Encouraging My Number Insurance Cards Use with Scripts and Lump Sum Rewards Raises Concerns

“Incentives Needed to Further Increase Utilization Rate” Doubling the Cap on Lump Sum Payments.

Prior to the December abolition of health insurance cards, the government is making vigorous efforts to increase the utilization rate of My Number insurance cards.

The Ministry of Health, Labour and Welfare designated May to July as ‘My Number Insurance Card Utilization Promotion Focus Months’ and launched campaigns aimed at expanding usage. Based on the usage data from October last year, the ministry announced in April that clinics and pharmacies would receive temporary support payments of up to 100,000 yen, and hospitals up to 200,000 yen, depending on the increase in the number of users during the focus months.

However, the Ministry of Health, Labour and Welfare is requesting medical institutions and pharmacies to distribute leaflets and display posters encouraging the use of My Number insurance cards as a condition for temporary payments. Furthermore, the ministry has even created and publicly released scripts called “My Number Insurance Card Promotion Talk Scripts” for soliciting this use.

“Even with card readers installed at reception, there are very few patients using My Number insurance cards for medical visits. While posters are displayed and leaflets are available, there isn’t much enthusiasm to actively promote usage just to obtain temporary payments.

During this focused campaign period, pharmacies seem to be leading in increasing the utilization rate of My Number insurance cards. Hospitals with larger administrative staff or pharmacy chains might have the capacity to invest effort into solicitation.”

This comes from Tomoyuki Nakata, director of a dental clinic in Saitama Prefecture.

Since the start of the focused campaign month in May, the utilization rate of My Number insurance cards has increased to 7.73%, up 1.17 points from April’s 6.56%. According to data from the Ministry of Health, Labour and Welfare, about 70% of this increase is attributed to efforts in pharmacies to promote usage. This has significantly contributed to the overall rise in numbers.

On June 21st, the Ministry of Health, Labour and Welfare announced an increase in the maximum temporary payments to medical institutions and pharmacies that have increased their number of users beyond a certain threshold. Clinics and pharmacies will see their maximum payments double from 100,000 yen to 200,000 yen, while hospitals will increase from 200,000 yen to 400,000 yen. As of May, a considerable number of medical institutions and pharmacies had already reached the maximum temporary payment limit, prompting the ministry to state that additional incentives are necessary to further increase utilization rates.

However, no matter how it’s explained, the increase in support payments appears to be nothing more than a handout aimed at boosting the struggling utilization rate, which stood at only 7.73% even after the campaign began.

“The temporary payments during the focused campaign month are paid from the Social Insurance Medical Fee Payment Fund.

The fund acts as an intermediary between medical institutions and health insurance associations, responsible for reviewing and disbursing medical fee payments for services provided by medical institutions. Its primary role is to reimburse medical institutions for the medical services they provide. Using insurance premiums entrusted by health insurance associations for temporary payments aimed at promoting My Number insurance card usage seems like a misuse of funds and feels a bit off-track.”

 

When visiting medical institutions that have raised nurses’ wages, the payment amount for initial and subsequent medical consultations increases!?

Starting from June, revisions to medical fees have increased charges for initial and subsequent consultations: the initial consultation fee has risen by 30 yen to 2,910 yen, and the subsequent consultation fee has increased by 20 yen to 750 yen. Basic hospitalization fees have also increased by 50 to 1,040 yen per day depending on the type of ward.

The purpose is to allocate resources for raising wages of healthcare workers, aiming to alleviate manpower shortages and secure talent. In clinics without hospital beds that raise nurses’ salaries, up to an additional 700 yen can be added to the initial consultation fee and up to 100 yen to the subsequent consultation fee. For patients covering 30% of costs, this translates to an increase of 9 to 219 yen for initial consultations and 6 to 36 yen for subsequent consultations at the counter.

“The patient bears 30% of the increase, while the remaining 70% is covered by health insurance. If the balance of health insurance revenues and expenditures is disrupted, it may lead to discussions about increasing insurance premiums or raising consumption tax.”

At medical institutions that have raised initial and follow-up consultation fees after raising the wages of nurses and other staff, patients receiving medical care might understandably rebel, asking, ‘Why should patients bear this burden?’

“There’s also discomfort among those providing medical care about whether this should be covered by insurance points. Among doctors at the frontline, there’s a growing sense of crisis that they might incur the public’s wrath.

The increase in initial and follow-up consultation fees due to revision of medical fees also aims to improve revenue for medical institutions in response to inflation. However, patients won’t find it convincing if hospital and dental fees increase just like other goods due to inflation. If it’s said that this is a price increase related to promoting the use of minor insurance cards and base-ups, patients might find it even more unacceptable.”

“In essence, it’s a story where medical institutions that listen to the government’s instructions will increase their medical fees.”

In this revision of medical fees, a new addition called the ‘Medical DX Promotion System Development Bonus’ has been introduced. Medical institutions that meet the government’s requirements for promoting medical DX, such as online qualification confirmation and billing with My Number insurance cards, as well as introducing electronic prescriptions, can add 8 points to initial consultation fees (6 points for dental and 4 points for pharmacies). Whether patients use the My Number insurance card or the current insurance card, the initial consultation fee will increase by 80 yen, resulting in a 24 yen increase for patients covering 30% of the cost.

By the way, displaying posters to promote the use of My Number insurance cards is also one of the requirements.

“The conditions for implementing the government’s medical DX bonus in medical institutions are all facility standards aimed at utilizing My Number insurance cards in medical practice. Institutions that align their systems and structures according to government directives are evaluated and receive higher scores through the medical DX bonus.

In essence, it’s a story where medical institutions that follow the government’s instructions will increase their medical fees. For instance, although prescription fees have been reduced this time, the government seems to think, ‘It’s okay if we increase initial and follow-up consultation fees as long as we cooperate in expanding the use of My Number insurance cards.’ Medical professionals on the frontline feel dismayed by such carrot-and-stick methods.”

Furthermore, Nakata points out the government’s eagerness to accelerate the use of My Number insurance cards in medical settings.

In order for medical institutions to calculate the medical DX bonus, they need to submit facility standards notifications to the local health bureau. To make it easier to obtain medical fees by lowering the application threshold, the Ministry of Health, Labour and Welfare has included transitional measures in the facility standards.

“The facility standards for the medical DX bonus include transitional measures for electronic prescriptions and electronic medical record information sharing services, allowing calculation even if these are not yet implemented by now and have a grace period until next year. Electronic prescriptions have not been widely adopted in medical institutions, and the electronic medical record information sharing service systems aren’t operational yet, but applications are still accepted.

It seems the Ministry of Health, Labour and Welfare is out of touch with reality. It feels like they are floundering. One might say, ‘Take a step back and reconsider.'”

Even if medical institutions haven’t set up systems for issuing electronic prescriptions or utilizing electronic medical record information sharing services, patients will bear increased initial consultation fees as long as they meet other facility standards for the medical DX bonus. From the medical field, there’s confusion about how to explain this to patients when asked about the medical DX bonus.

“Whether it’s flat-rate tax cuts or other measures, I believe the government keeps burdening the frontline excessively. It’s about time they reconsider their approach. We need to put an end to policies that increase the workload on the frontline, dragging us down, even under the Kishida administration.”

Tomoyuki Nakata, DDS, Periodontist. Born in 1984 in Saitama Prefecture. He also works as a healthcare administration writer.