Posts Tagged ‘national health insurance’

Competition taking a bite out of dentistry schools’ tuition schemes

Monday, December 5th, 2011

Drive 'n' drill: Former convenience store turned into dentist's office

Recently, the Japan Medical Association protested the government’s desire to increase the number of medical schools as a means of solving the doctor shortage. The JMA says that more physicians will undermine the pay potential of all doctors and points to the situation of dentists, whose average salaries have decreased markedly in recent years due to a glut.

In a society aging as rapidly as Japan’s is, you can never have too many doctors, but dentists? As a medical practice, dentistry tends to be self-defeating. The better job dentists do in promoting oral hygiene, the less there is for them to do. Like America in the ’50s and ’60s, Japan became more aware of dental health in the ’80s and ’90s and people spent more money on their teeth and those of their children. Such a development had two outcomes: More young people turned to dentistry as a career, and people’s teeth became healthier. Since the latter meant that people required less capital-intensive dental work in the long run, dentists on the whole made less money, especially since their numbers grew as the years progressed.

Consequently, fewer students are opting for careers in dentistry, which is bad news for dentistry schools, especially private ones. According to a recent article in the Asahi Shimbun, the number of university students who said they “wanted to enter dentistry” dropped below 10,000 for the first time in 2008. A year later that number had plummeted to less than 5,000. This year, the number of applicants to the nation’s 17 private dentistry schools is less than the number of openings.

Continue reading about dentistry in Japan →

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 →

Local governments crack down on health insurance scofflaws

Sunday, September 11th, 2011

Enough to make you sick: monthly Kokuho payment schedule

According to an article in the Aug. 29 Asahi Shimbun, the number of asset seizures initiated by local governments in an attempt to recoup delinquent national health insurance payments has increased startlingly in the past four years. Asahi asked the pertinent sections of all 23 wards in Tokyo, as well as those in 19 major cities about seizures. They received responses from 37 local governments in all, and the data indicates that between fiscal 2006 and fiscal 2010, the number of delinquent payments that led to actual seizures of assets increased by almost sixfold.

In this case, we’re talking about Kokumin Kenko Hoken, or National Health Insurance, which is paid by anyone who is not a member of the Shakai Kenko Hoken system, which is paid for by contributions from employers. Traditionally, National Health Insurance, known as Kokuho for short, was carried by people who are self-employed. And that’s still true. However, the ranks of Kokuho carriers has increased greatly over the past two decades as the employment situation has changed. With more people out of work and even more changing over from so-called lifetime employment to so-called non-regular employment, the number of people who are compelled to pay into the Kokuho system gets larger and larger. Kokuho is administered by local governments, and national insurance, whether paid for by the individual or by his/her employer, is mandatory in Japan. If the individual is too poor to pay the premiums, he or she should go to the local government office and tell an official. The only real way to get out of the system and still have insurance is to qualify for welfare. Other than that, in principle everyone has to pay. Some local governments have a system wherein someone who has not paid because of financial difficulties but needs medical care can pay the full amount of that care up front and receive at least partial reimbursement later, but those are exceptional cases.

Continue reading about health-insurance crackdowns →

The hidden economics of diabetes

Wednesday, June 29th, 2011

Last week the medical journal Lancet published the results of a study that found the number of diabetes patients rising rapidly throughout the world. Right now about 10 percent of the world’s population suffers from the disease, which is traditionally associated with countries that have higher standards of living, like the United States. However, Lancet reported that diabetes is reaching epidemic proportions in the developing world as well owing to obesity and inactivity. Since diabetes leads to all sorts of serious health problems, including kidney failure, heart attacks and blindness, the epidemic will add an insupportable burden to medical costs in the next century.

Pick-me-up: Patient delivery van outside of dialysis clinic in Chiba

Diabetes is on the increase in Japan, too, and is one of the reasons the national health insurance program is in trouble. A recent report on NHK’s “Closeup Gendai” showed how local governments are trying to reduce doctor visits among local residents. In Kure, Hiroshima Prefecture, officials have compiled a database of people who may be contributing to “wasteful medical costs.” To qualify for the database, a person has to have visited a clinic or hospital at least 15 times during the course of a single month. An official then talks to this person to learn the reason for the frequent visits.

NHK points out that these inquiries are delicate. The doctor-patient relationship is a private one, and the local government is careful not to come across as interfering with that relationship. Nevertheless, many older people, because they pay very little out-of-pocket for a doctor’s visit, go to the hospital often even if their medical complaints are very slight. Some have even confessed to going to the hospital for social reasons, to chat with friends or make new ones. In any case, the local government official often suggests other ways of dealing with health problems in order to cut costs, such as asking for generic drugs when filling prescriptions or recommending lifestyle changes that can prevent future illnesses.

Continue reading about diabetes in Japan →

More independent women taking out insurance

Saturday, January 15th, 2011

Every three years the Japan Institute for Life Insurance (Seimei Hoken Bunka Sentaa) conducts a survey to measure trends in the insurance market. Last year the institute quizzed more than 4,000 people and for the first time since the survey started in 1987 the percentage of women who say they have taken out insurance policies exceeded the percentage of men who said they have. The margin may seem negligible — 81. 4 percent to 79.9 percent — but in 1987 the rate for men was 84.9 percent and that for women was 71.2 percent, so at the very least there’s been a sizable increase in the female insurance market.

Insurance in this case is the personal kind, meaning life insurance, annunities and supplemental health insurance, all of which are related to long-term individual financial planning. The drop in insurance policy rates for men is attributable to several factors, concludes the institute, the main one being that men are marrying later (if at all) and thus putting off insurance purchases, in particular life insurance with death benefits. Certainly the main reason for the rise of insurance purchases among women is due to the increasing participation of women in the permanent workforce. Insurance companies have not neglected this trend and have duly developed products that target women, including supplemental health insurance covering illnesses that specifically affect women, such as breast cancer. Despite the fact that Japan’s national insurance program pays for cancer treatment and necessary hospital stays, women seem particularly interested in supplemental cancer insurance, not so much because they can upgrade to a better hospital care (which is the more traditional reason for buying it) but because such extra money, usually from ¥5,000 to ¥10,000 a day, helps alleviate the loss of income that often accompanies such treatment.

The institute doesn’t analyze their results to this extent, but it seems obvious that the women taking out these policies are single and thus financially dependent on no one but themselves. For instance, few seem to be actually taking out life insurance with death benefits. But as with suppliemental health insurance, one kind of policy that is quickly gaining popularity among this demographic is wage insurance (kyuryo hoken). Such insurance gives policy holders guaranteed income for limited periods of time when they cannot work due to illness or accident or reasons of an unforeseeable nature.

Hitachi Capital offers a policy that provides ¥100,000 a month for up to five years (and whose promos feature a salarywoman not a salaryman), while American Home Direct pays ¥120,000 a month for up to a year. The insurance provider AXA has a policy that combines cancer insurance with income insurance (shunyu hoken) and aims it squarely at women, as illustrated by the company’s TV commercial, which shows the famous model An (daughter of actor Ken Watanabe) playing an office worker facing her supervisor and forcefully telling him that she’s taking time off to fight her cancer. On its website AXA claims that two-thirds of working women who have cancer report that their income dropped after they were diagnosed, and elsewhere in the media a commonly cited, though somewhat misleading, statistic says that half of all Japanese will be diagnosed with cancer sometime in their lives.

Because Japanese people don’t trust the government and aren’t assured by public welfare policies, they comprise one of the most lucrative life insurance markets in the world. And since women have traditionally been marginalized in terms of employment, they may feel more of a need to assure for themselves a future that isn’t assured at all.

Price of mercy can be dear when it comes to transplants

Friday, November 5th, 2010

Home page of the Japan Assoc. for Kidney Disease Patients

Website of the Japan Association for Kidney Disease Patients

One of the lesser discussed principles of Japan’s national health insurance policy is that it only pays for treatment. That sounds like a pretty broad mandate, but what most people don’t realize is that “treatment” presupposes a condition that needs to be remedied. In other words, you have to be sick. If you’re not, insurance won’t cover it. That’s why pregnancy testing and periodic checkups are not covered by insurance, though many local governments provide free cancer screenings and other preventive measures to residents of a certain age.

This principle receives a thorough test in the realm of organ transplants. Last week, the Tokyo Shimbun ran a letter from a 65-year-old woman who said that she wanted to donate one of her kidneys to her brother, who had to receive dialysis treatment at least once a week. Living organ donors have to undergo a series of tests to make sure that the organ they are donating is compatible, and the woman spent one week in an Aichi Prefecture hospital where her kidneys, as well as her overall health situation, was thoroughly scrutinized. Afterward, doctors determined that her kidney was “not functional enough” for transplantation into her brother.

Continue reading about health insurance and organ donors →

What’s the real cost of quitting?

Friday, October 29th, 2010

Discontinued Pfizer ad: Hiroshi Kan is quitting, too

Pfizer poster: Tachi Hiroshi is quitting, too

Recently, the Health Labor and Welfare Ministry released the results of 15 years of research into the amount of money a person spends on health care during an entire lifetime. The research began in 1994, based on records of 52,000 male and female residents of Miyagi Prefecture aged between 40 and 79.

According to the research, a 40 year-old-man today with normal blood pressure could expect to live another 46.5 years and spent a total of ¥13.34 million for health care, which, if he has kokumin hoken (meaning individual national insurance rather than national insurance through an employer), means he would spend about ¥4 million out of pocket, given that patients have to cover 30 percent of a medical bill themselves. A man with high blood pressure can expect to live 44.8 years more and spend ¥17.1 million. The ministry makes no projections for women because the results were “too diverse.”

In terms of other lifestyle determinants, a person who walks more than one hour a day will live 1.5 years longer and spend ¥350,000 less than someone who walks less than one hour a day (on average). However, the most interesting estimate is that someone who smokes will live 3.7 fewer years than someone who doesn’t and will thus spend less during his lifetime on medical care than someone who doesn’t smoke, though the ministry doesn’t specify by how much. The rule of thumb is that elderly people spend exponentially more on health care than do younger people, so if smokers die before they get old, the government saves considerably.

Continue reading about the tobacco tax →


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