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Understanding Depreciation In Home Insurance Claims In Japan
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By Tomoyuki Takura Tomoyuki Takura Scilit Preprints.org Google Scholar * and Study Group: Research on Appropriate Prices of Medical Care for Foreigners Visiting Japan Study Group: Research on Appropriate Prices of Medical Care for Foreigners Visiting Japan Scilit Preprints.org Google Scholar †
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Department of Health Economics and Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
Special note: The study group was a committee formed as part of a government-affiliated subsidy project, and held a number of discussions related to this research.
Received: 12 April 2021 / Revised: 22 May 2021 / Accepted: 27 May 2021 / Published: 29 May 2021
This study proposes a method to calculate the appropriate price level of medical care for foreign visitors (FV) in Japan. Hospital management costs and overseas prices are analyzed from the perspective of market principles to determine the price of medical care. The study involved two stages: a preliminary survey and a follow-up survey, supplemented by an international survey. Relatively frequent diseases were selected, and costs incurred by hospitals for FV treatment were analyzed through data from three hospitals, including 24 outpatients and 4 inpatients. Payments made by three insurance companies for overseas medical institution services for Japanese tourists suffering from pharyngitis were analyzed. This study showed that the price of appropriate medical care for FV, taking into account benefits, was 1.22–4.26 times higher than the price under Japanese public health insurance plans. Additionally, these rates were 1.31–4.26 times higher for outpatients with pharyngitis and external injuries, and 1.22–3.66 times higher for inpatients with appendicitis and femur fractures. The price of pharyngitis treatment in 12 countries was USD 20.32–158.75 per patient for Japanese tourists, while FV paid 60.24 dollars (1.13 times higher than the price of general health services in Japan) in Japan. This study suggests that it is appropriate to set the ideal price level for FV higher than for Japanese patients.
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The Japanese government has designated tourism by foreign visitors (FVs) as an industrial policy. In 2018, 31.19 million FVs visited Japan [1]; this number has increased by 262%. Compared with 2018, the number of hospitals receiving FV increased by 7.6% in 2019, and the annual number of FV received increased by an average of 40.3% per medical institution [2]. The number of FVs in Japan has decreased by more than 80% due to the COVID-19 pandemic over the past year; However, FV inflow is expected to increase as the pandemic subsides due to the spread of vaccination and the acquisition of herd immunity.
Japan will host the Olympics and Paralympics in 2021 and various international exposition events in the near future, which is expected to attract many international tourists. Japan’s medical security scheme is characterized by the Universal Medical Care Insurance System. For the National Health Insurance (JKN) to run well, keeping the pricing system under control is necessary to serve the increasing number of FVs who require emergency medical treatment due to accidents [3].
Japanese public health insurance is largely based on a fee-for-service payment system. This system, which forms the basis of the national fee schedule for each type of medical care (inpatient, outpatient, and dental), applies to all Japanese citizens regardless of occupation/income or gender/age group in the NHI. A fee-for-service payment system lists all services, procedures (e.g. surgery), and products (e.g. drugs) for medical care. In the NHI, regardless of the operational form of the health facility (public/private), the amount charged by the health institution for providing health services—that is, the official price of health services—is determined by the government.
Therefore, each health institution has limited opportunities to independently consider the amount of medical costs, except for special medical services. Against this background, many medical institutions have not yet developed a pricing system. Because they do not subscribe to the NHI, FVs are not entitled to use medical care services under the same conditions as Japanese citizens. In other words, FV is not a locally insured patient. However, considering the above-mentioned background, it is believed that not all medical institutions have developed a pricing system for FV services. Therefore, it is necessary to determine the appropriate price for medical treatment of FV in Japan.
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In general, medical costs for FV are estimated to be higher than general costs under JKN because there are additional burdens as follows:
Charges 1–3 are additional costs not covered by locally insured patients, only by FV. These additional costs for FVs occur on top of the fee-for-service payments in the NHI and therefore, it is necessary to set appropriate prices for these FVs. For FV, who are local non-insurance patients, time requirements and resource consumption will increase for various reasons, such as collecting medical information and performing diagnostic tests, considering disease risks specific to their place of origin and race; formulate a treatment plan and obtain informed consent, taking into account the FV’s culture and religion; or negotiating payments with overseas insurance companies (burden 4: increased basic medical costs).
A survey conducted by the Ministry of Health, Labor and Welfare reported that only 4% of responding medical institutions (n = 4971) had an FV bill price of JPY 20 (USD 0.18), more than double the charge for Japanese patients ) or more per point in medical expenses [4] (NHI: 1 point = JPY 10: USD 0.09). Most medical institutions cannot consider additional treatment costs for FV, which may affect financial management and stability of medical service supply.
Theoretical and economic evidence regarding appropriate price levels of medical care for FV in Japan is insufficient. The aim of this study was to examine the price of medical care to ensure stable hospital management—a necessity for the stable provision of medical services to FV. Therefore, a method for calculating the price level of medical care for FV is proposed.
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To optimize prices, it is best to consider the behavior and motivation of market economic actors as well as the mechanisms for determining prices of goods and services, including resource allocation and income distribution. Overall, the general economic approach is limited because there are various uncertainties associated with highly specialized technologies in medical science. Therefore, studying pricing in the medical sector is generally considered difficult due to the complex involvement of various factors.
Pricing approaches in medical care can be discussed in two main categories: “market-based” and “input-based” [5]. The “market-based” approach determines price levels by considering the actual market price of medical treatment, while the “input-based” approach is based on the consumption of goods and services. In general, in countries with mature health systems, it is assumed that prices in the public health market are being shaped using these approaches.
Meanwhile, there is discussion of approaches that explain the economic value of individual medical technologies (services). For example, from the perspective of healthcare providers (supply approach), the “technical difficulty” and “medical cost” methods are often chosen from the viewpoint of quality evaluation and business management. Furthermore, from the payer’s (beneficiary) perspective, the “patient outcome”, “economic performance”, and “willingness to pay” methods are often chosen from the perspective of market and value evaluation [6, 7, 8, 9].
In addition, there are times when certain prerequisites are established for the use of these indicators. For example, in the universal health insurance system in Japan, most of the prices charged to public insurance companies by medical institutions center on direct medical costs, which are based on the consumption of medical resources taking into account the clinical and operational utility of the hospital. In addition, technical costs (such as surgical costs), which are influenced by the specialty of the doctor, are considered as technical factors.
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