急性期災害医療体制整備の政策過程：DMAT創設を事例に

完善緊急時期災害醫療體制的政策過程：以創立DMAT為例（An Analysis of Policy Process Focused on the Japanese Disaster Medical System in the Acute Phase: A Case Study of Establishing the ''Japan DMAT''）

"本文將以「災害派遣醫療團隊（DAMT, Disaster Medical Assistance Team)，以下簡稱「DMAT」）中的「日本DMAT」為事例，檢討現代日本的災害醫療體制是否完善。首先，本文將先梳理DMAT整體制度。其次，追溯DMAT的創立過程。探討為何創立DMAT需要時間上的醞釀，以及能夠成功創立DMAT的因素。在這一連串的檢討中，本文將採用垃圾桶決策模式修正理論，嘗試分析DMAT創設的過程。並特別聚焦在專家團體的活動，與統治機構改革的成效。本文認為，早在政治家開始關心DMAT相關案例之前，DMAT、大範圍醫療運送相關政策方案，已在厚生勞動省內部研究會中經過充分議論。議論過程呈現專家團體對於政策想法的累積，以及如何將想法落實成為實際政策的樣貌。此外，也藉此反映當初以強化首相輔佐體制為目的之制度改革，確實發揮其效果。DMAT的事例顯現的是，過去即使有因高難度的跨部會協調而無法實現的案例，只要首相做出必須推動的決斷，再透過統治機構改革形成制度並加以運作後，就可望落實成為政策的過程。 In this paper, we aim to examine the Japanese disaster medical system by using the case study of the establishment of the ''Japanese DMAT (Disaster Medical Assistance Team).'' We will first outline the institutional aspects of the DMAT. Next, it describes the process in which the DMAT was founded. The paper illustrates the exploration of what contextual factors influenced the delay in and what led to establishment of the DMAT. In a series of analyses, we attempt to analyze the process of the DMAT creation using the policy window model. Further, we also attempt to analyze the activities of the expert group and the certain effects of the institutional and governance reform. It revealed that, before politicians were interested in DMAT cases, policy proposals such as DMAT and wide-area medical transportation had been separately discussed in a study group within the Ministry of Health, Labor and Welfare research group. As a result, this fact shows that the expert group had already accumulated policy ideas and how those policy ideas were linked to actual policies. From this case, it also indicates the results of strengthening the support system for the prime minister. It depicts how even though it had been difficult to coordinate policies between the government ministries, certain policies are still created through the institutional and governance reform when the Prime Minister determines that certain policies are necessary for policy management."

本文將以「災害派遣醫療團隊（DAMT, Disaster Medical Assistance Team)，以下簡稱「DMAT」）中的「日本DMAT」為事例，檢討現代日本的災害醫療體制是否完善。首先，本文將先梳理DMAT整體制度。其次，追溯DMAT的創立過程。探討為何創立DMAT需要時間上的醞釀，以及能夠成功創立DMAT的因素。在這一連串的檢討中，本文將採用垃圾桶決策模式修正理論，嘗試分析DMAT創設的過程。並特別聚焦在專家團體的活動，與統治機構改革的成效。本文認為，早在政治家開始關心DMAT相關案例之前，DMAT、大範圍醫療運送相關政策方案，已在厚生勞動省內部研究會中經過充分議論。議論過程呈現專家團體對於政策想法的累積，以及如何將想法落實成為實際政策的樣貌。此外，也藉此反映當初以強化首相輔佐體制為目的之制度改革，確實發揮其效果。DMAT的事例顯現的是，過去即使有因高難度的跨部會協調而無法實現的案例，只要首相做出必須推動的決斷，再透過統治機構改革形成制度並加以運作後，就可望落實成為政策的過程。 In this paper, we aim to examine the Japanese disaster medical system by using the case study of the establishment of the ''Japanese DMAT (Disaster Medical Assistance Team).'' We will first outline the institutional aspects of the DMAT. Next, it describes the process in which the DMAT was founded. The paper illustrates the exploration of what contextual factors influenced the delay in and what led to establishment of the DMAT. In a series of analyses, we attempt to analyze the process of the DMAT creation using the policy window model. Further, we also attempt to analyze the activities of the expert group and the certain effects of the institutional and governance reform. It revealed that, before politicians were interested in DMAT cases, policy proposals such as DMAT and wide-area medical transportation had been separately discussed in a study group within the Ministry of Health, Labor and Welfare research group. As a result, this fact shows that the expert group had already accumulated policy ideas and how those policy ideas were linked to actual policies. From this case, it also indicates the results of strengthening the support system for the prime minister. It depicts how even though it had been difficult to coordinate policies between the government ministries, certain policies are still created through the institutional and governance reform when the Prime Minister determines that certain policies are necessary for policy management.