The number of people losing their national health insurance certificate because they failed to pay premiums due to salary reductions and other hardships is on the rise.

When an insured person fails to pay premiums for a year or more, the national health insurance law, which was revised in April last year, stipulates that local governments must nevertheless issue a qualification certificate.

The qualification certificate forces users to pay their full hospital bill and wait for the health insurance system to reimburse them -- a structure that could discourage people who need medical care from seeking treatment.

A total of 3.7 million households, or 17.5 percent of those enrolled in the national health insurance program, failed to pay their premiums as of June 2000, up 6.2 percent over the previous year and 25.4 percent higher than in 1995, according to the Health, Labor and Welfare Ministry.

Prior to the introduction of the qualification certificate in 1987, those insured could get insurance certificates even if they had failed to pay their premiums.

In 1987, however, the process was changed and the distribution of qualification certificates was left to the discretion of local governments. As of June last year, about 96,849 households received these certificates, 1.8 times more than in June 1995.

Since local governments are now required to issue qualification certificates, the number issued is most certainly expected to rise.

The qualification certificates will be issued to those who failed to pay premiums for one year, barring special circumstances such as drastic reduction in salaries or natural disasters.

However, if an insured person receives medical treatment using the qualification certificate but fails to pay premiums for another six months, benefits will be partially or fully halted.

One of the reasons that a growing number of people are failing to pay their premiums is the fact that premiums for national health insurance are higher than cooperative health insurance to which most company employees belong.

For a two-child family in Saitama Prefecture making 3 million yen a year, health insurance premiums plus premiums for nursing care insurance would add up to about 300,000 yen, or 10 percent of their income.

The system also makes it difficult for those who lose their jobs, because it continues to base their premium obligations on what their salaries were the previous year.

The ratio of those receiving qualification certificates to those using national health insurance in Fukuoka Prefecture stands at about 23 to 100, the highest among Japan's 47 prefectures.

One report on the burden of paying health insurance premiums tells of a restaurant owner in her 60s who finally resorted to a consumer credit company to make the payments because sales at her restaurant had were too slow.

The woman was forced into personal bankruptcy and had to receive social aid after collapsing from the distress of being hounded by the company for not being able to repay the money, it said.

The health ministry explained that making the issuance of qualification certificates obligatory was "a measure to respond to cases in which (premium) payment is not made and without special circumstances."

Others contend, however, that mandatory issuance of the qualification certificates has had the adverse effect of further increasing the number of households that fail to pay.