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How Japan is tweaking the cost of health care

April 1 revisions aim to unclog large hospitals, boost efficiency

by

Staff Writer

The price of health care is changing.

On Feb. 10, a government medical council approved a long list of revisions for the fees hospitals and pharmacies can charge under the nation’s public health insurance program.

The dictionary-thick list reflects an effort by the government to reduce wastage, improve efficiency and encourage community-based health care, by tweaking the earnings of professionals and the costs patients have to pay.

Under Japan’s universal health care system, all residents are required to join the public health insurance scheme. In exchange, they receive access to government-approved procedures and prescriptions, for which they pay only 30 percent of the cost or less.

The fee changes, which are approved every two years and will take effect on April 1, are a key policy tool for the government. In a rapidly aging society, needs for medical care are surging without a proportional increase in funds.

Here are highlights of this year’s fee review, particularly those with a visible impact on consumers:

Community care

The government is pushing for community-based care by increasing pay for family doctors who treat patients away from hospitals, such as by visiting patients in their homes.

The government wants to steer people away from bed-blocking inpatient care and into home-based or outpatient care. As part of that policy, it has created new pay categories for dementia specialists and pediatricians who see patients on a regular basis.

Hospital surcharges

“Universal access” in Japan’s health care has long meant that many patients rush to large hospitals, such as university-affiliated institutions, even for such common complaints as colds. This partly explains long waits at big hospitals, a situation described as “a three-minute consultation with a doctor after a three-hour wait.”

To discourage this, some hospitals have already introduced surcharges of ¥3,000-¥4,000 for people who show up without a referral letter from a doctor. The government is now making it mandatory for large hospitals to levy a surcharge of at least ¥5,000 on a first visit by any patient without a referral and at least ¥2,500 for subsequent visits.

The same goes for dentistry, where patients will be charged at least ¥3,000 for visiting the dental department of a large hospital without a referral and ¥1,500 for visits thereafter.

Pharmacists and dentists

Community-based care will be expanded to cover pharmacists and dentists.

Dentists who see their patients regularly and offer early intervention for tooth decay and periodontal disease will be rewarded.

Extra fees will also be paid to pharmacies whose customers name them as their designated family pharmacy.

The medical council is also cutting fees for pharmacies that open shop outside large hospitals and process prescriptions issued by those hospitals only.

The government believes those pharmacies — known as monzen yakkyoku (literally, in-front-of-the-hospital-gate pharmacies) — are not doing enough to serve patients’ needs, as they are able to survive commercially thanks to their prime location without being required to provide good service.

Under the new pay table, the fee such pharmacies receive for preparing medicine will be cut to ¥200 from the current ¥410 per prescription. The fee does not include the cost of medicine itself.

It is unclear, however, whether the move will have the intended effect of penalizing such pharmacies, because they might end up getting more business: Less pay for pharmacies means lower fees for patients. Pharmacies that handle prescriptions from a variety of hospitals, not just the nearest one, will avoid the cut in fees.

Generic drugs

The prices of newly released generic drugs will be reduced to 50 percent of the patented versions. They are currently priced at 60 percent. Patients will begin to see more generic names — or the actual ingredients — of drugs printed on their prescriptions, as the government is adding ¥30 for every prescription that lists them.

Quitting smoking

Young smokers who want to kick the habit will have easier access to doctors.

Those under age 35 will get 70 percent of their nicotine addiction treatment covered by public insurance.

Coverage has so far been limited to those who register 200 or more in the so-called Brinkman Index, derived by multiplying the number of cigarettes smoked per day by the number of years of smoking. The requirement will be removed for those under age 35, to offer young people a chance to stop smoking before they get heavily addicted.

Heating/cooling pads

Orthopedic specialists often prescribe heating or cooling pads for medical conditions, but some patients are known to ask doctors to bump up the number prescribed because the pads are more expensive to buy over the counter. To stop this, the pads will be limited to 70 sheets per prescription under the insurance scheme.

Robotic exoskeletons

The insurance coverage of HAL robot suits developed by Tsukuba, Ibaraki Prefecture-based venture Cyberdyne has been approved, to assist with lower-limb rehabilitation of people with progressive neuromuscular diseases. These conditions include spinal muscular atrophy, Charcot-Marie-Tooth Disease and muscular dystrophy. This will benefit some 3,400 patients across the country. The suits provide extra power for limb movements.