• Nishinippon Shimbun

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Prime Minister Yoshihide Suga’s administration has made digitalization a top priority in an effort to transform the nation’s economy and society, but as far as the medical care sector is concerned, steps toward that goal are not off to a smooth start.

Beginning in March, the government started rolling out My Number cards embedded with IC chips that can double as health care insurance cards.

The Health, Labor and Welfare Ministry says use of the new cards, which all Japan residents can apply for, would simplify administrative procedures at hospitals and streamline applications for tax deductions for medical expenses.

But the rate of uptake for the cards is low at around 25% and, due to the pandemic, many health care providers are not in a rush to install the facial recognition systems used to scan My Number cards.

In order to use their My Number cards as a health insurance card, users must apply for the card and register online, while health care providers need to install proper card-reading equipment and overhaul their computer systems.

After a card is scanned, a facial recognition monitor then scans the patient’s face. That gives the medical care providers instant access to their past health checkup results and their prescription drug history, meaning they don’t have to manually input information about their medical history.

The government originally planned the launch of trial operations at about 500 medical institutions and pharmacies on March 4, but only 54 facilities in 24 prefectures have so far begun the service. The full-fledged operations were slated to begin from the end of the month, but the government decided to push the schedule back to October, sources said. The government will provide facial recognition card readers free of charge and has beefed up subsidies for related costs, including up to about ¥2.1 million for hospitals and ¥430,000 for clinics and pharmacies that overhaul their receipt computer systems, provided applications are submitted by the end of this month.

But hospitals and clinics are reluctant to install the system.

“The priority is low,” says a dentist in his 60s in the city of Fukuoka, who decided against introducing the system for the foreseeable future.

Hit by a decrease in primary care visits amid the pandemic, his clinic’s revenue declined by about 40% last year. Out-of-pocket expenses for overhauling the system totaling several hundred thousand yen also weigh heavily.

“Shouldn’t the dissemination of the card come first?” he wonders.

Health minister Norihisa Tamura tries out the new My Number and health insurance card system at the ministry in November. | KYODO
Health minister Norihisa Tamura tries out the new My Number and health insurance card system at the ministry in November. | KYODO

Meanwhile, a medical practitioner in his 60s in Fukuoka Prefecture decided to invest about ¥300,000 to introduce the system after some patients asked if they could use the card. But he’s worried that installing the system may increase the burden on administrative staff if computers fail to read a patient’s card correctly.

According to the health ministry, around 31% of about 228,000 hospitals, clinics and pharmacies nationwide have applied for the system as of Feb. 14. The government had hoped to introduce the system at about 60% of them by the end of March, but reaching that goal appears unlikely.

The health ministry has emphasized the merits of using My Number cards in place of a health insurance certificate on its website, including outlining benefits such as the ability for participating hospitals to tell instantly if a patient’s health insurance is invalid.

If a person switches jobs, for example, he or she can also use the dual My Number and health insurance card at hospitals without waiting for a new health card to be issued. The health ministry says the introduction is necessary for improving the medical system over the mid- to long term but leaves the final decision up to each medical institution.

However, the National Insurance Medical Association, a group of medical practitioners, is opposed to the introduction for a number of reasons, including the risk that the loss of the card embedded with a wealth of personal information could lead to a leak of sensitive information. The group also says there are few advantages despite high operating costs. Hospitals are not facing significant problems over invalid health certificates as the number of such cases are low, it added.

Last November, the National Federation of Health Insurance Societies also called on the ministry’s health insurance panel to revise the scheduled launch in March.

“We’re afraid there‘s going to be confusion among people when they visit a clinic if medical institutions differ in how they deal with the situation,” a federation official was quoted as saying according to the meeting minutes.

In 2019, the government pledged to “aim to introduce the My Number-health insurance card at almost all medical institutions by the end of fiscal 2022.” To that end, a total of more than ¥90 billion in related costs were budgeted for fiscal 2019-20.

But the coronavirus pandemic has upended the medical system and there are growing calls from some front-line doctors and the Japan Medical Association, which has previously backed the government, for the funding to be allocated to medical care. They also say that there’s little benefit from rushing the introduction.

A business in the Kyushu region that is involved in overhauling the equipment at medical facilities also voiced concerns about the tight schedule and the lack of preparation time.

Hideaki Shibata, a professor of social welfare at Rikkyo University, says the existing health insurance certificates are functioning without issue, adding that it’s possible to set up a structure in place to make it easier for medical institutions and patients to share information without relying on the My Number Card.

“I am worried that by managing people’s medical information in a bundle and setting up a system in the future to justify disparities in premiums based on high or low risks of disease on the basis of lifestyle behaviors, the government will try to shift its policies to one that places more emphasis on self-responsibility,” Shibata said.

This section features topics and issues from the Kyushu region covered by the Nishinippon Shimbun, the largest daily newspaper in Kyushu. The original articles were published Feb. 28 and March 26.

How to use the My Number card as a health insurance certificate

The plastic My Number card can be used as a substitute for a health insurance card by using the electronic certificate mounted on the IC chip, rather than the 12-digit number listed on the back of the card.

To activate the card for use as a health certificate, individuals need to first register online.

Then, when visiting a clinic, you will be asked to enter a four-digit PIN code or use a facial recognition system to verify your identity.

The card needs to be presented and verified each time you visit a clinic.

Patients can still use their existing health insurance certificates at hospitals, but the ruling Liberal Democratic Party is seeking to eliminate the health certificate in the future by shifting to the My Number card.

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