Severe “Medical Insurance” Review Report What is it? September 3, 15:30

Public medical insurance that pays up to 30% when we visit a hospital. Although it is an indispensable system for receiving medical care with peace of mind, there are also voices of concern that it can be maintained as it is. In Japan, which has entered a super-aged society, medical expenses continue to increase, and in FY2016 it was approximately 42 trillion yen. This is expected to continue to increase in the future. On the other hand, working generations who pay insurance premiums are shrinking, and the environment surrounding the medical insurance system is becoming increasingly severe. Under such circumstances, we focused on one proposal from a research group. The title is “Review of the range of benefits for public medical insurance”. It is said that the scope of medical insurance should be reviewed at a maximum of 30%. What kind of content does this proposal have been presented to the Ministry of Finance and the Cabinet Office?

This proposal has been discussed for about half a year since last October in the form of an independent research project of the Foundation for Medical Economics. In addition to the former executives of the Ministry of Health, Labor and Welfare, the research group includes specialists related to medical administration, including members of the Financial Examiner and Chuikyo-Chuo Social Insurance Medical Council.

What is important in the health insurance system is to prevent the financial failure of individuals and households due to serious illness risk, and to make it a basic principle to cover “necessary and appropriate” health care coverage. .

On top of that, it is said that it is time to evaluate once again what is essential medicine.

Recommendation 1 “Drugs with the same ingredients as over-the-counter drugs”

Some recommendations are suggested in the recommendations, one of which is to remove drugs with the same ingredients as over-the-counter drugs from insurance coverage.

Specific examples include poultices, hay fever drugs, skin moisturizers, and gargles, but the medical expenses for receiving prescriptions from doctors are covered by insurance, but the purchase costs for the drugs are to be paid by the individual. Should be considered.

For example, if you look at a compress, you can now have a doctor prescribe up to 70 at a time, and just because you are covered by insurance, a large amount is prescribed every time, resulting in a surplus. There is also.

Proposal 2 “Contact Lens Inspection Fee”

The recommendations should also consider removing contact lens inspection fees and cost-effective medical technologies from medical insurance coverage, and paying for the full cost of room heat when the elderly are hospitalized. And so on. However, consideration should be given to reducing the burden on low-income earners.

According to the research group, the items listed in this proposal are about 800 billion yen in total in terms of medical expenses.

“Insurance finances are expected to become increasingly severe due to aging and the development of expensive treatments. Protecting life-saving medical care such as cancer treatments” In order to continue, we have to start discussion without waiting for how much insurance is covered. "

Not only the research group but also the opinion that the scope of medical insurance should be reviewed is also appealed by the Federation of Health Insurance Associations = Health Insurance Federation. Last month, the Health Insurance Federation said that removing hay fever with the same efficacy as over-the-counter drugs from medical insurance would reduce medical costs by approximately 60 billion yen.

There are also requests for careful discussion

On the other hand, there are many voices calling for careful discussion on the review of the scope of medical insurance coverage.

Among them, the Japan Medical Association said, “The patient's burden has increased, and as a result, the patient has become serious, and it should not lead to the suppression of the consultation. It is dangerous to create policies and trends that end up. "

In addition, doctors at the site pointed out, “There are many patients who are burdened with medical expenses and are difficult to pay, and there are some people who can not purchase if the full amount of medicines is at their own expense”.

What should be the system reform?

Discussions on how to keep medical costs down to maintain the public health insurance system are inevitable.

In proceeding with the discussion, the most important thing is to listen to the voices of people from various positions. I think we have opinions on the people who are receiving medical care, their families, and the doctors who are treating many patients. We want to convey that voice as much as possible.

Please let us know what you think based on your experience.

We are waiting for you on the NHK post form “News Post”.
Please write "Medical Insurance Reform" in the post.
https://www3.nhk.or.jp/news/contents/newspost/
(There is a link to “News Post” in “Featured Content” below.)