A new health insurance system that covers people aged 75 or over started April 1, 2008. It was unpopular at first because, in principle, premiums are withdrawn from people’s pensions at the source. Participants also felt that they were segregated from younger people.

So, in accordance with the Democratic Party of Japan’s call for abolition of the plan, the health ministry came up with a final revision plan on Dec. 8, but it contains many problems.

Under the plan, some 14 million people aged 75 or over and about 12 million self-employed or jobless people will join the kokumin kenko hoken health insurance plan now administered by municipalities, while some 2 million company employees or dependents of company employees will join corporate health insurance plans.

Prefectures will eventually administer the financing of the kokumin kenko hoken system to strengthen its financial footing. The out-of-pocket payment at medical institutions by people aged 70 to 74 will gradually increase from the current 10 percent of the medical cost to 20 percent. (The out-of-pocket payment for older people will remain at 10 percent.)

The future total premium burden for people aged 75 or over would be lower under the current system. The reverse side of the coin is that corporate health insurance systems for working generations will have to increase financial support for older generations to reduce their premium burden.

Inequality in the payment of premiums will also emerge. If elderly people who join the kokumin kenko hoken plan are claimed as dependents by their children, they won’t have to pay premiums. Those who join corporate health insurance plans as dependents of workers won’t have to pay premiums either. Half of the premiums by these workers are shouldered by their employers. Measures introduced to greatly reduce the premium burden for low-income elderly people under the current plan have helped the system win popular acceptance. But the ministry plan calls for scaling down the measures. One wonders whether there is any need to hastily scrap the current system.

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