{"title":"Report of Roundtable on the History of Patient Copayment in Japan's Health Insurance System","authors":"Masaru Wada, Shuzo Tsutsumi, Shuichi Nakamura","doi":"10.4091/IKEN.31-107","DOIUrl":"https://doi.org/10.4091/IKEN.31-107","url":null,"abstract":"","PeriodicalId":117299,"journal":{"name":"Iryo To Shakai","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115546605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cost containment policy is regarded as pivotal in the face of threatened financial sustainability due to aging and low fertility, while the discussion on contribution fairness and protection against household’s catastrophic payment to healthcare service has been left behind. Using the microdata derived from the most recently available microdata of the National Survey of Family Income and Expenditure, we assessed the prevalence of catastrophic payment due to healthcare services expenditure, and contribution fairness according to the household’s ability to pay. Our estimation indicated that the current system effectively protect against catastrophic payment due to medical services covered by the public medical insurance scheme, though the non-ignorable portion of households, especially with low capacity pay and higher long-term care demands faced the catastrophic impact of wider healthcare service expenditures. Fairness in financial contribution was well reserved thanks to the recently improved progressivity in direct tax contribution, though the regressivity in out-of-pocket copayment and social insurance premium payment was strong. The results indicated that the policy discussion on the healthcare financing should consider the potential impact of selective copayment rate rising in older households and stagnated economy due to COVID-19.
{"title":"Catastrophic Payment and Fairness in the Contribution to Medical and Long-term Care Cost","authors":"H. Hashimoto, Mutsumi Tokunaga","doi":"10.4091/IKEN.31-61","DOIUrl":"https://doi.org/10.4091/IKEN.31-61","url":null,"abstract":"Cost containment policy is regarded as pivotal in the face of threatened financial sustainability due to aging and low fertility, while the discussion on contribution fairness and protection against household’s catastrophic payment to healthcare service has been left behind. Using the microdata derived from the most recently available microdata of the National Survey of Family Income and Expenditure, we assessed the prevalence of catastrophic payment due to healthcare services expenditure, and contribution fairness according to the household’s ability to pay. Our estimation indicated that the current system effectively protect against catastrophic payment due to medical services covered by the public medical insurance scheme, though the non-ignorable portion of households, especially with low capacity pay and higher long-term care demands faced the catastrophic impact of wider healthcare service expenditures. Fairness in financial contribution was well reserved thanks to the recently improved progressivity in direct tax contribution, though the regressivity in out-of-pocket copayment and social insurance premium payment was strong. The results indicated that the policy discussion on the healthcare financing should consider the potential impact of selective copayment rate rising in older households and stagnated economy due to COVID-19.","PeriodicalId":117299,"journal":{"name":"Iryo To Shakai","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117150855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health policy making is very complex political process involving the interactions between multiple governmental agencies and pressure groups, requiring long time, and affected by socio-economical ups-and-downs and national elections. At the end of 2020, two policy issues reached conclusions under the COVID-19 calamity: the introductions of 20% patient burden into the Health Insurance System for the Late Elderly, and the increased outpatient burden without referral when visiting large hospitals. Why did these things happen? To answer why, this study did three things: the historical and institutional considerations on the strengthening of the Cabinet, the development of the governance structure of actors and conference bodies, and the process tracking of the above two issues. Findings are (1) under the parliamentary cabinet system and the stable majority of the ruling party the reform of the political system in 1994, the repositioning of the governmental agencies and conference bodies in 2001, and the gradual strengthening of the cabinet functions in later years, helped the cabinet to have more efficient consensus making mechanisms than before, and (2) appropriate measures were wisely adopted, depending on the level of political difficulties, which in turn depends on the unique features of the issue (and their effects on national election) and the level of the resistance by the opposing pressure groups. Limitations of the study were also discussed.
{"title":"The Structure and Process of Health Policy Making in Japan","authors":"Ichiro Innami","doi":"10.4091/IKEN.31-71","DOIUrl":"https://doi.org/10.4091/IKEN.31-71","url":null,"abstract":"Health policy making is very complex political process involving the interactions between multiple governmental agencies and pressure groups, requiring long time, and affected by socio-economical ups-and-downs and national elections. At the end of 2020, two policy issues reached conclusions under the COVID-19 calamity: the introductions of 20% patient burden into the Health Insurance System for the Late Elderly, and the increased outpatient burden without referral when visiting large hospitals. Why did these things happen? To answer why, this study did three things: the historical and institutional considerations on the strengthening of the Cabinet, the development of the governance structure of actors and conference bodies, and the process tracking of the above two issues. Findings are (1) under the parliamentary cabinet system and the stable majority of the ruling party the reform of the political system in 1994, the repositioning of the governmental agencies and conference bodies in 2001, and the gradual strengthening of the cabinet functions in later years, helped the cabinet to have more efficient consensus making mechanisms than before, and (2) appropriate measures were wisely adopted, depending on the level of political difficulties, which in turn depends on the unique features of the issue (and their effects on national election) and the level of the resistance by the opposing pressure groups. Limitations of the study were also discussed.","PeriodicalId":117299,"journal":{"name":"Iryo To Shakai","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134293491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An Analysis of the Relative Importance of “Fixed Amount out-of-Pocket Payment” When Deciding to Visit an Outpatient","authors":"T. Sugahara","doi":"10.4091/IKEN.31-31","DOIUrl":"https://doi.org/10.4091/IKEN.31-31","url":null,"abstract":"Since\u0007its\u0007introduction,\u0007fixed\u0007amount\u0007out-of-pocket\u0007payment,\u0007whose\u0007main\u0007purpose\u0007 is\u0007to\u0007optimize\u0007mild\u0007outpatients\u0007in\u0007large\u0007hospitals\u0007and\u0007to\u0007share\u0007functions\u0007with\u0007primary\u0007 care\u0007doctors,\u0007has\u0007gradually\u0007expanded\u0007its\u0007scope\u0007of\u0007application.\u0007From\u0007the\u0007point\u0007of\u0007view\u0007 of\u0007the\u0007purpose\u0007of\u0007the\u0007system,\u0007the\u0007fixed\u0007amount\u0007of\u0007out-of-pocket\u0007payment\u0007must\u0007be\u0007at\u0007a\u0007 level\u0007sufficient\u0007to\u0007suppress\u0007the\u0007incentive\u0007to\u0007visit\u0007a\u0007large\u0007hospital,\u0007but\u0007on\u0007the\u0007other\u0007 hand,\u0007it\u0007must\u0007not\u0007greatly\u0007hinder\u0007necessary\u0007consultations\u0007such\u0007as\u0007in\u0007severe\u0007cases. How\u0007to\u0007accept\u0007the\u0007fixed\u0007amount\u0007out-of-pocket\u0007payment\u0007might\u0007be\u0007different\u0007for\u0007 each\u0007individual,\u0007and\u0007how\u0007important\u0007fixed\u0007amount\u0007out-of-pocket\u0007payment\u0007in\u0007comparison\u0007 with\u0007various\u0007other\u0007conditions\u0007has\u0007not\u0007investigated.\u0007We\u0007examined\u0007what\u0007factors\u0007and\u0007 attributes\u0007affect\u0007the\u0007relative\u0007importance\u0007using\u0007conjoint\u0007analysis\u0007based\u0007on\u0007the\u0007data\u0007 collected\u0007from\u0007the\u0007web\u0007survey. As\u0007a\u0007result,\u0007it\u0007was\u0007suggested\u0007that\u0007the\u0007importance\u0007of\u0007the\u0007fixed\u0007amount\u0007of\u0007out-of-pocket\u0007payment\u0007when\u0007deciding\u0007to\u0007see\u0007a\u0007doctor\u0007is（1）there\u0007is\u0007a\u0007gender\u0007difference,（2） the\u0007relative\u0007importance\u0007of\u0007the\u0007elderly\u0007is\u0007low,\u0007and（3）the\u0007relative\u0007importance\u0007 increases\u0007in\u0007the\u0007group\u0007with\u0007low\u0007annual\u0007household\u0007income.","PeriodicalId":117299,"journal":{"name":"Iryo To Shakai","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127835267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of Out-of-pocket Payment Systems in Japan, Germany, France, and the United Kingdom","authors":"S. Okubo","doi":"10.4091/iken.31-45","DOIUrl":"https://doi.org/10.4091/iken.31-45","url":null,"abstract":"","PeriodicalId":117299,"journal":{"name":"Iryo To Shakai","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114805306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reform of the Medical Fee System from the Patients' Point of View and Reduction of Increase in Patients' Out-of-pocket Expenses to Promote “Choosing/saving wisely”","authors":"Hiroshi Nakamura","doi":"10.4091/iken.31-97","DOIUrl":"https://doi.org/10.4091/iken.31-97","url":null,"abstract":"","PeriodicalId":117299,"journal":{"name":"Iryo To Shakai","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115497975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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