Is the My Number Health Card’s Inability to Use My Number the Biggest Issue?

The My Number Health Insurance Card is the foundation of medical DX (Digital Agency). Yet, the cancellation process is super analog.

The integration of the My Number Card as a health insurance card, known as the “My Health Insurance Card”, officially began on December 2. From now on, new “paper health insurance cards” will no longer be issued.

However, prior to this integration, movements to cancel the registration for the My Health Insurance Card had been happening across the country since late October. Initially, the My Health Insurance Card could not be canceled once registered, but the government made it possible to cancel the registration starting from October 28. The main reasons for cancellation seem to be concern about carrying it around and wanting a certificate of eligibility.

The government decided to modify the system to allow for the cancellation of My Health Insurance Card registrations in August 2023. However, the Ministry of Health, Labour and Welfare only communicated the details to the health insurance associations and local governments in February 2024, and it was not until October 9—eight months later—that the operation to begin accepting registration cancellations was announced.

“The government probably thought that no one would want to go through the trouble of canceling their registration once they had signed up. In other words, they never anticipated this from the start.”

Toshihiro Enami, a senior researcher at the Administrative Systems Research Institute and a consultant at Fujitsu, who has been involved in the development of the resident registry system and is well-versed in the design of the My Number system, pointed out this issue.

The Ministry of Health, Labour and Welfare’s website explains the following regarding the cancellation of My Number Health Insurance Card registration:

• The registration can be canceled by applying to the insurer (health insurance associations or local governments).
• After cancellation, if there is no valid insurance card, a qualification confirmation document can be issued.
• For specific inquiries about the cancellation process, contact the insurer to which you belong.

The government has left the cancellation process to the insurers. In practice, the explanation of the cancellation method varies depending on the local government.

Moreover, the cancellation application requires a paper procedure. Applicants must visit the health insurance association or local government office or send the application by mail, along with an official identification document issued by a public agency. Despite the claim that “My Number Health Insurance Card is the foundation of medical DX” (Digital Agency), the cancellation process is decidedly analog.

If we use the My Number itself, no trouble would occur.

By the way, people who have not obtained a My Number Card or have obtained it but not registered it for health insurance use will be issued a qualification confirmation certificate. Even for those who have registered but face difficulties receiving medical treatment with the My Number health insurance card, such as the elderly, they can apply for the qualification confirmation certificate when their current insurance card expires.

“It feels like the government is taking an ad hoc approach. This is likely causing confusion at the local government level. The problem is that people who don’t understand the systems or the field operations are arbitrarily creating and moving forward with laws and systems,” said Toshihiro Enami.

The operation of the My Number health insurance card began in October 2021. Around the same time, Japan’s lag in digitalization, especially in terms of COVID-19 vaccine distribution, became apparent. The government seemed to have envisioned increasing the usage rate of the My Number health insurance card as a stepping stone to accelerate the digitization of healthcare (DX).

However, even three years after the full-scale implementation, problems related to the My Number health insurance card continue to persist. Where do the issues lie, and is healthcare DX advancing? I asked Enami once again.

“The My Number system was originally designed with the intention of using My Number for social security, taxation, and disaster management. Since healthcare insurance is part of social security, using the My Number card as a health insurance card was naturally assumed from the start.

However, the way My Number is used in healthcare is incomplete. The reason is that cash benefits and in-kind benefits in healthcare insurance are considered separately.”

Cash benefits in healthcare insurance refer to payments such as sickness allowances and high-cost medical expenses, while in-kind benefits refer to medical services like consultations, treatments, and prescriptions.

“Regarding cash benefits in healthcare insurance, the use of My Number is stipulated in the My Number Act. However, for in-kind benefits, such as medical procedures, medical records, and prescription histories, My Number cannot be used.

In fact, during the design of the My Number system under the Democratic Party administration, there was a discussion that using My Number for diseases, especially genetic disorders, could infringe on privacy beyond the individual. As a result, it was decided to create a special law, separate from the My Number Act, to handle in-kind benefits in healthcare.”

However, that special law has yet to be enacted.

 

“The My Number system was created under the Democratic Party administration, but after a change in government, the Liberal Democratic Party passed the My Number Act. However, the issue of creating the My Number special law seems to have been forgotten.”

It appears that the Liberal Democratic Party is no longer motivated to proceed with this. Therefore, My Number cannot be used for medical procedures, medical records, and other in-kind benefits, which should have been the intended use.

“In order to identify individuals at medical institutions and pharmacies, My Number is absolutely necessary. However, it cannot be used in the medical field.

So, what was done instead? First, insurers were required to link My Number with insured person numbers. Then, insured person numbers and qualification information were linked, and a new linking number was added.

Furthermore, by linking this linking number with the serial number of the digital certificate on the My Number card, identification is carried out. With this, medical records managed with qualification information and insured person numbers can be retrieved at medical institutions and pharmacies.

In the end, because My Number could not be used in the medical field, the My Number health insurance card was launched with this extremely complicated system.”

So far, troubles related to the My Number health insurance card, such as issues with card readers and mistakes in linking health insurance information, have been reported. However, Mr. Enami points out that if the My Number itself were used, such problems would not occur.

“For example, regarding the card reader issue, if only the My Number were used, there would be no need for complicated systems or devices like reading the IC chip’s digital certificate or facial recognition. If you scan the QR code on the back of the My Number card with a smartphone, you can easily read the My Number. At the hospital or pharmacy counter, you can simply show your My Number and confirm your identity using the photo on the card.”

 

The improvement of the reliability of the My Number health insurance card and the advancement of medical DX depend entirely on the enactment of a special law.

On the other hand, what is the situation regarding medical DX, which begins with the use of the My Number health insurance card?

For example, when a patient receives treatment using the My Number health insurance card, medical information such as diagnosis and prescriptions is stored in a database. Doctors and pharmacists can access this information, and the patient can view it through the My Portal. However, medical information is only updated once a month, and the most recent month’s data cannot be accessed.

“At this point, the information available for viewing is receipt information, meaning medical insurance billing data. Medical institutions close their billing every month and submit it to the health insurance union, so the data is updated once a month.

However, starting from the 9th of this month, the emergency summary used in emergencies has become accessible, allowing for the viewing of the most recent data.”

The government promotes the advantages of the My Number health insurance card, such as real-time sharing of prescription medication data through electronic prescriptions and sharing of medical records between medical institutions, which would enable patients to receive better healthcare based on data.

The database integration within hospitals has progressed to a certain extent.

Regarding electronic medical records, it seems that the Ministry of Health, Labour and Welfare has finally entered the stage of promoting the “Electronic Medical Record Information Sharing Service.” However, it may still take some time before electronic medical records are shared across national medical institutions and pharmacies via the network.

This is because, in order to share electronic medical records, the data needs to be standardized, but at the moment, the unification of electronic medical records by the government is not progressing. From observing the situation, I feel the Ministry of Health, Labour and Welfare lacks strong leadership. This could also be seen as a result of the strength of the medical association.

When will citizens actually experience the benefits of the My Number health insurance card?

“First, the system needs to function smoothly. To achieve this, what is needed is the unification of codes and the standardization of data. With My Number, code unification has been achieved. That’s why it’s essential to use My Number.

When it comes to data standardization, even standardizing kanji hasn’t been done. In My Number health insurance card issues, there’s a problem where black circles (●) appear on names and addresses during qualification checks. This is because kanji is not standardized.

As I mentioned earlier, the system using the serial number of the electronic certificate has become extremely complex. I wonder if DX can be steadily advanced in this state.”

Would it be possible to pass a special law for My Number and simplify this complex system?

“If a special law is passed, leading to the use of My Number, such a shift could happen. However, politicians likely do not view the inability to use My Number as the root cause of the My Number health insurance card issues. They probably think the system will work once its design is functional.

I’ve been making recommendations about these issues for over 10 years, and we are still in this situation, so I’m starting to get tired.”

The My Number system was created during the administration of the Democratic Party. Considering that former Prime Minister Yoshihiko Noda has returned as party leader, it might be time to consider reviving the special law along with the proposal to reinstate the current health insurance card.

Toshihiro Enami (Consultant at Administrative Systems Research Institute, Chief Researcher at Tateshina Information) joined Fujitsu in 1981. He worked on developing municipal systems, including the Basic Resident Registration system. Since 1995, he has been engaged in research activities related to e-government, e-local government, and My Number at Fujitsu Research Institute. He is the author of books such as “Digital Procedure Law and Its Impact on Corporate Practices” (Nihon Horei) and “The Curse of My Number” (Aoyama Life Publishing).