When talking about reforming the healthcare system, the starting point of the discussion is often the increase in the demand for healthcare services and rising medical expenses as the population ages, with claims that “we therefore must increase insurance premiums,” “we therefore must increase the consumption tax rate,” and “we therefore must increase the number of facilities providing medical services and nursing care services” being common. Instead, what we should be asking ourselves is how can we change the healthcare system so that we can live healthier and longer lives without it costing so much.
1. Approve the Entry of Corporations and Significantly Expand Eligibility for “Mixed Billing”!
Until a few years ago, the impending collapse of the healthcare system due to hospital bankruptcies was frequently reported. In response, the government revised the medical service fees and increased hospital fees. I wonder if low fees for medical services were the only reason for the problems, however. I think rather that the issue was caused by a failure of hospital management.
Doctors are professionals in medicine but laymen in terms of managing a business. The rule to limit candidates for appointment as directors of medical corporations to doctors should be abolished. In addition, in order to free up business and increase scale through business mergers, the entry of corporations into the management of hospitals should be approved. It is also necessary to drastically expand eligibility for mixed billing, or a combination of medical treatment that is covered by the public health insurance system and treatment that is privately billed.
2. Promote the Widespread Use of Information Technology in Healthcare Services and Adopt the My Number System!
Health insurance claims have been significantly computerized during the last few years and have been made more efficient than before. The next issue is how to use the data effectively. If medical records, in addition to health insurance claims, will also be digitized and linked to My Numbers, the scope of use of such data would be rapidly broadened. It is said that by avoiding unnecessary duplication of examinations and drug prescriptions we can reduce medical expenses by more than one trillion yen. Moreover, if we can use consolidated, anonymized medical information as big data, it is expected that we can reduce medical expenses even further.
3. Decrease the Number of Patients rather than Increasing the Number of Doctors!
When comparing the number of doctors between different countries around the world, we find that the number of doctors per 1,000 people in Japan is 2.2, which is not remarkably lower than the 2.4 doctors in the United States and 2.7 doctors in the United Kingdom. On the other hand, while the average number of days spent in hospital is 6.2 in the U.S. and 7.7 in the U.K., in Japan it is 32.5 days. With regard to the number of outpatient visits per year, which is 3.9 in the U.S. and 5 in the U.K., the number in Japan is remarkably high at 13.1.
These figures indicate that in Japan it is not the number of doctors that is small but the number of patients that is large. We need to change our way of thinking and more emphasis should be placed on implementing measures to reduce the number of patients.
4. Incorporate Incentives for Preventive Healthcare into the System! Remove Restrictions on Online Sales and Abolish Pharmaceutical Management Fees to Facilitate Access to Drugs!
The key to reducing the number of patients is to shift to preventive healthcare and health promotion. In order to achieve a society where people can live a long and healthy life at an inexpensive cost to society, it is necessary to add preventive care to the list of medical care services and offer incentives for medical institutions, individuals, and corporations to maintain our health. The annual cost of dialysis treatment for diabetes is 1.5 trillion yen. If lifestyle-related diseases and other manageable diseases can be managed on a society-wide basis, it will be possible to significantly reduce national healthcare spending. The government should consider establishing a system that offers people incentives to maintain their health, such as differentiation of insurance premiums, and penalties to those who have failed to take responsibility for their health.
Furthermore, in terms of shifting from treatment to ongoing healthcare and from hospitals to care at home, it is important to make access to drugs easier. As a result of the revision of the Pharmaceutical Affairs Law in 2014, restrictions on online sales of non-prescription drugs were, in principle, removed. However, new rules have created barriers once again. Removal of restrictions without any exceptions is necessary. The pharmaceutical management fee of 300 yen for dispensing drugs is paid per prescription. By simple arithmetic, more than 210 billion yen is paid annually for more than 700 million prescriptions. This fee should be abolished as quickly as possible so that people can get drugs at cheaper prices.