MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C628B8.8F2F19C0" このドキュメントは単一ファイル Web ページ (Web アーカイブ ファイル) です。お使いのブラウザ、またはエディタは Web アーカイブ ファイルをサポートしていません。Microsoft Internet Explorer など、Web アーカイブをサポートするブラウザをダウンロードしてください。 ------=_NextPart_01C628B8.8F2F19C0 Content-Location: file:///C:/B0D95909/060201_iryoujosei.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" ２００６．２．１最近の医療状況

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最近の医療状況
　　    　２００６．= ２．１版
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生涯を通じた医療と保健と福祉
　　　　　　　　ヴィジョン（= ２００５−２００９）
４４兆円
３１．５兆円
日本医= t会
６９兆円
３１．５兆円
厚生労= ｭ省
２０２５年
２００３年
•〜 国民医療費 〜
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•（１９９８年以降の前年度比平均値１０１．５）
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  疾病予防保険 （平成９年創= 設）
•対　     象： １８歳以上
•保  険  者： 国
•財　 　  源： 国、地方自治体、保険料、
•　　　　 <= /span>　　  自己負担１割まで
•給付内容：=   健康手帳交付、健康教育、基本健康
•        = ;            診査、がん検診、精密診査、訪問= w導
------=_NextPart_01C628B8.8F2F19C0 Content-Location: file:///C:/B0D95909/060201_iryoujosei.files/slide0005.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" ２００６．２．１最近の医療状況
高齢者医療保険制度案
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６５歳以上
日本経団連
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日本医師会
財源構成
対象年齢
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医療と保健の体制強化
•１　医療計画の見= 直し、
•　　かかりつけ医= のあり方、
•　　第一線医療の= 充実、有床診療所の展望、
•　　感染性廃棄物= の処理問題、
•　　地域における= 糖尿病対策、
•　　病院および医= 療法人制度、
•　　医療における= IT化の促進、
•　　地域における= 医師確保、少子化対策推進
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• ２　医療の安全確保
•　医療安全向上のための人員確保、
•　原因究明と紛争解決のための新たな制度 <= /span>
•  （組織）の必要性の研究、
•　医療事故発生の客観性あるデータ収集方法、&#= 13;
•　その原因の科学的分析方法の確立、
•　医療安全と質の評価方法の確立、 =
•　自浄作用活性化の浸透とその徹底
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平成１８年度厚生労働省= 一般会計予算
社会保障関係費の内訳
▲３３５（= ▲７．２％）
４，３２５=
４，６６０=
　　雇 = 　用
= ▲１，９８９（▲５．= ８％）
３２，５１= ８
３４，５０= ７
　　福祉等
▲３７５（= ▲１．９％）
１９，１４= ３
１９，５１= ８
　　介　 = 護
３，８８３= （６．２％）
６６，５７= ８
６２，６９= ５
　　年    金
７２４（０= ．９％）
８１，５８= ６
８０，８６= ２
　　医    療
１，９０９= （０．９％）
２０４，１= ４９
２０２，２= ４０
社会保障関係費
増▲減額
平成１８年= 度
予算案=
平成１７年= 度
予算額=
単位：億円
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医　療　
= ８１，５８６億円
= （４０．０％）
年　金　
= ６６，５７８億円
= （３２．６％）
介　護　
= １９，１４３億円
= （９．４％）
雇　用　
= ４，３２５億円
= （２．１％）
福祉等　
= ３２，５１８億円
= （１５．９％）
［計数整理の結果、異動を生ずることがある。］
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診療報酬改定の内訳
•引き下げ本体１．３６％   − ３８００億円
•小児・産科など引き上げ − １４００億円
•
•　　療養病床の評= ｿ見直し        = ;           −　１２００億円&= #13;
•　　初･再診料　　= 　　　　　　　        = ;         −　　７００億円&= #13;
•　　ＤＰＣ　　　= @　　　　　　　　        = ;          −　　１００億円&= #13;
•　　コンタクトレ= 塔Y関係　  　        = ;         −　　９００億円&= #13;
•　　検体検査　　= @　　　　　 　　　　  &nbs= p; 　   −　　７００億円
•　　放射線治療、= 闖p、画像診断など  −　　９００億円
•　　食事療養費　= @　　　　　　　　　         −　　７００億円<= /span>
＞ ５２００億円
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平成１８年度診療報酬改定に係る議論
•T  患者から見て分かりやすく、患者の生活の   　質（ＱＯＬ）を高める医療を実施する視点
•
•T−１　診療報酬体系の簡素化
•　●医療内容の点検= ｻを検討
•　●老人診療報酬点数表と
•　  &nbs= p; 医科診療報酬点数= ﾌ原則一本化
•
•T−２　診療報酬上の算定項目の分かる領　
•　　　　　収書の発行
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•T−３　患者の視点の重視
•　●セカンドオピニオンに係る患者からの要望に　 = <= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:106%;mso-ansi-language:EN-US'>よる情報提供の評価 •　●初診、再診の際、同日中に検体検査の結果　= に基づき診療を行う場合、検体検査実= 施料　 = <= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:106%;mso-ansi-language:EN-US'>加算を新設
•　●入院患者に係る情報について •　　 入院基本料等についてそれぞれの勤務帯で　 = 実際に働いている看護職員等の表記を= 算定　 = = 条件とする
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•T−４  生活習慣病等の重症化予防に係る　 　　 = 評価について = •　●ニコチン依存症で禁煙希望のある患者に　 = 対し禁煙指導を行った場合、診療報酬= の　　 = 加算 •　●地域におけるがん診療連携拠点病院に他　 の医療機関からの紹介による悪性腫瘍= 患　 = 者に入院医療を提供した場合の加算を= 検　 = = 討
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•T−５　手術に係= る評価について
•　●手= pに係る施設基準については年間手術症例　数による手術点数に対する加算はいったん廃　　止する
•　 　但し、今後継続して調整・検討= 行う
•　●手= p実績、年間手術症例数を院内に掲示する  　 ことを= _数の算定要件とする
•　●手術の難易度、内視鏡下手術= ﾌ再評価、
•　　 見直し
•       同一手術野等において２以上の手術を同時に　= 行った場合の費用の算定方法の特例の対象　　 範囲の= g大　　　
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•U 質の= 高い医療を効率的に提供するために医療機能の分化・連携= を推進する視点
•
•U−１　在宅医療に係る評価について
•　●在宅療養支援診療所（仮称）を設け、 在宅　 療養患者を対象とした診療報酬点数を= 算　 = 定するための要件の一つとする方向で= 検　 = = 討　　　
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•要 件　
•・ 保険医療機関であること
•・ ２４時間連絡を受ける医師・ 看護師を配置。 その連絡先を文書で患者に提供 •・ 他の保険医療機関の保険医と連携し２４= 時間往診可能。往診担当医の氏名を患= = 者に文書で提供
•・ 緊急入院の受け入れの体制を確保など
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•  ●在宅における療養の終末期に係る評価の充実
•      死亡前一定期間内に訪問診療を一定回数以上 　実施していることを算定要件とするとともに、在　宅療養支援診療所（仮称）関与し、かつ死亡前　２４時間以内にターミナルケアをおこなっていた　場合には評価を引き上げる。訪問看護も同様　　に評価し引き上げる。 •  = ●退院後の療養指導について、現行の退院時共　同指導料等を再編・統合する中で在宅療養支　　援診療所（仮称）の医師や訪問看護を行う看護　師等、多職種が協働して行う指導について評価　を引き上げる。
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•U−２　初再診に= 係る評価について
•　●病= @及び診療の初再診料の点数格差につい　て、患者の視点から見ると病院及び診療所の　= 機能分化及び連携を推進する効果が期待で　　= <= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; mso-ansi-language:EN-US'>きないのではないかとの指摘があることを踏　　まえ、初診料については病院の評価を引き上　= げ、診療所の評価を引き下げて両者の点数を　= 統一する。再診料については、病院の評価を　= 引き下げる以上に診療所の評価を引き下げて　= = 両者の格差を是正する。
•　　 外来診療料については、再診料に係る評価  　の見直しに合わせて評価を引き下げる。 <= /span>
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•U−３　急性期入院医療における診断群分　　　　= 類別包括評価（DPC）について　
•　
•　●DPCによる支払対象病院を拡大する。
• = ;
•U−４　リハビリ= テーションに係る評価
• = ;
•　●新たに脳血管疾患等リハビリテーション、運　動器リハビリテーション、呼吸器リハビリテー　ション及び大血管疾患リハビリテーションの４　疾患別の評価体系とする。 •　　 集団療法に係る評価は廃止し、個別療法の　= みに係る評価体系とする。
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•●１月に一定単位数以上行った場合の逓減   制は廃止する。 <= span style=3D'position:absolute;top:27.75%;left:6.92%;width:103.18%;height:7.25= %'>•   長期にわたり継続的にリハを行うことが医= 学的に有用な場合を除き、新たに算定= 日数の上限を設ける。
•
•●リハの従事者１人、１日当たりの実施単位 数の上限緩和
•
•●機能訓練室の面積要件の緩和
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•U−５　精神医療に係る評価について
•
•　●精神科救急入院料及び精神科急性期治療　　 病棟入= @料について、入院後早期の評価を　 引き上げ、長期入院の場合の評価を引き下　 げる方向で検討する。 •　●精神病床における重度の認知症患者に対す　 る医療= ﾉついて、診療報酬上の評価を新た　 に設ける。デイ・ケア料については介護保険  　 で提供できることを踏まえ、一定期間を設け　 て廃止= ｷる。
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•U−６　その他
•　●特定の疾患につ= いて、地域連携クリティカ　　= ルパスを活用するなどして医療機関で= 診療　= 情報が共有されている体制について、= 診療　<= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:106%;mso-ansi-language:EN-US'>報酬上の評価を新たに設ける。 <= /span>•　●介護老人保健施設における他科受診につ    　 いて、特に専門的技術や医療機器を必要と　 する診療行為については、算定可能と= する  　 = 方向で検討。
•　●臨床研修病院の評価を引き上げる。<= /div>
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•V 我が= 国の医療の中で今後重点的に対応していくべきと思われる= 領域の評価の在り方について検討する視点=
•
•V−１　小児医療及び小児救急医療に係る　　　　評価について
• = ;
•　●診療報酬体系を簡素化する観点から、乳幼児= ﾁ　　算と時間外加算、休日加算及び深夜加= Zとを併　　せて算定する場合には、新たに乳幼児= 條ﾔ外加　　算（仮称）、乳幼児休日加算（仮称）= yび乳幼児深　夜加算（仮称）を算定することとし、= 幼児加算に　ついては、時間外、休日又は深夜以外= ﾉ算定する　こととする方向で検討することとして= ﾍどうか。
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•●小児医療の提供体制の確保を図る観点から、
•　 = ・ 小児入院医療管理料の評価を引き= 繧ｰる
•　 = ・ 小児入院医療管理料の算定要件と= ﾈってい　 る小児科の医師の常勤要件について、複数　 の小児科の医師が協同して常勤の= 鼾と　　 同等の時間数を勤務できている場合には、　 常勤として取り扱うこととする方= で検討す　 ることとしてはどうか。 •●地域における小児医療の集約化及び重点化を図る観点から、中核的な役割を担う病院= ﾉ係る評価を引き上げる方向で検討することとし= ﾄはどうか。
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•●小児科を標榜する保険医療機関については、 = 小児に対する初再診に係る乳幼児深夜= 加算 = （仮称）の評価を引き上げる方向で検= 討する = <= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:106%;mso-ansi-language:EN-US'>こととしてはどうか。
•●個々の手術の特性に応じて加算を設ける取 = 扱いとする中で、新生児及び乳幼児に= 対する = = 手術に係る評価を見直す。
•●低出生体重児に対して手術を行う場合の加       算を新 たに設ける。
•●新生児及び乳幼児に対する検査、処置等に = = 係る評価を引き上げる方向で検討する= ことと= してはどうか。
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•V−２　産科医療に係る評価について
•　●合併症等により母体や胎児の分娩時のリスク　が高い分娩（ハイリスク分娩）の妊婦に対する　分娩管理について、診療報酬上の評価を新た　= = に設ける方向で検討することとしてはどうか。
•
•V−３　麻酔に係る評価について
•　●麻酔管理料の評価を引き上げる。
•　●マスク又は気管内挿管による閉鎖循環式全　　身麻酔について、重症の患者に対して麻酔を　= 行う場合の加算を新たに設けるとともに、加算　= の対象となる手術の範囲を拡大する。<= /div>
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•V−４　病理診断に係る評価について
•　●病理診断料の評価を引き上げる。
•　●病理診断料の算定要件となっている病理学的　検査を専ら担当する医師の常勤要件を緩和す　る。
•
•V−５　急性期入院医療に係る評価について = ;
•　●急性期入院医療の実態に即した看護配置を　　適切に評価する観点から、一般病棟入院基本　料等の体系について、見直しを行う方向で検　　討する。
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•●社会= ﾛ障審議会医療部会において有床診療所における４８時間を超える入院を禁止する医療= 法の規定を廃止する方向性が示されたことを踏= まえ、有床診療所入院基本料について、看護職= 員配置による区分を大幅に簡素化するとともに、入院期間に応じた加算に係る入院後早期の評価を引き上げ、長期入院の場合の評価を引き下= げる方向で検討する。
• = ;
•●紹介= ｦを基準とした入院基本料等加算については、廃止する方向で検討することとしてはどうか。その際、特定機能病院及び地域医療支援病院については、別途評価を行う方向で検討することとしてはどうか。
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•V−６　医療のＩＴ化に係る評価について <= /span>
•　●医療のＩＴ化を集中的に推進していく観点から、= @個人情報の保護に配慮した診療報酬明細書の　ＩＴ化及び診療報酬上の算定項目の分かる領収　= 書の発行を必要的に具備すべき要件とし、バー　コードタグ等による医療安全対策の実施、遠隔　医療支援システムを活用した診療の実施等の　　医療のＩＴ化に係る事項を選択的に具備すべき　　要件として、診療報酬上の評価を新たに設ける　方向で検討することとしてはどうか。
•
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•V−７　医療安全対策等に係る評価について = ;
•　
•　●入院診療計画の策定、院内感染防止= 対策　　 = = の実施、医療安全管理体制の整備及び= 褥　　 = 瘡対策の実施に係る入院基本料の減算= の　　 = 仕組みについて、既に大半の医療機関= にお　 = いて体制が整備されている現状を踏ま= え、　　 = 入院基本料の算定要件とする方向で検= 討す　 = = ることとしてはどうか。 =
<= span style=3D'font-size:106%;visibility:hidden'>•
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•V−８　医療技術に係る評価について
•
•　●臓器移植について、高度先進医療= 専門家　= 会議における検討結果を踏まえ、心臓= 移　　= 植、脳死肺移植、脳死肝臓移植及び膵= 臓　　= 移植を新たに保険適用とするとともに= 、臓　　<= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:106%;mso-ansi-language:EN-US'>器提供施設における脳死判定、脳死判= 定　　<= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:106%;mso-ansi-language:EN-US'>後の医学管理等について、診療報酬上= の　　<= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:106%;mso-ansi-language:EN-US'>評価を新たに設ける方向で検討するこ= とと　<= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:106%;mso-ansi-language:EN-US'>してはどうか。
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•W　医療費の配分の中で効率化余地があると思われる領域の評価の在り方に= ついて検討する視点 <= /span>
•
•W−１　慢性期入= 院医療に係る評価について
•　
•　●慢性期入院医療について、医療保険と介護保　 険との役割分担の明確化を図る観点から、新  　 たに患者の状態像に応じた評価を行う方向で　 検討す= 驕B　
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•●療養= a棟入院基本料、有床診療所療養病床入 院基本料及び特殊疾患入院施設管理加算に　　ついて、新たに、医療の必要性による区分及び　ＡＤＬの状況による区分並びに認知機能障害　　加算に基づく患者分類を用いた包括評価を行う。
• = ;
•●慢性= 入院医療に係る評価の見直しに併せ、　入院医療の必要性は低いが、１８０日を超えて　入院している患者に関し、入院基本料を減額して特定療養費制度の対象とする仕組みについて、= その対象から療養病棟入院基本料及び有床診療所療養病棟入院基本料を除外する方向で検討= する。
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•W−２　入院時の= 食事に係る評価について
•　　 <= /div>
•　●新たに 入院時食事療養費として１食当 　 たりの費用を設定して、３食を限度とし　　 = て実際に提供された食数に応じて評価= 　 = <= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:113%;mso-ansi-language:EN-US'>を行う方向で検討することとしてはど= う　　 = = か。
<= span style=3D'font-size:113%;visibility:hidden'>•
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•W−３　コンタクトレンズに係る診療の評価　　　　　<= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:113%;mso-ansi-language:EN-US'>について
•　●初診時に、コンタクトレンズの処方を目的とし　　て、屈折異常の患者に対して眼科学的検査等　 を行う= ｱとは、保険給付の対象となる。 •　●コンタクトレンズの処方を行った後、コンタクト　レンズ装用者に自覚症状があるなど、疾病に　罹患していることが強く疑われる場合に眼科　　= 学的検査等を行うことは、再診として保険給付　= の対象となる。
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•　●初診時には、コンタクトレンズの処= 方を　　 = <= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:113%;mso-ansi-language:EN-US'>目的として行われる定型的な眼科学的= 　　 = = 検査を包括した点数を算定する。 = ;
•
•　●再診時には、コンタクトレンズ装用者が　　= <= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:113%;mso-ansi-language:EN-US'>疾病に罹患していることが強く疑われ= る　　= 場合に行われる基本的な眼科学的検査= 　<= span lang=3DJA style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"= ＭＳ Ｐゴシック"; font-size:113%;mso-ansi-language:EN-US'>を包括した点数を算定する。<= /span>
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•W−４　検査に係る評価について
•
•　●検体検査実施料について、市場実勢= 価格　 = 等を踏まえ、個々の検査ごとに評価を= 引 　 き上げる又は引き下げる方向で検討する　 こととしてはどうか。
•　●生体検査料について、検査の難易度等を　 = 考慮した評価の見直しを行う方向で検= 討 　 することとしてはどうか。
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<ヘッダー>
<日付/時刻>
マスタ テキストの書式設定
第 2 レベル
第 3 レベル
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第 5 レベル
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animRuntimeInstalled && !(isFullSc= reen && parent.IsSldVisited()); if( g_animUseRuntime ) { collSeq =3D document.all.tags("seq"); if( collSeq !=3D null ) { for(ii=3D0;ii numSlds ) gSldJumpIdx =3D numSlds; if ( gSldJumpIdx >=3D 0 ) { if ( gSldJumpIdx =3D=3D 0 ) gSldJumpIdx =3D 1; var jumpTo =3D parseInt(gSldJumpIdx); gSldJump =3D 0; gSldJumpIdx =3D ""; win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref ) } } } function _KDH() { if( event.keyCode =3D=3D 8 ) { event.returnValue =3D 0; parent.GoToPrevSld(); } } function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && !parent.IsFramesMode() ) || (event && (event.keyCode=3D=3D32) ) ) parent.GoToNextSld(); } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"スライド ショーの最後です。 クリックすると終了します。"= , SCREEN_MODE=3D"Frames", gIsEndShow=3D0, NUM_VIS_SLDS=3D36, SCRIPT_HREF=3D= "script.js", FULLSCR_HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var g_fBaseHyperlink =3D false; var gMainDoc=3Dnew Array(new hrefList("slide0001.htm",1,-1,1),new hrefList(= "slide0002.htm",1,-1,1),new hrefList("slide0003.htm",1,-1,1),new hrefList("= slide0005.htm",1,-1,1),new hrefList("slide0009.htm",1,-1,1),new hrefList("s= lide0010.htm",1,-1,1),new hrefList("slide0007.htm",1,-1,1),new hrefList("sl= ide0008.htm",1,-1,1),new hrefList("slide0049.htm",1,-1,1),new hrefList("sli= de0019.htm",1,-1,1),new hrefList("slide0020.htm",1,-1,1),new hrefList("slid= e0021.htm",1,-1,1),new hrefList("slide0022.htm",1,-1,1),new hrefList("slide= 0023.htm",1,-1,1),new hrefList("slide0025.htm",1,-1,1),new hrefList("slide0= 026.htm",1,-1,1),new hrefList("slide0029.htm",1,-1,1),new hrefList("slide00= 30.htm",1,-1,1),new hrefList("slide0031.htm",1,-1,1),new hrefList("slide003= 2.htm",1,-1,1),new hrefList("slide0033.htm",1,-1,1),new hrefList("slide0034= .htm",1,-1,1),new hrefList("slide0042.htm",1,-1,1),new hrefList("slide0035.= htm",1,-1,1),new hrefList("slide0036.htm",1,-1,1),new hrefList("slide0037.h= tm",1,-1,1),new hrefList("slide0038.htm",1,-1,1),new hrefList("slide0039.ht= m",1,-1,1),new hrefList("slide0043.htm",1,-1,1),new hrefList("slide0040.htm= ",1,-1,1),new hrefList("slide0041.htm",1,-1,1),new hrefList("slide0044.htm"= ,1,-1,1),new hrefList("slide0048.htm",1,-1,1),new hrefList("slide0045.htm",= 1,-1,1),new hrefList("slide0046.htm",1,-1,1),new hrefList("slide0047.htm",1= ,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function RemoveFilePrefixFromHref(href) { var regExp =3D /^file:\/\/\//i; return href.replace(regExp, "") } function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix();=20 function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') {=20 href=3Dnew String(document.location.href)=20 Start=3Dhref.indexOf('!')+1=20 End=3Dhref.lastIndexOf('/')+1=20 if (End < Start)=20 return href.substring(0, Start)=20 else=20 return href.substring(0, End)=20 } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { // Clear any sounds playing before launching another browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if (MHTMLPrefix !=3D "") href =3D RemoveFilePrefixFromHref(href) if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; =09 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(obj.mSldHref= )) else PPTSld.location.replace(obj.mSldHref) =09 if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(href)) else PPTSld.location.replace(href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('


' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"次へ",sPrev=3D"前へ",sEnd=3D"スライド ショーの終了",sFont=3D"= lＳ 明朝",sArrow=3D"矢印",sFreeform=3D"フリーフォーム",sRect=3D"四角形",sOv= al=3D"楕円" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; 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charset="shift_jis" ２００６．２．１最近の医療状況 ------=_NextPart_01C628B8.8F2F19C0 Content-Location: file:///C:/B0D95909/060201_iryoujosei.files/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis"
 ノ= ート
スラ= Cド ショー
アウトライン
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