EDITORIAL: Revising medical fees

A government advisory panel has proposed changes to the schedule of medical service fees. The first revision to the schedule under the government of Prime Minister Yukio Hatoyama, which has pledged to prevent the collapse of the nation's health care system, will be implemented in April.

The proposal has come from the Central Social Insurance Medical Council, which advises Health, Labor and Welfare Minister Akira Nagatsuma.

Its main feature is increased payments for emergency care, pediatrics and obstetrics, areas suffering from a serious shortage of doctors.

The panel has also called for measures to ease the strain on doctors working for hospitals, such as increasing manpower at medical institutions and supporting team-based efforts at hospitals.

The biggest issue was the fee paid to doctors in private practice for treating follow-up patients, which is currently set higher than the fee paid to hospitals for the same services.

The panel decided to set a new uniform fee of 690 yen for treating follow-up patients. Although the step doesn't represent a major reform, the panel deserves some credit for lowering the fee for practitioners, from 710 yen, while raising the overall level of remuneration.

Practitioners who respond to telephone calls from patients seeking advice outside clinic hours, such as on holidays or at night, will receive an additional 30 yen for their contribution to local health care.

If practitioners respond to requests for advice from patients at night and on holidays, congestion at emergency outpatient units may be eased.

If, however, practitioners can receive the additional fee simply by claiming they deal with such requests, the system could be abused as a convenient means to cover the loss of income.

Regular checks for abuse are indispensable.

Another positive component of the panel's recommendations is the requirement that medical institutions issue in principle itemized statements to all patients without charge.

Despite growing calls by patients for the mandatory issuance of such expense statements, the step has not been taken until now mainly because of opposition from the Japan Medical Association.

The information included in these bills will allow patients to check whether their doctors and hospitals are seeking payment for treatments and tests they have not provided. It will also help prevent fraud and errors in requests for reimbursements.

The new rule should lead to substantial cost savings, allowing the government to spend more on measures to revitalize the nation's health care system.

Doctors and hospitals will probably receive more questions about medical expenses as more patients examine their medical bills.

Medical institutions should offer detailed answers to such questions.

Convincing patients that the treatments they receive and their costs are reasonable is a basic step in health care.

It is hoped that the medical fee scheme will be simpler and easier to understand for patients.

The Hatoyama administration showed political leadership when it removed the representatives of the medical association from the panel. This raised expectations of a radical overhaul of the scheme.

Needless to say, the proposed revision alone will not be enough to turn around the deteriorating situation in the health care sector.

Policy efforts are clearly needed to enhance in a fundamental way the system to train doctors and correct the concentration of doctors in certain regions and medical fields combined with acute shortages in others.

Policymakers should also continue to review the division of roles and cooperation between hospitals and private practitioners and between institutions.

What should be done to reinvigorate the nation's frayed health care system? How much money should be spent on the policy efforts and how should the financial burden be shouldered?

This policy challenge requires debate and measures based on a broad perspective with due attention paid to the nation's fiscal condition.

We hope the health ministry under Nagatsuma will build on this first step by making great strides toward the policy goal.

--The Asahi Shimbun, Feb. 13