The government has decided to lower medical fees paid through the public health-insurance systems to hospitals, clinics and pharmacies, beginning in April. Fees paid to doctors will be reduced by 1.36 percent; fees for drugs and medical supplies will be cut by 1.8 percent. The decision is in line with the government’s efforts to get a handle on the nation’s medical costs, which are growing annually by 1 trillion yen due to the aging of Japanese society. The decision is expected to lower government spending by some 240 billion yen in fiscal 2006.

The Japan Medical Association, a medical doctors’ lobby group, had urged that fees to them be raised. But if the decline in salaried workers’ incomes for the past seven years is taken into consideration, the government decision is not unreasonable, and medical institutions should accept it. The fee-reduction percentages are averages and will not apply uniformly to all types of medical services and drugs.

Coming at a time of fiscal tightening, the actual distribution of fees to each of the various services will become important in providing optimal medical service as a whole. Raising fee levels for some types of services while drastically lowering them for others are likely to better serve the purpose.

The Central Social Insurance Medical Council, under the Health, Welfare and Labor Ministry, is tasked with the job of translating the government’s overall decision into a concrete plan. It must decide on what fee levels are appropriate for individual services and drugs. Emergency-care doctors, pediatricians, obstetricians and anesthesiologists, for example, are not receiving the remuneration they deserve for their hard work. Payments to them should be raised. Such a move will help attract and nurture specialists in these fields.

In fact, pediatricians and obstetricians are in seriously short supply nationwide, while some depopulated areas of Japan are suffering from a shortage of doctors in general. The council should decide on medical-fee levels with an eye toward ensuring a balanced distribution of doctors, both geographically and with regard to medical specialties.

Apart from imbalances in the rewards of the medical profession, the council is expected to lower fees for hospital beds used by patients recuperating for a long time and fees for original drugs — in case newer or generic drugs come on the market with the same efficacy but with lower price tags. The government decision represents the largest-ever reductions in medical fees. Levels are revised almost every two years.

A political motive also lies behind the government decision to lower fees. The government apparently seeks to strike a balance with its earlier decision to increase the financial burden on elderly people receiving medical services. As part of its efforts to protect the public health-insurance systems from the ill effects of a rapidly aging population, the government had decided to have the elderly pay more for treatment at hospitals and clinics.

From next October, people at least 70 years old with incomes comparable to those of younger workers will have to pay 30 percent of their medical fees, up from the current 20 percent. From 2008, people between 70 and 74 who are now paying 10 percent of their medical fees will have to shoulder 20 percent.

The government hopes to push national financial reconstruction by reducing government spending related to medical services. Under normal circumstances, the JMA and lawmakers representing its interests would have strongly resisted a plan to lower medical fees. Riding on the strength of an overwhelming victory in the Sept. 11 general elections, though, Prime Minister Junichiro Koizumi went ahead with lowering medical fees, quashing opposition by medical lobbies.

Reducing treatment and medication fees might sound like only good news for patients, but that’s not necessarily the case. Elderly people will have to pay more under the government’s earlier decision. And patients’ burden could increase further if the frequency of their appointments with doctors rises or if doctors prescribe unnecessarily large amounts of medication to try to compensate for the fee reductions.

Patients, however, are not without the means of curbing their medical costs. By closely checking their receipts, they may be able to detect and avoid receiving the same treatments or an excessive dispensation of drugs.

Still, it is more important to establish a system attuned to eliminating unnecessary treatments and drug prescriptions altogether. One step will be made in this direction if the health ministry instructs hospitals to provide patients with detailed information about their medical treatments.

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