国民健康保険 都道府県移管は必要な方策だ

The Yomiuri Shimbun August 5, 2013
National health insurance program should be managed by prefectures
国民健康保険 都道府県移管は必要な方策だ(8月4日付・読売社説)

The financial condition of the national health insurance program, which was originally started as medical insurance for the self-employed, has taken a serious turn for the worse. The program must be rehabilitated as soon as possible.

The National Council on Social Security Reform will propose in an upcoming report that the national health insurance program, currently managed by cities, towns and villages, should be run by prefectures.

The biggest aim of the proposal is to enhance the financial foundation of the program. We think having prefectural governments, which are larger than city, town and village governments, manage the program is a necessary means to maintaining the program.

There are about 35 million subscribers to the national health insurance program. With a decrease of farming families and private shops, about 70 percent of the subscribers are now nonregular workers and the unemployed.

Because more and more low-income earners are joining the program, revenues from insurance premiums remain low. In fact, less than 30 percent of the more than 11 trillion yen in national health insurance payouts a year is covered by premiums.

To cover revenue shortages, the program must depend on financial assistance from employees’ insurance programs such as those operated by corporate health insurance unions and on public money from the national and prefectural governments. Nonetheless, this does not cover the deficits. To compensate for the deficits, 350 billion yen is allocated to the insurance program every year from the general accounts of municipal governments. The structure of the insurance program apparently ensures it will lose money.

Besides, small municipalities that operate the program easily find themselves in the red with high medical costs from advanced treatments. Depopulation worsens this situation.

Adjust insurance premiums

Another problem is that premiums have become a heavy burden on subscribers.

As a percentage of income, subscribers to national health insurance pay twice as much in premiums as do subscribers to health insurance programs run by corporate health insurance unions and mutual aid societies for public servants. And even among cities, towns and villages within the same prefecture, the difference between the most and least expensive national health insurance premiums is up to 2.8 times.

If management of the national health insurance program is transferred from cities, towns and villages to prefectures, its financial foundation would be improved by economy of scale.

And the difference in premiums among subscribers would become smaller if prefectural governments recalculated premiums necessary to sustain the national health insurance within their jurisdictions.

Of course, a reduction in medical spending is important to rehabilitate the finances of the national health insurance program.

If they run the programs, prefectural governments will be able to gather a great deal of information about medical treatment within their jurisdictions. Analysis of such information would enable them to monitor wasteful spending such as expenses for unnecessary medical tests and excessive administration of drugs.

This would eventually help prefectures exercise leadership in the operation of medical institutions after scrutinizing the contents of treatment.

However, there are still many problems in transferring management of the national health insurance program to prefectures.

For example, the National Governors’ Association demands the central government increase its financial assistance to them before they will agree to manage the program. But where is that money going to come from?

According to the proposal, cities, towns and villages will likely keep collecting premiums for the national health insurance program. However, it is doubtful that municipalities no longer running the national health insurance program will collect premiums in a responsible manner.

It will be necessary to create a system to prevent the rate of national health insurance premium payments from declining further.

(From The Yomiuri Shimbun, Aug. 4, 2013)
(2013年8月4日01時22分 読売新聞)

by kiyoshimat | 2013-08-06 07:22 | 英字新聞

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