Reining in medical expenditures
(From The Japan Times Oct. 15 issue)

医療給付費抑制の道

    The figure of 2 percent may be a small and acceptable growth, requiring no stricter lid on the rise of the nation's medical spending. But Japan's financial deterioration has made a reduction in medical costs an important policy issue. A reduction in medical spending is necessary to help rehabilitate the government's financial situation and to keep the health insurance system from going bankrupt. Helping the nation's citizens maintain a healthy, productive life depends on the sound management of the health insurance system.

    Mr. Hidehisa Otsuji, minister of health, labor and welfare, hopes to push down medical service benefits paid by health insurance plans and the central and local governments to about 9 percent of national income in fiscal 2025. Unless special measures are taken to reduce total medical spending, it is estimated that the amount of benefits will reach 11 percent of national income in fiscal 2025, up from 7 percent in fiscal 2004. The Health Ministry envisages reducing medical benefits by about ¥6.5 trillion that year.

    Rising medical costs for elderly people are the largest contributor to the increase in the nation's medical service outlays. The per capita medical cost for elderly people is about five times higher than the amount spent on younger people. Elderly people visit hospitals more frequently and are hospitalized for longer periods of time than younger people. To reduce the length of hospitalization stays, the Health Ministry plans to strengthen public preventive education on adult-onset diseases, including diabetes and hypertension, and to build a system to care for sick people at home instead of in hospitals.

    Other measures considered by the Health Ministry include: having elderly people whose income is above a certain level pay more of their medical costs instead of the current 10 percent (20 percent from August 2006); charging fees for meals, electricity and city water from patients who are hospitalized for a long time; and raising the cap on payments by patients who receive advanced medical treatment. It even proposes that public health insurance not be applied to low-cost medical treatment, thus having patients shoulder all the cost for certain types of medical treatment.

    The ministry is also considering lowering fees for drugs and medical treatment covered by public health insurance systems in step with recent price and wage movements. Since this means lower revenues and income for pharmacy owners, doctors and nurses, organizations such as the Japan Pharmaceutical Association and the Japan Medical Association are likely to put up fierce resistance.

    The Finance Ministry and the Council on Economic and Fiscal Policy, an advisory body reporting to the prime minister, call for a drastic approach. They propose introduction of a numerical target linked to the economic growth rate to limit increases in the nation's medical spending. If medical costs continue to grow at the current rate, it will rise to 7.7 percent of gross domestic product in fiscal 2025, up from 5.4 percent in fiscal 2004.

    Some members of the council think the growth in medical costs can be held to 5.8 percent of GDP in fiscal 2025 by using the GDP-linked numerical target. The Health Ministry fears that such a system may lead to an unbearably high increase in the patients' share of medical costs, resulting in a deterioration of public health.

    Apart from the introduction of the numerical target, the Health Ministry's ideas overlap some of the Finance Ministry's proposals. The latter strongly wants to narrow the range of drugs and medical services covered by public health insurance, increase the financial burden shouldered by wealthy elderly people for medical services, and steeply reduce fees for drugs and medical treatment that are determined by the government and paid by public health insurance associations. Regarding the last point, the Finance Ministry points out that while the National Personnel Authority has recommended lowering wages for public servants, the personnel costs for doctors and nurses have risen.

    Whichever approach the government may take, the effect of efforts to restrain medical spending will vary, depending on the combination of methods used and the weight given to various components.

    Both the government and the Diet must conduct thorough and detailed discussions in order to work out a reasonable and viable plan.

The Japan Times Weekly
Oct. 22, 2005
(C) All rights reserved

    尾辻厚労相は、2025年度の医療給付費を国民所得の9%程度に抑制する意向である。特別の措置が取られなければ、同年度にはその比率は11%（04年度は7%）に達すると予想されている。

    医療給付費が増加を続けている原因として高齢者の問題が挙げられる。通院回数が多く入院期間も長いため、1人当たりの費用がその他の国民の5倍以上に達し、医療給付費全体を圧迫している。

    この問題について厚労省は、糖尿病や高血圧などの生活習慣病予防や在宅介護制度の改善、高齢者の自己負担増などを計画している。

    さらに同省は、健康保険が適用される医薬品代、治療費などの診療報酬を引き下げることを検討しており、日本医師会、日本薬剤師会などからの強い抵抗が予想される。

    財務省と経済財政諮問会議は、医療給付費の増加を抑制するため、経済成長率にリンクした数値目標導入を提案している。現在のペースで同費用が増加し続ければ、2025年度にはGDPの7.7%（04年度は5.4%）に達する計算だ。

    経済財政諮問会議では、GDPにリンクさせた数値目標の採用で、2025年度の医療給付費はGDP比5.8%に抑制できるという意見が出ている。厚労省は、そのような制度では医療費の患者負担分が異常に高くなり、国民の健康が損なわれる可能性があると指摘している。

    医療給付費を抑制する取り組みの効果は、さまざまな手法の組み合わせ、それぞれの優先順位によって変わってくる。

    政府、国会は合理的で、実行可能な計画を策定するため十分議論をせねばならない。