Relatively complete Japanese health insurance system

Author: Hu Dengliang Single Miao Is one of the most perfect countries in the world, especially the establishment of a relatively complete and mature medical insurance system, which better protects the national health, it is worth studying and drawing on.At present, the Japanese health insurance system is mainly composed of employee health insurance, national health insurance and special industry health insurance.The Employee Health Insurance System covers employees and their families of businesses and chambers of commerce and is divided into two types of combined health insurance and government regulation of health insuranceThe combination governs health insurance coverage for large companies, employees of large enterprises, employers and employees, the Government is in charge of health insurance covering small and medium-sized enterpriseemployees, employers and employees pay joint contributions, and the Government subsidizes themThe national health insurance system covers farmers, university students, freelancers, housewives and other groups, divided into the city and village national health insurance and industry association health insurance two categories, the former mainly, the premium is mainly paid by individuals, fees (taxes) rate by the city and village situ, the government to give subsidiesHealth insurance in special industries mainly covers state civil servants, local civil servants, crew members, private school teachers, etc., and the cost of medical insurance for civil servants is borne jointly by the State, the local and myself, and the rate is determined and dynamically adjusted according to their own financial situation; In order to alleviate the challenge of population ageing, Japan has also established a "aged care system", which mainly covers the elderly over 70 years of age and those with disabilities or bedridden over 65 years of age, with the remainder of the cost being shared by the health insurance systems, in addition to the government's burden.The payment of medical insurance systems includes outpatient, inpatient, drug and life allowance spending during illness, childbirth allowance and funeral allowanceThe rate of payment of medical expenses is relatively consistent, with out-of-patient and inpatient services paying 30%, 20% of children under 3 years of age, 10% of the over-70s and 20% of the old people over a certain income.The management system of medical insurance fund The Medical Insurance Fund of Japan is managed according to law, and the laws and regulations related to medical insurance include the National Health Insurance Law, the Health Insurance Law, the Social Insurance Review Officer and the Social Insurance Review Council Law, the Social Insurance Review Council and the Social Medical Insurance Medical Association Law, which under this premise form a reasonable division of labor and a clear system of medical insurance management and supervision with clear responsibilitiesAt the central level, the medical insurance system is managed by the Medical Insurance Bureau under the Ministry of Health, Labour and Welfare, and at the local level, the medical insurance system is managed by the Regional Social Insurance Bureau, the Social Insurance Office and the Regional Health and Welfare Bureau.Various types of medical insurance systems are managed separately by different operating agenciesIn particular, the portfolio health insurance is administered by the respective health insurance portfolio on behalf of the Government, which administers the health insurance in a number of "combinations" organized by the GovernmentThe insurance portfolio is composed of representatives of both employers and employees, and is a non-governmental health insurance management organization, consisting of a private health insurance portfolio at the central level and a separate health insurance portfolio established by enterprises in various industries at the local level, with a certain subsidy granted by the Government, without interfering with specific businessThe National Health Insurance is administered by the city and village where the insured person is locatedThe crew medical insurance is administered by the Social Insurance AgencyThe medical insurance of state civil servants, local civil servants and private school staff shall be managed by the corresponding combination of free-form staffThe medical security system for the elderly is managed by the Ministry of Health for the Elderly in The Prefecture of Tudu Prefecture or by the municipal and village NHS combinations.In order to regulate the behavior of medical services and control the unreasonable growth of medical expenses, all kinds of medical insurance operators have entrusted professional and independent third-party institutions to audit and supervise the expenditure of medical expensesFor example, the employee health insurance system entrusts medical expenses audit and payment foundation audit, the NATIONAL Health Insurance System entrusts the national health insurance group federation to review, after the third-party institutions approve, the relevant situation is sent to the insured person's administrative body for review, and finally in accordance with the relevant provisions to the medical institutions to pay.New trends of the reform of The medical insurance system in Japan With the aging of the population and the changes in the macroeconomic environment, especially the impact of the global financial crisis since 2008, Japan's medical insurance system has gradually exposed some problems, mainly the rapid rise of medical expenses, especially for the elderly, the pressure of payment of medical insurance funds has increased sharply, and the financial burden of the state has been increasingIn response to the challenge, Japan has repeatedly raised insurance rates, but as the economy continues to falter, there is less room to expand health insurance revenues, and the current reforms are focused on controlling health care costs.The first is to reform the "old-age health care system"In order to solve this problem, Japan raised the age of the "old-age health care system" to 75 years of age, and then established the "seniors' health care system" for the elderly over 75 years of age, and separated its medical insurance settlement from the general medical insurance settlement to better control the costIn addition, the out-of-pocket ratio is appropriately increased, increasing the out-of-pocket ratio of medical expenses for the elderly population aged 65 to 74 from 10 per cent to 20 per cent, while the rest is subsidized by the Government, and other health insurance systems are financially adjusted according to the number of people insuredSecond, the establishment of a system of division of labor in medical institutions, reform of the medical price mechanismClarify the functions of hospitals and clinics, actively promote the division of labor system for major diseases to hospitals and minor diseases to clinics, and improve the efficiency of the use of medical resourcesReform the "pay-for-visit" mechanism, the implementation of "bag-dry payment", that is, according to the type of disease provisions of the total amount of payment, the implementation of a package of payments, control the number of patients, extend the doctor's diagnosis time for a single patient, to ensure the quality of medical careThird, promote the use of ordinary drugsUnless the doctor explicitly objects to the diagnosis, generic drugs can be used as prescription drugs to control the cost of the drug as much as possible.These "saving" measures play a role in restricting medical expenses, but they are also restricted by people's health outlook, disease spectrum changes and other factorsFundamentally, the solution to the above-mentioned problems still depends on the reform of the institutional structureTake the national health insurance system as an example, as the largest number of insured medical insurance system, mainly covering non-wage income groups, this part of the low income, age structure is old, accounting for the majority of the Japanese government's subsidy for health insurance, and the scope of co-ordination is small, resulting in the fund's financial conditions are not stable, low anti-risk capacity Therefore, in the prefecture of Tudu, the integration of the national health insurance between the cities and villages, expand the scope of the combination, has become one of the key points of the reform of the health insurance system in Japan However, due to the issues involving Japan's autonomy and the financial system, the reform is difficult to advance, and further progress needs to be seen (Responsible Editor: Wang Jinbao)