Tokyo, Sept. 25 (Jiji Press)–Japan’s health care system is often held up abroad as a model of universal coverage. But universal does not mean uniform: patients undergoing the same expensive treatment can pay very different amounts themselves depending on which insurer they belong to, and the government’s latest reform will widen the gap. Under the high-cost medical expense benefit system, a ceiling is placed on the amount patients must shoulder themselves when they face large bills for surgery or other treatment, with public health insurance covering the remainder. Still, the sum actually paid for identical treatment varies by the type of insurance they are enrolled in. This is because health insurance societies, which mainly cover employees of large companies and their dependents, operate their own programs to ease members’ financial burdens. The Ministry of Health, Labor and Welfare has now revised the system to raise the out-of-pocket ceilings as it tries to slow spending in one of the world’s most aged societies–a change that will widen the disparity further. Out-of-Pocket Ceilings Japan’s public health insurance includes health insurance societies; the Japan Health Insurance Association, known as Kyokai Kenpo, which covers employees of small and midsize companies and their dependents; mutual aid associations for civil servants and others; the national health insurance program run by municipalities for the self-employed and the unemployed; and the medical care system for people aged 75 or older. Health insurance societies and mutual aid associations are free to set their own, lower ceilings on members’ out-of-pocket costs and to reimburse any amount above them. Many societies provide such extra benefits as part of the welfare services they offer members. Of the 1,380 health insurance societies in Japan, 929 offered such additional benefits to their employee members as of the end of fiscal 2023, according to the National Federation of Health Insurance Societies. Most cap members’ monthly out-of-pocket payments at 25,000 yen. Under the high-cost medical expense benefit system as revised in August, the base monthly ceiling for a patient with an annual income of 7 million yen stands at some 86,000 yen. If the patient belongs to a health insurance society offering the extra benefits, the actual burden is in many cases limited to 25,000 yen, with the society covering the remaining 61,000 yen or so. Annual Cap Kyokai Kenpo and the municipal national health insurance programs, by contrast, offer no such extra benefits, leaving patients to shoulder the entire out-of-pocket portion themselves. Because these programs are partly financed by public funds, “it would be inappropriate to use taxpayer money to provide benefits unique to a particular group of enrollees,” a health ministry official said. The official said that the decision rests with each insurer. “Extra benefits are introduced at the discretion of each health insurance society, so the ministry is in no position to ask them to adopt or abolish such programs.” The system will be revised again in August next year. For a patient with an annual income of 7 million yen, the monthly ceiling will climb to around 110,000 yen, widening the gap between those with and without extra insurer benefits to some 85,000 yen. The official instead pointed to the annual cap on out-of-pocket payments introduced under the revision in August this year. For people earning 7 million yen a year, their own payments are limited to 530,000 yen over a 12-month period. The yearly cap should help hold down the burden to some extent for patients who receive no extra benefits, the official said. END [Copyright The Jiji Press, Ltd.]
