As the government continues looking for ways to reduce expenses in the face of the world’s biggest debt burden, every ministry is expected to pitch in. The Health, Welfare and Labor Ministry has probably the biggest job in this regard since it is responsible for the primary drain on future fiscal resources, namely all those old people on the horizon. We’ve already talked about the ministry’s attempt to make elderly patients pay a little bit more for their care, a scheme that was shot down by doctors who say such a move would discourage older people from seeking the help they need, though critics suggest the doctors are worried more about their own bottom lines.
Now the ministry has come up with another money-saving plan that will likely irk the medical profession. Starting in April, the ministry will start withholding reimbursements for basic hospitalization fees if the hospitalization is deemed to be “unnecessary.” At issue is weekend hospital stays, which the ministry believes are wasteful. When the length of a hospital stay was measured against the day that the hospitalization began, the longest ones were found to start on Fridays, with an average of 18.14 days. In contrast, hospitalizations that begin on Wednesday average three days less. The ministry concludes that Friday-start hospitalizations are longest because nothing is really done over the weekend, and that whatever treatment is involved begins in earnest on Monday. However, the patient has to pay for the weekend hospitalization and national insurance will reimburse him or her for much of that payment. Hospitals can charge the full amount for the stay even though their personnel and overhead costs over the weekend are less than they are during the week.
The health ministry’s plan is to pay less for weekend hospital care. The point is to dissuade hospitals from starting patient stays on Fridays, but the ministry also wants to persuade them to discharge patients before weekends as well. The basic hospitalization fee (nyuin kihon ryokin) that the ministry now pays is between ¥9,340 and ¥15,550 per day, and no matter what time of day the patient is discharged, the hospital seeks payment for the full day, so theoretically a hospital can discharge a patient early on Monday morning and receive three extra days of fees without doing much of anything except feed the patient. Hospitalizations that end on Monday last for an average of 17.9 days, while those that end on Saturdays last three days less. Consequently, the ministry will not reimburse payments for a full day when the patient is discharged before lunch.
Japan is famous for its long hospital stays, which critics say have more to do with Japan’s national health insurance system than it does with quality of care. Hospitals want to make as much money as possible from patients and so are believed to “recommend” long hospitalizations. It’s why old people in Japan invariably die in hospitals rather than at home or in hospices and nursing homes.
So far, private insurers haven’t commented on the ministry plan. Since private medical insurance is mostly supplemental in that it provides subscribers with cash depending on how many days one is hospitalized, these private insurers should also be concerned if hospitals are keeping patients for unnecssarily long stays, but then again the whole idea of long hospitalizations is what makes their insurance policies attractive. If hospital stays were significantly shorter, most people wouldn’t see the need for supplemental insurance in the first place.