『保健医療科学』 2024 第73巻 第4号 p.265-272（2024年10月）
特集 : 多様な分野の行動変容研究と社会実装の現在
＜解説＞
第 4 期特定健康診査・特定保健指導のアウトカム評価における行動変容について
川中淑恵
厚生労働省保険局医療介護連携政策課医療費適正化対策推進室
Behavioral change in outcome evaluation of the 4th phase of specific health checkups and specific health guidance
KAWANAKA Yoshie
Rationalization of Medical Expenses Measures Promotion Office, Division for Health Care and Long-term Care Integration, Health Insurance Bureau, Ministry of Health, Labour and Welfare
＜抄録＞
2024年から開始された第 4 期特定健康診査(特定健診)および特定保健指導においては，腹囲および体重の減少に加えて，行動変容を含むアウトカム評価が新たに導入されることとなった. 特定保健指導は，将来的な生活習慣病の発症予防を目的とし，医療費の抑制効果が期待されている. そのため，第 4 期特定健診および特定保健指導の見直しにおける議論では，アウトカム評価の導入に対して概ね 前向きな意見が多かった一方で，保険者が特定保健指導の成果を求められる責務が，制度に影響を及ぼす可能性が示唆された.
今回の見直しにより，アウトカム評価は行動変容と組み合わせて段階的に評価されることとなったが，保険者が義務として行動変容を客観的に捉えることの難しさや，特定保健指導の目的との齟齬が懸念された. しかしながら，腹囲および体重の減少に加えて行動変容を評価することが，対象者にとってセルフケアに繋がるとの見解が概ね支持された.
行動変容を特定保健指導のアウトカムとして評価することについては賛否が分かれたが，今後，データの蓄積を通じて第 4 期の計画期間中に更なる検討を進めることが求められている. また，特定保健指導においては，対象者の行動変容に係る情報の「見える化」を推進し，保険者がアウトカムの達成状況を把握し，達成要因の検討を行うことで，対象者に対して質の高い保健指導を還元する仕組みの構築が重要である. 今回の見直しを契機に，保険者の創意工夫と実績の積み重ねにより，特定健診および特定保健指導の発展に寄与することが期待される.
キーワード：特定健康診査，特定保健指導，生活習慣病，医療費適正化，行動変容
Abstract
In the fourth phase of the Specific Health Checkups and Specific Health Guidance, which commenced in 2024, outcome evaluation, including behavioral change in addition to a reduction in abdominal circumference and body weight, has been newly introduced. The Specific Health Guidance is designed to prevent the future onset of lifestyle-related diseases, with the additional objective of reducing medical expenses. In the discussions on the revision of the fourth-stage specific health checkups and specific health guidance, the introduction of outcome evaluation was generally viewed favorably. However, it was also suggested that the responsibility of insurers to deliver results from specific health guidance might impact the system.
With this revision, outcome evaluation will be conducted in stages, in conjunction with behavioral changes. However, concerns have been raised regarding the feasibility of having insurers objectively assess behavioral change as a duty, and the discrepancy between the objective of specific health guidance and the aforementioned assessment. Nevertheless, the opinion that evaluating behavioral change in addition to abdominal circumference and weight loss will result in self-care amongst the target population was largely endorsed.
There were mixed opinions regarding the evaluation of behavioral change as an outcome of the specified health guidance. It is necessary to conduct further deliberation during the fourth planning period, through data accumulation. Moreover, in the context of specific health guidance, it is crucial to facilitate the “visualization” of information pertaining to the behavioral changes of the target group. This necessitates the establishment of a system that enables insurers to assess the status of achievement of outcomes and to examine the factors contributing to success. This will ensure the provision of high-quality health guidance to the target group. It is hoped that this revision will provide an opportunity for insurers to contribute to the development of specific health screening.
keywords : Specific Health Checkups, Specific Health Guidance, lifestyle-related diseases, appropriate medi- cal expenses, behavioral change