、かなりの頻度で出くわすので、快く思っておりません。
しかし、親戚の市役所の職員あたりは、へたなことを言うと、刺されるから何も言えないということを、本気か冗談かわからない言い方で言ってましたので、調べることも、簡単ではないのではないかという気持ちで書いたのです。
＞公務員が果たすべき義務を果たさないでいいと思っている訳ではありません。
申し訳ありません。私の論調もチョット表現が行き過ぎていたようです。m(_ _)m
＞親戚の市役所の職員あたりは、へたなことを言うと、刺されるから何も言えないということ
う～ん、市役所職員が、そんなに刺される危険度が高い職業とは思えないのですが･･･。
私も前職の小売りサービス業の頃には、売掛金回収に行った先がヤバイ先で、３時間近く恐ろしげな形相の男数人に威圧されたことがあります。また難癖としか思えない苦情客に、営業時間終了後５時間も居座られたり、いろいろ経験しました。でもその両方とも翌日一番に所轄署に相談に行ったら、たちどころにクレーム付けたお客様は、すぐさま代金を支払ってくれました。
でも、あの時（飲み屋ビルの裏にある事務所で取り囲まれたとき）は私もまだ20代半ばの若造で、正直本当に恐かった。しかし翌日警察が入った途端、異様にニコやかな表情で金を支払いに来た豹変ぶりが忘れられません。アノ手の人間はコチラが弱気だと一気につけこんで来るが、コッチが強いと知るとシッポを蒔くときも素早いもので、その情勢判断の確かさにはある種の敬服の思いがあります。
最後はレスとは言えない、全くの個人的経験談になってしまいました。擦れ違いのコメントとなりましたこと、重ねてお詫び致します。
＞親戚の市役所の職員あたりは、へたなことを言うと、刺されるから何も言えないということ
ありそうでなさそうな例ですね。
この手の商売は、相手に「刺されるかも知れない」と思い込ませるのが仕事で、本当に刺してしまうと取れるものも取れないばかりか、以後業界での出世は望めません。
泥棒であれ、暴力団であれ、それを生活の糧にしている人は損得勘定の最適値で行動しています。
まれに例外もありますが。
ところで、行政のプロのほうも、一般市民より不正受給の手口については知悉しているので、今回の事件は「だまされた」ものではないでしょう。
彼らは市民から職務権限を委託され報酬を受けているのですから、滝川市民の損失について不正受給者、タクシー会社、権限のあった滝川市職員の三者で弁済すべきものと思われます。実態がよくわからないから、職員全員で弁済するのは「お金さえ戻ればいい」ということではないでしょうか。
生活保護って、制度そのものが余り知られていませんね
小生も医療扶助と生活扶助しか知りませんでした(^^;)
市区町村職員各位（広義の事務職に限って。）が感じる身の危険。。。
勿論、部署によると思いますけど、刺殺事案とか傷害（刺されたとか暴行とか）事案とか、事案の被害当事者（基礎的自治体職員氏）を直接知らないわけではないというか。
滞納処分とか、生活保護とか、公共事業関係とか、なら現実の脅威としてありそうですし、人事異動を考えれば全庁的に脅威を感じるという事があっても、不思議ではないというか。表沙汰にならない範囲なら、あながち杞憂でも無いというか。
はじめまして。生活保護ケースワーカー１年目のものです。
他の窓口はともかく,生活保護の窓口は危険が一杯です。
残念ながら何年に１回はどこかの福祉事務所で職員が殺されています。私のところの福祉事務所でも今年度だけでも数回警察を呼んでいます。さすまたも常備されています。この職場への内示をもらった時の周囲の反応は,「刺されないようにね」という生温かいかいものでした。
Yamakojiki様の前半部分でおっしゃることは理解できるのですが,精神的に疾患を抱えた方が生活保護を受給している場合もあることもご理解ください。人格障害の方の応対のために業務の半分以上を費やし,通常の業務ができないこともあります。精神的に疾患を抱えた方が職員を殴っても警察は来てくれますが,事件性は無いとして逮捕はしてくれません。
現物給付の件は賛成です。できれば全員公的施設に入れることができれば住宅扶助で敷金,家賃,更新料及び保険料の支出をしなくてもすむのですが。また支給したばかりの保護費を落としたから何とかしてくれなどと言われることもなくなるでしょう。
いろいろ書きたいことはあるのでが,このへんで。
生活保護制度とその運用について多くの問題があることは承知しているつもりです。
しかし、このエントリで取り上げた事案は、かなり特別な事案だろうと考えています。
つまり、この事件を例にあげて、多くの一般的な事件を議論するのは適切ではなかろうということです。
７年ほど前までケースワーカーやってました。
少し制度の誤解があるようなので。
生活保護は補足性の原則（法第４条）があるので、近親者の扶養に入れる場合は入るようにしなければなりません。それに近親者といっても、生活のすべての面倒を見てくれる（それが可能な）方もいらっしゃれば、金銭的な援助は出来ないけど、扶養に入れるくらいはできるという方もいらっしゃるはず。
また、被保護者であれど能力に応じて働かなければならない。（法第４条及び第６０条参照）正規雇用で頑張って働きながらも収入が最低基準を下回り保護を継続されている方もいます。パート労働やアルバイトでもない限り厚生年金や健保の加入はあるはず（ないのは会社側の問題…）で、生活保護を受給しながら、健保に加入している場合もあります。
ただし、おっしゃるように国民健康保険には生活保護受給者は加入できません。
生活保護受給者でも、健保の被保険証を持つ場合（ご指摘の本人が就業している場合）があることは否定しません。また健保の被扶養の金額要件と生活保護の金額要件とが合致する、限られた要件範囲を満たす場合において、健保の被扶養者である生活保護受給者という存在もあり得ます。
ただし、健保の被扶養については年収130万円未満という金額要件の他に、もう一つ生計費の過半額（1/2以上）の援助を受けていること、という要件があります。別居の被扶養関係の場合は毎月の仕送り額等を審査することとなっており、別居の親族より仕送りは受けていないが、健保の保険証だけは被扶養に入れて貰っているといったことは、健康保険法3条7項1-4号の規定と行政通達（昭52.4.6保発9号・庁保発9号、平5.3.5保発15・庁発4号）からすれば、あってはならないとされています。
ということは、健康保険法からすると認められないことになります。すなわち
実際には自治体の福祉担当窓口の裁量により、仕送りを受けていない健保被扶養者の生活保護受給者という扱いをしている実例は承知していますが、これは厳密には違法な便宜を図った措置と言えます。仕送りを受けていない生活保護受給者が被扶養者になっていることが判明すれば、健保保険者（健保協会又は健保組合）は当該被扶養者証の返納を命じるのが普通です。
なお、何故このような窓口での健保被扶養者である生活扶助受給者という、一種の違法黙認の行為が横行するのかという原因としては、生活保護受給者が健保被扶養者であれば医療扶助を支給する必要が無く、自治体の生活保護予算への負担が減るからという、自治体側の財政面からの思惑が影響しているものと考えられます。
以上は、このモトケンさんのエントリ主旨からすればトピズレですが、元ケースワーカーさんという福祉の専門職の方のコメントですので、制度の理解不足の無用な誤解が蔓延することを防ぐ意味で、あえて解説のレスを付けておきます。
前投稿に追記。
生活保護受給に関係なく、「金銭的な援助は出来ないけど、扶養に入れて被扶養者として保険証を」という被保険者の届出は、原則通りなら健保の保険者は一切認めずに却下となります。あり得るのは「金銭的な援助をしているとウソをついて、扶養に入れて被扶養者として保険証を」という被保険者の虚偽の届出を見抜けず、扶養の要件審査をくぐり抜けてしまった場合です。（一部の健保組合を除き、残念ながら政管健保は数年前までは、相当この被扶養の認定は杜撰でした）
この虚偽の届出が審査をくぐり抜けて通ってしまい、被扶養者証が交付されているとしても、一昨年より社保庁（政管健保＝現協会けんぽ）でも毎年、被扶養者の現認という定期的な再審査を行っており、仕送りの有無等を調べています。仕送り援助が行われていないか、基準の1/2未満であることが判明すれば被扶養者証の返納が命じられます。
ＲＯＭの皆さんでも、仮に仕送り援助の事実が無いにも関わらず、故郷で別居している老親を扶養として保険証を得ている場合は、今後は定期的な被扶養の現認審査が厳しくなることは承知しておいて下さい。
まず、ケースワーカー氏の業務の危険性と困難性については、全く仰るとおりとしか申し上げようもないです。
で、「被扶養者異動届提出時」及び定期の「検認・更新・扶養者確認」の時の話ですね。（健保規則第２４条・第３８条・第５０条）
時折、ご指摘の生活保護受給者で、「本来健康保険法上被扶養者に該当しない筈の健康保険法上の被扶養者」が確認される事例が昔からあったようです。
そうすると、被扶養者の認定を取り消し、被扶養者証を回収し、既に給付された実績があればそれは不正な届出による給付（不正な利得）なので国庫への返納金として給付相当額を回収し、、、という事になります、当然。それでもって、自治体の生活保護主管課との間で話が・・・（略。まぁ確かに調整は手間がかかるのですが、被保護者が一番困惑する事になるので（こういう事案では、市役所で説明受けたとおりにしたという展開が多いので。）、最初から防げるにこしたことはないです、きっと。
「被扶養者異動届提出時」などに的確な審査が出来てない負い目が保険者側にあるのも事実ですが、地区町村の生活保護主管課に於いても資産調査の段階で違法行為を説明するのは止めて欲しいというのが、被用者医療保険制度の保険者側の現場の感覚だったり。（涙
※）認定基準の要領２番目 ただ要領３番目の記載があるので、話がややこしいのですが、少なくとも別居の場合収入の１／２は仕送りされている事実が必要でしょう。（昭和５２年４月６日付通知）
昨日は脱字の多い投稿をしてしまい申し訳ありません。
私も本件は特別な事案だと思っています。
現役のCWとして本件は自分だったらどう対応するか考えるところはあります。「ケース診断会議」を行い,福祉事務所として病院のある市に転居を指示する「指示書」を出すべきではないか。「指示書」に従わなければ保護廃止にできるし。などと。
元暴力団関係者のケースとの対応は慎重に行うべきで,担当CW１人で対応すべきではないと思います。私も本日元暴力団関係者のケースを保護廃止にすることができましたが,福祉事務所で対応するときも査察指導員と２人で対応,家庭訪問も査察指導員と同行し,相手につけいる隙を見せないようにするなど苦労しました。私のところでは元暴力団関係者のケースには必ず上級の部署の監査の対象となり,その指摘事項を潰していくのも大変です。
ところで「病院職員を含む全職員約６５０人の給与削減で補う」というのは私も賛同できません。ここに至るまでのどこかでトップが何らかの判断すべきで案件で,それを放置していたのはトップの責任だと思っています。私のところだったらカンパとしてなら協力するかもしれませんが。
隣の町の医師会長の先生にいやだから生活保護は診ないという小児科がいます。
小児科といっても内科も見ているので高血圧のおばあちゃんなどが生活保護になると
当院にやってくるのです。
医師会が違うので面と向かってお話しすることもできず患者さんには
いろいろと手続きがあって生活保護になると診たくても診れない診療所も
あるのですよ。先生のせいではないのですよとおはなしして同じ薬があれば院内処方で、
ない薬があれば院外処方で出します。そういう患者さんにかぎって１０種類以上の処方で院内処方だと
丸減になってしまいます。
もっとも暴力団関係者の生活保護は当院でもお断りでたとえばC型肝炎は当院ではインターフェロンをやっていないので
専門医にご紹介しますなどと言って紹介をしています。
それでも風邪だといわれるとやむを得ず診て背中の般若と聴診器を持ってにらめっこをしています。
生活保護法による医療扶助を提供する医療機関は、あらかじめ生活保護法による指定医療機関としての指定を受けることが必要であるので、指定を受けなければ生活保護（医療扶助）による医療の提供は行わなくて良い理屈になりますよね。逆を言えば、被保護者は指定医療機関でしか医療扶助を受ける事が出来ないという。
また、生活保護(医療扶助)を実施する医療機関の指定は開設者の同意が必要で、３０日以上の予告期間を設ければ任意で指定を辞退する事が出来るのが法律上の建前ですから、最初から指定医療機関として指定されていない事を前提にすれば、生活保護の被保護者に対して医療扶助の枠組みの中での医療を行わないことは、理屈の上で責められる話では無いのでしょう。
まぁ、たとえ理屈がどうであっても、現実問題として諸々の周辺事情も含めてどうなのか？という部分があると思うので、被医療者には判らない色々な問題を内包しているであろう事は想像できます。m(__)m
隣町の小児科の医師会長先生は乳幼児医療費受給資格証は受け付けているので生活保護の医療券がめんどうだからというのは理由がよくわからないのです。むしろ乳幼児医療費受給資格証は月半ばで年齢が６歳を超えるとかえってややこしいのでむしろこちらのほうを返上したいぐらいです。こんど市町村合併で医師会が一緒になるのでどういう理由なのか聞いてみようかと思います。
生活保護は年齢制限がないので一度手続きをしたら面倒なことは何もなくというより３０年以上前のことでどんな手続きをしたのか４代目の自分ではもうわからないのですが、乳幼児は猫の目のように仕組みがかわるので小児科を標榜していない当院ではやめてしまおうかと思っています。なんで市に医療機関がこんな人が受診しましたからと本人の代わりに手続きを代行しなければいけないのでしょう。生活保護の患者様の方が手間が少ないのです。乳幼児医療費受給資格症は使えませんと受付で言ったら乳幼児はただだからという時間外受診も受けずににすむでしょうか。
乳幼児の医療費助成制度は、市町村や都道府県という実施主体の自治体ごとに異なるので、現場実務としてはいろいろと厄介な問題を内包しています。
Yosyan先生のブログでも、助成制度が違う自治体が入り組んだ地方での、隣接市町村からの受診者対応の話題が取り上げられていますね。
http://d.hatena.ne.jp/Yosyan/20090217
医療機関窓口の事務処理も、なかなか大変だろうとは推察いたします。
私どもの所でも「何でコッチでは無料じゃないのですか？無料なのはアタリマエでしょ、オカシイじゃないですか。引越前住んでいたアッチでは･･･」なんて相談が舞い込んで、結構往生します。
社労士と言ったって、日本全国の市町村がテンデンバラバラに実施している、全ての医療費助成制度を知り尽くしている訳じゃネェよ。第一そうした独自の助成制度を網羅した解説書すら存在しないのだから、聞かれても答えられネェ～よ。もし仮に全国完全網羅なんて解説書があったとしても、半年ごとにお国の健保制度自体コロコロ変わる現状じゃ、コッチの情報収集や頭の対応が追いつかネェよ。選挙目当ての人気取り政策はいい加減にシヤガレ！
（失礼、ホンネが出ました）
社会保障制度も租税制度のように、全国統一の原則を徹底して欲しい。
隣町には優良企業があって予算が潤沢なくせに町立を含めて病院がなく当市は請願の末に市営図書館がやっとできたばかりの貧乏な自治体なのに病院があるため夜間救急はこちらで対応するしかないのです。いとこどおしのインフルエンザが受診したとき隣町の患児の方が無料でなんでこっちは無料じゃないのかを説明しなければいけないときには困ってしまいました。つくづく隣町の町長は頭がいいと思います。
担当と決裁権者が支給すると決めたら、それ以外の職員にはとめようがないと思うんですが、マスコミにでもリークせよということでしょうかね。
そこで「市長への手紙」「都道府県警察本部へのタレこみ」ですよ。お題目とはいえ、公務員は職務上で犯罪を覚知したら告発通報義務が一応ありますので、正当業務行為となります。
トピズレなのですが、役所など公的な機関は保険の加入費として予算を計上できないと聞いたことがあります。
また、今回はあくまで特殊とのモトケンさんの指摘もありますが、こういった正当業務を行わなかった事例に保険を適用するとモラルハザードとなるのではないでしょうか。
それ以外のケースでは、官公庁だけではなく経済犯罪全般の話ではないかと思います。
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