Issues Regarding Patient Copayment under Japan's Public Healthcare Insurance System

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  • 公的医療保険制度における自己負担をめぐる諸問題
  • コウテキ イリョウ ホケン セイド ニ オケル ジコ フタン オ メグル ショ モンダイ

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<p>Charging patients for copayment of medical expenses has the following three main purposes.</p><p>1） To avoid the moral hazard of excessive use of medical resources</p><p>2） Cost shifting to shift the finances for medical expenses from public subsidy and insurance premiums to patients</p><p>3） To moderate the excessive orientation toward large hospitals and other inappropriate behavior of patients in selecting hospitals</p><p>Japan's public healthcare insurance system controls the medical expense copayments of patients through the official copayment rate and the high-cost medical care expenses system. The high-cost medical care expenses system places a cap on patient copayments, enables patients to receive high-cost medical care, and may be called a safety net for medical expenses payments.</p><p>While medical expenses continue to rise, the patient official copayment rate is being increased because medical insurance finances are worsening. As a result, the maximum copayment amount is being reached in a growing number of cases, and high-cost medical care expenses are rising. The percentage of high-cost medical care expenses in total medical expenses grew from 3.2％ in 2002 to 6.4％ in 2017.</p><p>Because of this increase in high-cost medical care expenses, even though the official copayment rate is on a rising trend, the effective copayment rate is declining. Specifically, the effective copayment rates were 22.7％ for patients age 74 or younger and 8.8％ for patients age 75 or older in 2003, and these declined to 19.7％ and 8.0％ , respectively, in 2017. Comparing the effective copayment rates between outpatient and inpatient treatment, the rates were 18.3％ for outpatient treatment and 6.6％ for inpatient treatment in 2017, with an extremely low effective copayment rate for inpatient treatment. This is because of the large expenditures paid as high-cost medical care expenses because of the high medical expenses for patients admitted to hospitals.</p><p>The official copayment rate for patients age 75 and older is set at 10％ in principle. The opinion has emerged that the health insurance premiums and copayment rates of the elderly are too low compared with those of the younger generation, and that therefore the copayment rates of the elderly should be increased. In contrast, others have noted that the elderly have low income and high medical expenses, and that their copayments constitute a higher percentage of their income than those of the younger generation, and argued that the copayment rates of the elderly should remain at 10％ to ensure their access to medical care. It took a long time to resolve this debate, but ultimately in 2020 the policy decision was reached that the copayment rate of seniors age 75 and older with annual incomes of at least ¥2 million will be increased to 20％.</p><p>There is no doubt that the pressures to increase patient copayment of medical expenses will intensify in the future as well. In that process, the key issues will likely be further increasing the official copayment rates of the elderly and revising the high-cost medical care expenses system.</p>

Journal

  • Iryo To Shakai

    Iryo To Shakai 31 (1), 11-30, 2021-07-08

    The Health Care Science Institute

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