Is “Increased Burden with Use of Minor Insurance Card” a Prelude to the Collapse of Universal Health Coverage?

Another price hike! First Medical Examination Fee Increased due to Increase in Medical Reimbursement

The end of Japan’s proud “universal health insurance system” is about to begin.

Amidst the continuing news of price hikes, medical institutions and pharmacies using the “Mynah Insurance Card,” in which a my number card (Mynah Card) is used as a health insurance card, will be charged an additional fee for patient payments starting this April.

This is because medical institutions and pharmacies must install an “online eligibility verification” system in order to check the insurance eligibility of patients with the miner insurance card, and medical fees were increased in April to cover the cost of this system.

If a patient visits a medical institution that has introduced an online eligibility verification system with a miner insurance card, an additional 21 yen for an initial visit, 12 yen for a follow-up visit, and 9 yen for dispensing of medicine will be added if the patient pays 30% of the medical expenses. Even if a conventional insurance card is used, an additional 9 yen will be charged for the first visit until March 2024 if the medical institution has already introduced online eligibility verification.

The medical fees for medical institutions that accept the miner’s insurance card have been raised, which means that the medical fees paid by the patient have increased. This is effectively a price pass-through.

Tomoyuki Nakata, a dentist and healthcare administration analyst, says, “As the rush of price hikes continues, the “price pass-through” of the cost of medical care has become more and more difficult.

Full-scale operation of the miner insurance card began last October. The government must be hoping to promote the spread of the miner card and use of the miner insurance card in one fell swoop. However, the government has taken measures that may have the opposite effect of promoting the use of the card, such as raising medical fees, which would lead to a “price pass-on.

The government initially intended to begin full-scale implementation of the miner insurance card at the end of March 2021. But in the end, it was postponed to October, about six months later. We were aiming to have all medical institutions and pharmacies in Japan introduce an online eligibility verification system by October to coincide with that.

To this end, we provided card readers with facial recognition to hospitals, medical and dental clinics, and pharmacies nationwide free of charge. Subsidies ranging from about 210,000 yen to 1,050,000 yen were also provided to cover the costs of purchasing eligibility verification terminals and related software to be connected to the card readers, modifying existing systems such as online receipts, and improving the network environment.

However, the number of medical institutions and pharmacies nationwide that had introduced online eligibility verification was below 10% as of last October. Therefore, the MHLW conducted multiple written and telephone surveys of medical institutions.

In order to promote the use of the miner insurance card, it is not enough if there are no places where it can be used. I guess the government, after understanding the current situation through the survey, decided to raise reimbursement rates in order to increase the number of medical institutions introducing online eligibility verification.”

As of April 17, 40,384 facilities lined up on the “List of Participating Medical Institutions and Pharmacies Using the Health Insurance Card with My Number Card” published by the Ministry of Health, Labor and Welfare. Even after six months of full-scale operation, only about 17% of the approximately 230,000 medical institutions and pharmacies in Japan are participating.

The government intends to have approximately all medical institutions and pharmacies introduce online eligibility verification by March 2023 so that the miner insurance card can be used, but as of April 1, the miner card issuance rate was approximately 43% to begin with. As of April 10, only about 6.5% of the population had registered to use the Minor Insurance Card.

Even if one acquires a miner card, it is meaningless to register for use if there are only a few medical institutions that accept the miner insurance card. With only a limited number of patients using the miner insurance card, it is no wonder that the number of medical institutions introducing online eligibility verification is slow to increase.

High quotations from telecommunication providers far exceed government subsidies.

However, that is not the only reason why medical institutions have not yet developed their systems.

Last spring, the Council of Four Hospital Associations reported that telecommunications carriers had offered expensive quotations, far exceeding the government subsidy, for the installation of dedicated computers required for the operation of the online eligibility verification system and for the modification of the online receipt and electronic medical record systems. From this, we infer that some of the medical institutions that introduced the system at an early stage may have had to take out the cost of the system.

In addition to this initial cost, we also found that the running cost of the system is a fixed monthly cost. The card readers provided free of charge by the government are four models from four different manufacturers, but the running costs seem to vary depending on the model you choose because of compatibility with the receipt computer and electronic medical record to be connected.

Every medical institution should be aware of the advantages of online eligibility verification. However, if they have to pay out-of-pocket expenses and running costs, they may be reluctant to introduce the system.

Mr. Nakata himself is hesitant to introduce the system at his own hospital.

Actually, I had already applied for a card reader the year before last. Around spring of last year, I received instructions through the dental association to put the card reader, which was provided free of charge, into operation.

So we contacted the telecommunications carrier to get it up and running, and they explained that we would have to pay a monthly system connection fee of 6,000 yen and other installation costs. We were puzzled because we had already used up our subsidy on the installation of the line.

Subsequently, the response of the telecommunication providers changed, and information became mixed within the industry group. We decided to wait and see what would happen, as this is often the case in the diffusion phase of new systems and medical equipment.

The current situation may be that not a few medical institutions and pharmacies are waiting to see what information is available in the industry and what the patient trends are.

However, sooner or later we will have to introduce the system, so we are thinking of starting at some point.

How about making patients bear the cost of system implementation? ……

It is a bit difficult to read whether the number of medical institutions introducing the system will increase steadily in the future. In regard to the recent revision of medical fees, some doctors and medical administrators are asking on social networking sites, ‘What about making patients bear the cost of system implementation?

Medical fees are covered 70-90% by insurance premiums and taxes, and patients pay the remaining 10-30% at the counter as co-payment. According to Nakata, medical fees have been raised in the past by medical institutions meeting facility standards.

In the U.K. and other countries, investment in new facilities and medical equipment is generally financed by income from free medical care. In Japan, when it is deemed desirable for a new facility or system to be widely used, an industry group appeals to the Ministry of Health, Labor, and Welfare (MHLW) for the need for it to be covered by insurance. The result is the current situation.”

It is inevitable that medical technology will become more advanced and medical equipment more digitalized in the future.

The cost of introducing digital equipment and other devices will increase reimbursement for medical care, and each time this happens, the burden on the public will increase again and again,” he said. I myself have my doubts about the incorporation of this and that into the insurance system.

The co-payment of insurance premiums will rise year by year, and the burden at the counter will also increase repeatedly. If this happens, there is a possibility that some citizens will not be able to pay the premiums and will not be able to receive necessary medical care.

The additional burden for using the miner’s insurance card is indeed a small amount. However, this may possibly be a step toward the collapse of the “universal health insurance system” ……?

Tomoyuki Nakada, dentist and healthcare administration analyst, was born in 1984 in Saitama Prefecture. He writes for the news site “SAKISIRU.