Yoshio Mitsumori07.24.08
In the United States, April Fools Day marks a day of gags and laughs, but ever since April 1, Japan’s political arena has been more confusing than amusing with the rollout of a new healthcare initiative. Indeed, one of the hottest political issues today pertains to Japan’s Late-Stage Elderly Healthcare Insurance System. Although this new system theoretically is supposed to make healthcare more affordable for elderly individuals who are older than 75, from the very beginning there has been confusion about the system, particularly as criticism escalates about administrative mistakes and clerical errors that have arisen since its introduction.
The Late-Stage Elderly Healthcare Insurance System originally was established in 2006—well before it was formally launched. The impetus that led to its development was that healthcare expenditures for elderly patients tend to be much greater than they are for younger generations and, as such, the rapid growth of Japan’s elderly population would lead to an even sharper increase of healthcare expenditures in the near future. To cope with these increases and provide a sort of financial balance to the National Healthcare Insurance system, the government devised the new system for elderly populations.
By the system’s design, the elderly population now contributes a certain amount of money to receive healthcare benefits. All individual beneficiaries are charged a premium through the local government, while a local insurance organization operates the plan. The beneficiary funds 10% of the plan from his or her own pocket, 50% is funded via taxes and the remaining 40% is contributed from health insurance unions organized by active (ie, younger) generations. The actual financial burden for beneficiaries varies by district, averaging about 6,200 yen (approximately $57) per month.
Although the system was designed to alleviate financial burdens, for now it has proven more problematic than helpful—and criticism about the system has become widespread. Just a few short months after the system’s introduction, administrative procedures already have been deemed as too confusing and serious mistakes have been cited. For example, some elderly citizens received an insurance certificate while others didn’t or, in some cases, the monthly premium was mischarged. Another area of particular contention has been that the beneficiary’s monthly premium is directly debited from his or her pension. Japan’s pension system has seen its own share of colossal administrative errors and, as such, has been a big political hotbed.
Given the problems arising from both the new healthcare system for the elderly and the pension system, the Ministry of Health, Labor and Welfare (MHLW) is faced with tackling two extremely challenging political issues at the same time. The opposing political party, Japan Democratic Party, already has called for cancellation of this Late-Stage Healthcare Insurance System, and its voice is gaining strength as some politicians from the MHLW’s supporting parties join the ranks in criticizing the system. With Japan’s next general election just around the corner (it will be held sometime late this year or early next year), the controversy is gaining steam as a huge political issue.