Medical reforms for an aging nation

The Central Social Insurance Medical Council on Feb. 12 decided on a new payment plan for medical services under public health insurance, which is revised every other year. The fee charged for patients’ first visits will be raised by ¥120 to ¥2,820 and the fee for additional visits will be raised by ¥30 to ¥720.

In fiscal 2014, the average medical fee will be raised by 0.1 percent. When the portion to cope with the consumption tax hike from April is taken into account, the fee goes down by 1.26 percent.

What is important about the latest revision is that it is designed to help make preparations for a medical service system that will be functioning properly by 2025, when all postwar baby boomers are at least 75 years old.

Due to the graying of the population, the number of elderly people suffering from chronic diseases is increasing. In this situation, it is becoming more difficult to provide complete medical care for them in hospitals. The council hopes to establish a system in which various community resources will be fully utilized so people can receive necessary medical and nursing care services as well as other necessary support within their communities.

The council’s thinking is basically correct but careful implementation is needed. The council plans to reduce the number of hospital beds for patients with advanced diseases and increase the number of hospital beds for patients who have chronic diseases or are convalescing, and boost inclusive medical care in communities. The council hopes that this measure will enable more hospitalized elderly people to return to their homes.

In fiscal 2006, the health and welfare ministry raised the fees of hospital beds for patients with advanced diseases. The policy has led to hospitals to dedicate more beds for such patients, reaching 360,000 or about 40 percent of the nation’ total hospital beds. This has created a situation in which many patients whose conditions are not serious continue to occupy hospital beds and some hospitals don’t even have room to accept emergency patients who require hospitalization.

Many hospitals have also used the lure of better working conditions to attract a large number of nurses to care for patients with advanced diseases, thus leading in some cases to the closure of hospital beds in other categories.

The council plans to tighten the hospitalization standard for patients with advanced diseases from October so that a quarter of such beds, or 90,000, can be changed to other statuses. Eventually it hopes to halve the number of hospital beds dedicated to such patients. If the decrease is pushed too rapidly, however, the quality of patient care may suffer. The council should be careful.

In an attempt to increase the number of family doctors, a fee of ¥15,030 per patient per month will be paid to doctors who care for elderly patients who suffers from multiple diseases — mainly lifestyle-related diseases and senile dementia — on a 24-hour basis. Family doctors can also introduce patients to specialized hospitals when necessary.

The family doctor system can nurture a sense of security among patients and promote efficient use of hospital beds, but vigilance should be maintained to guard against abuse. The plan for new medical fees may lead to a fierce competition among doctors for patients. The council and the government should carefully manage the new fee scheme to prevent doctors from trying to get a large number of patients just for the sake of boosting their income.