Japan? Today s topics: Today s topics: Ongoing Reforms of Health Care Financing Systems in Japan. Projected Population & Life Expectancy

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1 Ongoing Reforms of Health Care Financing Systems in Japan Japan? Naonori Yakura, FIAJ, MScHM Sompo Japan Research Institute Inc. Population: 127,767,944 Area:377,835km² Projected Population Projected Population & Life Expectancy Male Female Source: National Institute of Population and Social Security Research 4 Source: National Institute of Population and Social Security Research 5 1

2 6 Basic Structure - Public Health Insurance 1) Every person is required to subscribe 2) Medical Service in Kind (not indemnity) 3) No mix of covered practice and uncovered 4) Fee-for-Service Payment to Provider 5) Uniform Coverage and Fees Nation-wide 3 more points for further information Coverage includes dental, prescription drug 30% co-insurance Uniform Provider Network 7 Public Health Insurance Scheme covers every Japanese resident,though there are many payers (managing organizations). Many Payers Public Health Insurance National Govm t Health Insurance Managed Scheme Societies Mutual Aid Associations Municipalities Uniform Coverage Every Japanese resident 8 9 Insured 30% co-insurance Medical service Medical Provider Premium Claim 70% of Medical Fee Claim Insurer (Payer) 70% of Medical Fee Social Insurance Medical Fee Payment Fund Clearing House Basic Structure - Health Service System for the Elderly Established in 1983 Eligibility: 70 years old or over in principle Financed by contributions from more than 5,000 insurers and from the national and local governments 2002 Amendment: Eligibility: step up to 75 from 70 years old Contribution from public fund: step up to 50% from 30%

3 12 Amendments - Highlights 1961 Established the universal health insurance regime for all Japanese % co-insurance from co-payment (YEN 800), etc Pay-as-you-go Medium-Term Financial Approach (5 years) 1997 Co-insurance: 20% from 10%, etc % co-insurance for the elderly (70 years old and over) 2002 Co-insurance: 30% from 20% Premium increase to 8.2% of annual salary for Government-managed Employees Health Insurance 20% co-insurance for infants and babies from 30% Elderly program: eligibility step up to 75 from 70 years old contribution from public fund 50% from 30% 13 Medical Benefite Projection by MHLW (7.3%) [5.4%] 40 (8.7%) [6.4%] 37 (8.1%) [6.0%] (10.5%) [7.7%] GDP growth assumption: 2.1% in 2006, 2.4% in 2007, 2.8% in 2008, 1.9% in 2009 and 2010, 1.6% in and after (9.1%) [6.7%] Unit: Yen trillion (): % against NI []: % against GDP Ongoing Reforms (passed on 2006/06/16) Objective: Sustainability of Universal Health Care System Measures: 1. Comprehensive implementation of medical expenditure rationalization 2. Establishment of new health service system for the elderly 3. Restructure/consolidation of insurers Comprehensive implementation of medical expenditure rationalization (1) 5 year planning by national and regional governments (2) Specified health checkup and follow-up health guidance & intervention for insureds over 40 years old will be obligatory for public health insurers (3) Revision of covered benefits valuing prevention appropriate system of medical expenses Nationally Mandated DM New law makes specified health checkup and intervention for insureds over 40 years old obligatory for public health insurers. (from April, 2008) Specified health checkups will focus on Metabolic Syndrome. According to the checkup results, the insured are to be stratified into 3 groups or more, which have different intensities of intervention

4 Metabolic syndrome diagnostic criteria of Japan published by eight academic societies(*) in April 2005: Visceral fat accumulation Abdominal circumference Male: 85 cm and over Female: 90 cm and over (equivalent to 100 cm2 or more of visceral fat area) Two or three of the following 2. New health service system for the elderly (1) Establishment of new health service system for the old elderly (New independent social insurance scheme from April 2008) (2) Financial Adjustment for the medical expenditure for the young elderly <Current> <New> (1) Abnormal serum lipid either one or both of: Triglyceride value 150 mg/dl HDL cholesterol value < 40 mg/dl Hypertension either one or both of: Systolic blood pressure 130 mmhg Diastolic blood pressure 85 mmhg Hyperglycemia Fasting blood sugar 110 mg/dl Age:75 Age:75 Age:65 (2) * It is desirable to measure the amount of visceral fat by methods such as CT scans. * The abdominal circumference should be measured at navel height with light breathing while standing. If there is obvious fat accumulation and the navel points downward, the circumference should be measured at mid-level between the subcostal edge and the anterior interspinal line. * If an individual is diagnosed with metabolic syndrome, a glucose tolerance test is recommended, although not necessary, for the diagnosis. * If an individual is receiving medication for hypertriglyceridemia, decreased blood HDL-C, hypertension, or diabetes, this should be noted as respective items. Eight academic societies(*): the Japan Society for the Study of Obesity, the Japan Atherosclerosis Society, the Japan Diabetes Society, the Japanese 18 Society of Hypertension, the Japanese Circulation Society, the Japanese Society of Nephrology, the Japanese Society on Thrombosis and Hemostasis, the Japanese Society of Internal Medicine Municipality Employment Based Based Municipality Based Employment Based Scheme Scheme Scheme Scheme 19 New independent social insurance scheme for the elderly with age 75 years old and over Financial Contributions: premium 10% health insurers 40% Government 50% The amount of contribution by each health insurer will be adjusted to reflect the performance of specified health checkup and intervention measures within a range of +/- 10%. (from April, 2013) Restructure/consolidation of insurers (1) Reorganization of Social Insurance Agency (2) Strengthen of financial base of National Health Insurance (3) Health Insurance Society based on Locality <Key Points on the Reorganization of Social Insurance Agency> -Fiscal Administration by Prefecture Unit To establish a new public legal entity as insurer independent from the Government and premium rates reflecting the local medical expenditure level by prefecture unit -Stabilization of Fiscal Administration The new public legal entity can not be authorized to dissolve and the necessary measures should be taken to stabilize its fiscal administration -Autonomic & Self-directed Insurance Operation To ensure an autonomic and self-directed insurance operation reflecting premium payers opinion, push ahead with the rationalized and streamlined operation. EEs of the new entity are not in government employ. 21 Reorganization Scheme <Current> Ministry of Health, Labour and Welfare Minister of HLW Oct <New> Ministry of Health, Labour and Welfare Establish, Supervise New Public Legal Entity Decision Making Board Executing Board auditing organization Social Insurance Agency Prefecture A (Executing Board) Prefecture A (Executing Board) external audit Council Council

5 Premium rates by prefecture unit Prefectures Base Data Age Adj. Income Adj. Prem. Rate Trial calculation by N. Yakura The actual medical expenditures vary among prefecture units. Hokkaido Current The Uniform premium rate within the organization Tokyo New The difference in age and income distribution is to be adjusted. The remaining difference of local medical expenditure level is reflected on the premium rates by prefecture units. Okinawa Concluding Remarks 1.Specified health checkup and follow-up intervention Obligatory for public health insurers But no incentive / disincentive for the insureds Participation Rate? 2.New health service system for the old elderly Details is now under planning. (reimbursement scheme, etc.) 3.Reorganization of Social Insurance Agency Will fiscal administration by prefecture unit work? Thank you very much for your attention See you in Tokyo in October!! Contact: Naonori Yakura Sompo Japan Research Institute Inc. nyakura@sj-ri.co.jp 28 South East Asia Health Insurance Conference - Sunday, July 29, 2007 in Singapore 5