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How to curb ever-increasing medical expenses is an important task to study. That being said, carelessly reducing pharmaceutical costs to serve the interests of political parties would only cause turmoil in frontline medical institutions.
It is necessary to proceed with reform while keeping an eye on the overall social security system, taking into consideration the viewpoint of patients who would have to bear an increased burden and the viewpoint of hospital management.
Working-level talks between the ruling Liberal Democratic Party and its coalition partner Komeito, and the Japan Innovation Party have begun regarding reform of the social security system. The focus is on how to reduce pharmaceutical expenses.
There are two types of medicine prescribed by doctors: Prescription drugs that could be harmful to a person’s health if taken incorrectly, and medicine similar to over-the-counter (OTC) drugs that are less risky, such as pain-relief patches and stomach medicine.
About 7,000 OTC-like drugs can be bought at pharmacies without a doctor’s prescription. However, if a doctor prescribes them, the drugs are covered by insurance and can be purchased more cheaply than OTC products.
The JIP calls for such drugs to be exempt from medical insurance coverage, arguing that there is little need for doctors to bother prescribing them. If reforms of the system cut social security spending by ¥4 trillion per year, the insurance premiums paid by members of working-age generations could be cut by ¥60,000 per person annually.
In fiscal 2022, medical expenses totaled about ¥46.7 trillion, up by more than ¥7 trillion from 10 years before.
If medical costs continue to increase, the burden of social insurance premiums on the working-age population and the amount of taxpayers’ money used to cover medical expenses will only continue to grow. It is inevitable that patients be asked to bear a certain amount of the burden.
However, there are cases when a patient thinks they only have mild symptoms but a serious illness gets overlooked. Pain-relief patches and other items are prescribed based on the results of medical examinations, so their use does not necessarily mean that the patient did not need treatment in the first place.
In addition, for medical institutions that rely on insurance revenue for a large part of their earnings, an increase in patients who refrain from receiving treatment will affect their business.
It must be said that the JIP’s arguments lack this perspective.
The government and the ruling parties have agreed on a policy to make high school tuition free, a position touted by the JIP, in return for gaining the JIP’s cooperation in the budget proposal for fiscal 2025. However, the JIP came under criticism for failing to present a plan to secure the ¥400 billion needed to implement the policy.
Behind the ongoing campaign to reduce pharmaceutical costs may be the JIP’s attempt to propose a solution to the financial shortfall to be caused by the introduction of free high school education.
The JIP has set a deadline of May for compiling its reform plan. This can be interpreted as an attempt to demonstrate its achievements to prepare for the House of Councillors election in the summer.
The government was forced to postpone its review of the high-cost medical expense benefit system because insufficient coordination resulted in seesawing policy changes. How social security should operate must be discussed from a comprehensive perspective.
