みなさんこんにちは！
最近は世間的には暗い話題が続いていますね。
このブログではあまり時事的なことをお伝えするつもりはないのですが、それでも今のご時世に色々と考えが浮かんでしまうのも事実ですね。
でも、自分がコントロールできないことをいつまで考えても仕方ありません。
前向きに考え、今一つずつできることをしていくしかありませんよね。
さて今回は、自分が生業（なりわい）にしている医療業界がどんな特性を持った業界なのか、その世界にいるとネガティブなことばかり考えてしまうので、無理やりポジティブな視点から考えさせていただきたいと思います！
医療業界の形態
さて、医療業界という表現をしてもピンキリありますので、ここでは一般的なクリニックや診療所レベルのことを考えていきたいと思います。
医院には個人事業として行っていくものと、医療法人として行っていくものの双方があります。昔は法人の設立はしやすかった時代があったようですが、近年は医療法人の設立にはハードルが高く、個人事業として行ったうえで数年間の実績を積み上げてようやく法人設立が認められるようです。
よって当初は個人事業として開業をしていくことになります。
近日は税制や仕入れも複雑化しており開業のコンサルタントの契約が必要で、また開設時にはレセプトコンピュータ、電子カルテの導入も既定路線であり、どうしても開始時にはコストがかさむ世の中にはなってしまっています。現代において、ただただ勤務医をやっていただけのバックグラウンドの人が誰の力も借りずに開業するのはほぼ不可能です。
開業してしばらくは我慢
そんなこんなで開業したとしても、しばらくは我慢です。
昭和の時代ほど経営は甘くなく、ある程度まとまった患者さんがつくのには時間がかかります。何なら患者さんがつかないこともある時代です。
当初は休診日にはバイトをして食いつなぐ、ということもよくあるようです。
開業当初はどうしても知識がないわけで、そのために
業務をアウトソーシングしがち
↓
経費がかかりがち
の構図ができます。
ここをぐっとこらえて、どれだけ「出来るだけ自分で」の精神でやっていけるかが大事なのかと思います。
特に開業当初は、ボリュームは多くないわけです。ただバリエーションが多いだけなのです。税理士や労務士など「顧問契約」ではなく、「アドバイザー契約」程度にとどめて、
相談は専門家にきちんとする
でも、届け出など決まったことは出来るだけ自分でする
という程度にとどめてランニングコストを抑えることが重要なのではないでしょうか？
一度軌道に乗ったらひと安心？
そんなこんなで創世記を乗り越えた場合の話です。
医療機関の収入は、特殊な医療機関を除いて、基本的には保険収入です。
国保、社保、後期高齢、生保などの様々な保険形態の患者さんから入ってくる窓口収入（0割～3割負担）と、その情報を基に各組織へ請求するレセプト情報がキモになってきます。
そこで、特に内科系クリニックにとって重要なのは大きく分けて2種類になります。
・再診料・外来管理加算・特定療養疾患管理料といった定時通院関連の加算
・初診に伴う初診料
初期はとにかく初診、初診です。
そのために休日診療などを多くする、それを機に固定の通院患者になることも多いです。
通常、固定の通院患者が増えて上記の最新関連の加算をとれる患者数が増えてくると、そこでクリニックは軌道に乗ったと言われます。どうしても初診の患者数には限りがあり変動もありますからね。
医療業の強み
個人事業を行うのはいくつかのデメリットもあります。
それは経営が不安定性をはらんでいることです。
調子がいい時はいいですが、このようなご時世の時にキャッシュフローが突然回らなくなることもありますし、それに伴って従業員の雇用が継続できないリスクが出てきます。大企業に比べてその余力は小さいわけです。
但し、私はそんな中で医療業は強いのではないかと思います。
理由としては、
医療業は無（に近い状況）から付加価値を生み出すことが出来る
からです。
内科系クリニックにおいては、診察自体にコストはほぼかかりません。
聴診器一本で診察をすることができます。
そこにレントゲン、尿検査、採血くらいでしょうか。
レントゲンは確かに多少の設備を要しますが、多くが短期間の償還とその後はメンテナンス代程度で長持ちします。あとはちょっと点滴できるグッズがあれば。
（CTや、創傷処置の道具を要するかどうかはクリニックの診療内容にもよります。）
つまり、在庫をそれほど抱える必要がないのです。
ここは他業種との大いなる違いです。
結果として、医薬分業によって薬の在庫も現在は不要です。
よって患者数の増減による打撃は、「収入面の」減少にのみ影響を与えるだけです。
例えば本屋では、そのために大量に在庫を抱える必要があり、先行投資を常にしないといけない状況です。急にお客さんが増えてしまうと、「古い」本の在庫が増え、結果として廃棄をしなければならないわけです。
この点、医業は不景気にも強い部門といえます。
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