NRI Papers
No.106 July 1, 2006
  Future Reforms of Medical and Long - Term Care Insurance Programs  
Minoru NAKAMURA
      The number of medical treatment bills exceeding 5 million yen per month per patient amounted to some 2,500 in 2004. In reforming the medical service system, the issue of rising costs incurred as a result of the progress of technology cannot be ignored, and any waste of medical service must be thoroughly eliminated.
Preventive medicine should be promoted, and the family doctor system that can be closely connected with the long-term care system should be introduced during a sweeping review of the medical service system.
      The government decided to increase the rate of copayments paid by seniors. In order to use the limited insurance premium revenue effectively, consideration may well be given to the introduction of an "insurance exemption system" in which all expenses of low-cost medical treatments are paid by patients, and only high-cost medical treatments are covered by insurance.
      While the number of low-income persons has been increasing among participants in regional health insurance programs, the rates of insurance premiums paid by participants under these programs are higher than are those of any other health insurance program. Regional and occupational health insurance programs should be integrated to equalize insurance premiums. With respect to long-term care insurance, insurance premiums must also be collected from the age segment of 20 through 39 years.
      In improving medical care and nursing care for seniors, priority should be given to the "quality of life." To enable seniors to live at home as long as possible and to live their remaining days comfortably, a home hospice network must be established. Medical care insurance and long-term care insurance are closely related.
      With advances in medical technology, issues that cannot be dealt with using the traditional sense of ethics have been emerging one after another, such as informed consent, fertility medicine, organ transplants, death with dignity, etc. These issues should be resolved on the assumption that priority is given to the right of individuals to make their own decisions.
Contents
I Review of Long-Term Care Insurance Program in 2004
II Reforms of Medical Service System for Seniors in 2005
III Restructuring of Regional Health Insurance
IV Reviewing the Distribution of Medical Care Expenses
V Respect of Self-Determination and Medical Treatment

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