the study on japanese health care insurance and medical...
TRANSCRIPT
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2 0 1 0 - 3
The Study on Japanese Health Care Insurance and
Medical Service Reimbursement System
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SUMMARY
The purpose of this study aims that 1) to study the situation of the
Japanese health insurance systems and reimbursement system, 2) to study
the health insurance fee through translation of the Japanese health
insurance reimbursement fee, 3) to study the situation of the revision of
japanese health insurance fee and its implications for Korea.
To achieve the study goal, two groups of specialist was organized. One is
Japanese specialist of health insurance the other one is Korean specialist.
Japanese researchers divided duties according to their specialty. Korean
researcher translated the code book of Japanese health insurance fee. The
results are as follows:
In 1961 the Japanese achieved national coverage of health insurance. The
system consists of two major pillars: The Employees' Health Insurance(EHI)
that covers employed working population and their dependent family
members and The National Health Insurance(NHI) that covers
non-employed population. The Employees' Health Insurance is further
divided into Health Insurance Societies that are established in major
corporations and the Social Insurance Agency that covers employees and
medium to small sized corporations.
In 2008, the health insurance system was radically restructured. The
elderly population aged 75 years or older was separated and covered by
the newly created the Health Insurance System for the Old-old. The
reimbursement is basically fee-for-service and the government sets the
national uniform fee schedule as well as the price list of all drugs covered
by insurance. The fee schedule is revised every two years through the
negotiation between the government and the provider side as Japan
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Medical Association etc. The fee schedule revision is important in health
policy making because not only it changes the price but also it implements
certain health policy. The implications of this study shows as follows:
1) Treatment fee between hospital and clinic must be control to achieve
health care delivery system.
2) To develope preventive service items for preventing disease.
3) Strengthen the pediatric fee for service to invigorate pediatric service for
children.
4) To develope the item of disease management fee for chronic disease
patients.
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Table of Contents
Chapter 1. Introduction 1
Section 1. Background and Objective 1
Section 2. Contents and Methodology 4
1. Contents 4
2. Translations 5
Section 3. Literature Review 6
Chapter 2. Healthcare Insurance System in Japan 8
Section 1. Healthcare System and Development in Japan 8
1. Development of Health Insurance 8
2. Separation of Prescribing and Dispensing Drugs 11
3. Healthcare System for the Elderly 14
4. Herb Medicine and Alternative Medicine 23
5. Allied Systems of Health Insurance 25
Section 2. Healthcare Finance and Expenditure 30
1. Healthcare Finance and Expenditure 30
Section 3. Healthcare Providers and Supporting Administrative System 32
1. Ministry of Health 32
2. Professional Associations 33
3. Insurer Groups 36
4. Medical Societies 37
5. Allied Professional Groups 38
6. Medical Service Organizations 38
Section 4. Healthcare Insurance Society and Benefit 47
1. Healthcare Insurance Society 47
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2. Non Applied Health Insurance Service 56
Chapter 3. Healthcare Service Payment System in Japan 61
Section 1. Healthcare Service Payment System 61
1. Decision Rules of Healthcare Insurance Fee 61
2. Revision of Healthcare Insurance Fee 75
3. DPC(Disease Procedure Combination) 86
Section 2. Healthcare Services Fee Claim, Review, Assessment and
Related Statistics 94
1. Claim, Review and Payment 94
2. Review of Healthcare Services Fee Claim 100
3. Digitalizing of Healthcare Services Fee Claim 118
4. Assessment of Healthcare Services 126
5. Related Statistics 130
Chapter 4. Medical Errors and Compensation 137
Section1. Medical Errors and Solutions 137
Section2. Compensation of Damages from Drugs 146
Chapter 5. Contemporary Issues of Japanese Healthcare System
159
1. Physician Shortage 159
2. Criminal Liability of Medical Errors 164
Chapter 6. Conclusions and Speculations 174
Section 1. Characteristics of Japanese Healthcare Insurance Fee 174
1. Characteristics of Evaluation and Management Fee and Medical
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Management Fee 175
Section 2. Plans for Improvement of Healthcare Insurance Fee 184
1. Improvement of Evaluation and Management Fee 184
2. Establishment of Medical Management Fee 187
3. Evaluation and Management Fee Improvement for Children 189
Section 3. Implications 190
1. Restructuring Healthcare Delivery System 190
2. Provision of Qualitative Healthcare Services 192
3. Improvement of Healthcare Insurance Fee for Children 193
Section 4. Anticipation and Application Plan 195
Chapter 7. References 196
Appendix 1. Japanese Health Insurance Law
Appendix 2. Japanese National Health Insurance Law
Appendix 3. The Index of Japanese Healthcare Insurance Fee
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i
1 1
1 1
2 4
1. 4
2. 5
3 6
2 8
1 8
1. 8
2. 11
3. 14
4. 23
5. 25
2 30
1. 30
3 32
1. 32
2. 33
3. 36
4. 37
5. 38
6. 38
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ii
4 47
1. 47
2. 56
3 61
1 61
1. 61
2. 75
3. DPC 86
2 , , 94
1. 94
2. 100
3. 118
4. 126
5. 130
4 137
1 137
2 () 146
5 159
1. 159
2. 164
6 174
1 174
-
iii
1. 175
2 184
1. 184
2. 187
3. 189
3 190
1. 190
2. 192
3. 193
4 195
7 196
()
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iv
13
15
15
21
22
26
29
31
31
31
35
39
10 1 40
42
3 3 45
48
50
51
52
2008 4 53
() 54
57
59
60
62
63
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v
64
67
ADL 67
ADL 67
69
: 71
72
(2008 4 ) 73
76
77
20(2008) 78
85
88
DPC 90
94
1() 13() 95
101
105
() 105
( ) 107
( ) 108
111
111
119
(2009 2) 121
121
ICD-10 125
130
131
-
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131
2007 132
, , 2007
132
134
141
146
158
175
177
180
181
184
186
186
(2001-2008) 190
191
191
193
194
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vii
[ 1] (2008 3 ) 16
[ 2] 18
[ 3] 19
[ 4] 22
[ 5] 23
[ 6] 28
[ 7] (() ) 28
[ 8] 30
[ 9] 32
[ 10] 41
[ 11] 42
[ 12] 100 46
[ 13] (1996-2008) 76
[ 14] 87
[ 15] 89
[ 16] 89
[ 17] DPC 91
[ 18] 92
[ 19] DPC 93
[ 20] 6 93
[ 21] 96
[ 22] , , 96
[ 23] 6 , , 97
[ 24] 99
[ 25] () 127
[ 26] 128
[ 27] 14() 133
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viii
[ 28] 135
[ 29] 135
[ 30] 136
[ 31] 139
[ 32] 140
[ 33] , 144
[ 34] , (2006 ) 162
[ 35] (1995-2007) 165
[ 36] 167
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2003 ()15 315,375 247.1 3,580,792 8.81
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2006(18) 2005(17)
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121,274 36.6 120.61 36.4
81,895 24.7 82,992 25.1
39,379 11.9 37,618 11.4
162,245 49 162,93 49.2
66,923 20.2 67,082 20.2
95,322 28.8 95,811 28.9
47,757 14.4 47,786 14.4
47,555 14.4 47,572 14.4
2006(18) 2005(17)
331,276 100 331.289 100
250,468 75.6 249,677 75.4
122,543 37 121,178 36.6
127,925 38.6 128,499 38.8
25,039 7.6 25,766 7.8
47,061 14.2 45,608 13.8
8,229 2.5 9,807 3
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8,862 8,943 1,620,173 1,626,589 100.0 100.0 100.0 100.0
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1,325 1,351 338,200 347,299 15.0 15.1 20.9 21.4
123 125 36,357 36,699 1.4 1.4 2.2 2.3
5,702 5,694 847,587 842,864 64.3 63.7 52.3 51.8
533 604 49,061 55,161 6.0 6.8 3.0 3.4
888 877 225,760 220,375 10.0 9.8 13.9 13.5
99,532 98,609 155,143 159,898 100.0 100.0 100.0 100.0
631 637 2,301 2,332 0.6 0.6 1.5 1.5
3,827 3,896 2,931 3,003 3.8 4.0 1.9 1.9
700 727 42 44 0.7 0.7 0.0 0.0
34,317 32,196 95,470 94,270 34.5 32.7 61.5 59.0
49,010 50,355 52,673 58,432 49.2 51.1 34.0 36.5
11,047 10,798 1,726 1,817 11.1 11.0 1.1 1.1
108,394 107,552 1,775,316 1,786,487
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[ 10] . 2007
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1987 137,275 9,841 79,134 24,975 54,159
1988 139,542 10,034 79,752 24,598 55,154
1989 141,849 10,081 80,572 24,372 56,200
1990 143,164 10,096 80,852 23,589 57,263
1991 145,817 10,066 82,118 23,369 58,749
1992 148,359 9,963 83,394 23,151 60,243
1993 149,878 9,844 84,128 22,383 61,745
1994 152,532 9,731 85,588 22,082 63,506
1995 155,082 9,606 87,069 21,764 65,305
1996 156,756 9,490 87,909 20,452 67,457
1997 159,284 9,413 89,292 19,796 69,496
1998 161,540 9,333 90,556 19,397 71,159
1999 163,270 9,286 91,500 18,487 73,013
2000 165,451 9,266 92,824 17,853 74,971
2001 167,555 9,239 94,019 17,218 76,801
2002 169,079 9,187 94,819 16,178 78,641
2003 171,000 9,122 96,050 15,371 80,679
2004 172,685 9,077 97,051 14,765 82,286
2005 173,200 9,026 97,442 13,477 83,965
2006 174,944 8,943 98,609 12,858 85,751
2007 176,192 8,862 99,532 12,399 87,133
-
2 41
[ 10]
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4 1 .
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42
[ 11] 19)
(: )
1987 158 35 5 0 117
1988 163 35 5 0 122
1989 166 36 4 0 125
1990 168 36 4 0 126
1991 169 36 4 0 127
1992 169 36 4 0 127
1993 168 36 4 0 127
1994 168 36 4 1 126
1995 167 36 3 2 124
1996 166 36 3 4 122
1997 166 36 3 6 121
1998 166 36 3 10 116
1999 165 36 2 17 109
2000 165 36 2 24 102
2001 165 36 2 27 99
2002 164 36 2 30 97
2003 163 35 1 34 92
2004 163 35 1 35 91
2005 163 35 1 36 90
2006 163 35 1 35 91
2007 162 35 1 34 91
19) 2007
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5 , () 5 .
1963 ( 38)
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1968( 43)
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2001 1 .
1984( 59)
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2001( 13)
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2 53
2002( 14)
3 7 8 .
2003( 15)
, ,
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13 563 549
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15 7:1 70% 1787 1387
16 10: 1 70% 1592 1192
17 13:1 70% 1349 949
18 15:1 70% 1298 898
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30 20:1 70% 1129 670
31 20:1 40% 1117 658
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1968 (3)
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1969
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1975
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1978
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1981
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