Posts Tagged ‘Ministry of Health Labor and Welfare’

Hospitals redefine the meaning of ‘weekend getaway’

Tuesday, February 7th, 2012

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.

In light of the health ministry's plan, patients looking to save on healthcare would do well to fall ill early in the week (Kyodo photo)

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.

Doctors afraid new fee will reduce customers … er, patients

Sunday, October 30th, 2011

At the end of September the Ministry of Health Labor and Welfare released figures for medical care expenditures in fiscal 2009. Based on national insurance records, Japanese people spent ¥36.67 trillion on medical care that year, a 3.4 percent increase over 2008. That boils down to ¥282,400 for each man, woman or child, which is a 3.6 percent increase over the previous year. Broken down demographically, patients between the ages of 65 and 74 accounted for 55.4 percent of money spent (¥19.94 trillion) and patients 75 and over 32.6 percent (¥11.73 trillion). Per capita, Japanese under 65 spent ¥163,000 for the year, those between 65 and 74 ¥687,000, and those 75 and older ¥855,800. In terms of sources of revenue, 48.6 percent (¥17.5 trillion) came from premiums for both the Kokumin Kenko Hoken (National Health Insurance) and the Kenko Hoken (Employees Health Insurance) systems; 37.5 percent (¥13. 49 trillion) came from national and local taxes; and the remaining 13.9 percent (¥4.99 trillion) came from patients’ pockets.

The kid stays in the picture: JMA ad against proposed ¥100 fee

These amounts were the highest since MHLW started keeping track. Japan’s Gross Domestic Product went down in 2009, but the portion of GDP accounted for by medical care, 7.6 percent, was higher than the previous year’s portion, which means that not only is more money from premiums being spent, but more people are paying out-of-pocket for medical care, since 10-30 percent of a doctor’s and pharmacist’s bill is paid for by the patient. This portion can be extremely large when hospitalization or special treatments are involved, and in many cases where patients’ expenses are exceedingly high (kogaku iryohi) the government will reimburse them depending on their individual incomes. The MHLW has decided that the current pay schedule for this excessive medical expense system is obsolete, and has restructured it to allow more income brackets and higher reimbursements. The problem is that as the population ages revenues from premiums are going down since people over a certain age pay less, even as they use more insurance. So where are they going to get the money to fund this new excessive medical expense system?

The provisional answer is something called the madoguchi futan (literally, “window burden”), a ¥100 fee that will be added to every doctor’s visit and paid by the patient. The Japan Medical Association has roundly condemned this fee, saying that it penalizes older people and others on fixed incomes, effectively widening the gap between rich and poor. In the long run, it will discourage lower income people from seeking medical help.

Continue reading about bump in doctots' fees →

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