Annual Report on Health and Welfare 1999

Status of the Finance of the Health Insurance System

Overview
Status of the Finance of the Health Insurance System (FY1997)

Status of the Finance of the Health Insurance System (FY1997)

Detailed Data 1
Ratio of the Health Expenditure Borne by the National Treasury to the National Government's General Expenditure

Ratio of the Health Expenditure Borne by the National Treasury to the National Government's General Expenditure

Health Insurance System

Overview
Outline of the Health Insurance System

Outline of the Health Insurance System

Detailed Information 1
History of the Health Insurance System

1905 Kanebo and Yawata Iron and Steel Works established mutual aid associations.

1922 The Health Insurance Law was enacted.

1927 The Health Insurance Law was enforced in full scale (for factories and workplaces of mines and transportation industry with constantly employing at least ten employees).

1934 Amendment of the Health Insurance Law:
Minimum number of employees for coverage of the health insurance was expanded to five.

1938 The Ministry of Health and Welfare was established.
The National Health Insurance Law was enacted.
This system is owned by associations voluntarily established by municipalities or industries.

1939 The Staff Health Insurance Law was enacted (for the employees working for companies and stores in specific municipalities).
The Seamen's Insurance Law was enacted.
Amendment of the Health Insurance Law: It was commenced to supply family benefits (voluntary benefits).

1942 Amendment of the Health Insurance Law: The Staff Health Insurance was merged (Copayment system was introduced).
The Ministry of Health and Welfare Establishment Law was enacted.: Health Insurance Bureau was established.

1944 Amendment of the Health Insurance Law: Benefit supply period was extended to two years.

1947 The Workmen's Accident Compensation Insurance Law was enacted.
Amendment of the Health Insurance Law: The benefits for occupational injures/diseases were abolished.

1948 The Social Insurance Medical Fee Payment Fund Law was enacted.

Amendment of the National Health Insurance Law:
The basic principle of publicly operating the program by the municipalities was laid out. The program may be voluntarily established and relevant residents are required to participate.
The National Public Service Employees Mutual Aid Association Law was enacted.

1953 The Day Laborers' Health Insurance Law and the Private School Teachers and Employees Mutual Aid Association Law were enacted.
Amendment of the Health Insurance Law:

The benefit period was extended to three years.

1954 The payment from the National Treasury was introduced for the first time to the government-management health insurance (\1 billion.)

1956 The Public Corporation and National Enterprise Employees Mutual Aid Association Law was enacted.

1958 Overall amendment of the National Health Insurance Law (promotion of universal coverage and 50% benefit coverage as the benefit for the insured)

1961 Universal coverage was achieved.

1962 The Social Insurance Agency was established. The Local Public Service Employees Mutual Aid Association Law was enacted.

1963 The restriction on the medical care benefit period was removed.

1967 The Special Exception Law on the Health Insurance was enacted (the creation of a copayment for drugs.)

1968 70% benefit coverage was completely implemented.

1969 The copayment for drugs under the Health Insurance was abolished.

1972 Amendment of the Welfare Law for the Elderly (the so-called "free of charge" medical care for the elderly)

1973 Amendment of the Health Insurance Law:

The family benefit coverage, etc. were raised to 70%, the high-cost medical care benefit system was created, and flat rates were applied to the national subsides under the government-managed health insurance.

1977 Amendment for the Health Insurance Law:

The special premium which applies to bonuses was created.

1980 Amendment for the Health Insurance Law:

The hospitalization benefit coverage for family members was raised to 80%, the upper limits of the Standard Remuneration Class Table were revised flexibly, and the upper limits of the premium rates were revised.

1982 The Health and Medical Service Law for the Elderly was enacted.

1984 Amendment of the Health Insurance Law, etc.:

The 10% copayment for the insured was introduced, specified medical care coverage was created, the high-cost medical care benefit was improved, and the Medical Care Service Program for Retired Employees was created.

1986 Amendment of the Health 2nd Medical Service Law:

The copayment was revised. The imbalance of copayment was redressed. Health services facilities for the elderly were established.

1988 Amendment of the National Health Insurance Law, etc.:

Stable program operation in municipalities with high health expenditures was reinforced, the Insurance Financial Base Stabilizing Scheme was encouraged, and the Joint Program for High-Cost Medical Care Benefit was expanded.

1990 Amendment of the National Health Insurance Law, etc.:

The Insurance Financial Base Stabilizing Scheme was well-established, expansion of the national subsides reinforcement of and financial adjustment function was achieved, and the National Treasury's payment for contributions to the health services for the elderly was rationalized.

1991 Amendment of the Health and Medical Service Law for the Elderly:

The copayments were revised, the price indexation system was introduced, the ratio of public payments was raised, attention was paid to long-term care, and the home-visit nursing care system for the elderly was created.

1992 Amendment of the Health Insurance Law, etc.:

The mid-term financial operation system for government-managed health insurance was adopted, children-related benefits were improved, the Council on Health Insurance was created, and the standard remuneration classes were revised.

1993 Amendment of the National Health Insurance Law, etc.:

The Support Program for Financial Stabilization of the National Health Insurance was institutionalized and the national payments under the Insurance Financial Base Stabilizing Scheme were reviewed.

1994 Amendment of the Health Insurance Law, etc.:

Benefits for nursing offered by nursing attendants and for long-term care were reformed. In-home medical care system was promoted. The inpatient dietary therapy fee, the maternity and child care lump-sum allowance were created, as well as the Council on Health and Welfare for the Elderly was created.

1995 Amendment of the National Health Insurance Law, etc.:

The premium reduction system was expanded. Temporary measures were conducted on the Insurance Financial Base Stabilizing Scheme. The Joint Program for High-Cost Medical Care Benefits was expanded. The Support Program for Financial Stabilization of the National Health Insurance was extended. The upper and lower limits of the elderly's participation rates in calculating contributions for the health expenditure for the elderly were increased (health and medical service for the elderly).

1997 Amendment of the Health Insurance Law, etc.:

The Council on Health Insurance was created. The copayment system for employees was reviewed. Copayment for medication for outpatients was introduced. The National Treasury copayment was incremented for the National Health Insurance Financial Base Stabilizing Scheme. State subsidy for the National Health Insurance associations was revised.

1998 Amendment of the National Health Insurance Law, etc.:

Contributions for insurance health expenditure for the elderly were revised for the retired. The elderly participation rate was increased. Prevention measures against unlawful request for medical fee payment and arrangements including bed allocation for insurance medical care facilities are revised.

National Health Expenditure

Overview
Changes in the National Health Expenditure

Changes in the National Health Expenditure

National Health Expenditure for OECD Countries (1997)

National Health Expenditure for OECD Countries (1997)

Structure of Insured Medical Treatment

Overview
Conceptual Chart of Insured Medical Treatment

Conceptual Chart of Insured Medical Treatment

Medical fees are classified into three types: medical, dental and dispensing fees.

The medical fee is calculated by adding stipulated numbers of points for the individual medical activities provided (so-called "fee-for-service system"). The unit price for one point is \10. For a typhlitis hospitalization case, for example, the first visit fee, the hospitalization fee multiplied by the length of stay (days,) the typhlitis surgery fee (7,400 points,) the test fee and the drug fee are added to one another and the medical institution will receive the total amount less the patient's co-payment from the payment fund, etc.

Detailed Information 1
Examples of Medical Fee Points !!(Unit price for 1 point is \10)

$Examples of Medical Fee Points !!(Unit price for 1 point is \10)$

Detailed Data 1
Historical Development of the Revisions of Medical Fees and
the Drug Price List

Historical Development of the Revisions of Medical Fees and the Drug Price List

Detailed Information 2
Range of Medical Fees and Health Insurance Coverage (Conceptual-Chart)

Range of Medical Fees and Health Insurance Coverage (Conceptual-Chart)

Detailed Information 3
Health Expenditure Flow Chart

Index / Back / Next

1905	Kanebo and Yawata Iron and Steel Works established mutual aid associations.
1922	The Health Insurance Law was enacted.
1927	The Health Insurance Law was enforced in full scale (for factories and workplaces of mines and transportation industry with constantly employing at least ten employees).
1934	Amendment of the Health Insurance Law: Minimum number of employees for coverage of the health insurance was expanded to five.
1938	The Ministry of Health and Welfare was established. The National Health Insurance Law was enacted. This system is owned by associations voluntarily established by municipalities or industries.
1939	The Staff Health Insurance Law was enacted (for the employees working for companies and stores in specific municipalities). The Seamen's Insurance Law was enacted. Amendment of the Health Insurance Law: It was commenced to supply family benefits (voluntary benefits).
1942	Amendment of the Health Insurance Law: The Staff Health Insurance was merged (Copayment system was introduced). The Ministry of Health and Welfare Establishment Law was enacted.: Health Insurance Bureau was established.
1944	Amendment of the Health Insurance Law: Benefit supply period was extended to two years.
1947	The Workmen's Accident Compensation Insurance Law was enacted. Amendment of the Health Insurance Law: The benefits for occupational injures/diseases were abolished.
1948	The Social Insurance Medical Fee Payment Fund Law was enacted. Amendment of the National Health Insurance Law: The basic principle of publicly operating the program by the municipalities was laid out. The program may be voluntarily established and relevant residents are required to participate. The National Public Service Employees Mutual Aid Association Law was enacted.
1953	The Day Laborers' Health Insurance Law and the Private School Teachers and Employees Mutual Aid Association Law were enacted. Amendment of the Health Insurance Law: The benefit period was extended to three years.
1954	The payment from the National Treasury was introduced for the first time to the government-management health insurance (\1 billion.)
1956	The Public Corporation and National Enterprise Employees Mutual Aid Association Law was enacted.
1958	Overall amendment of the National Health Insurance Law (promotion of universal coverage and 50% benefit coverage as the benefit for the insured)
1961	Universal coverage was achieved.
1962	The Social Insurance Agency was established. The Local Public Service Employees Mutual Aid Association Law was enacted.
1963	The restriction on the medical care benefit period was removed.
1967	The Special Exception Law on the Health Insurance was enacted (the creation of a copayment for drugs.)
1968	70% benefit coverage was completely implemented.
1969	The copayment for drugs under the Health Insurance was abolished.
1972	Amendment of the Welfare Law for the Elderly (the so-called "free of charge" medical care for the elderly)
1973	Amendment of the Health Insurance Law: The family benefit coverage, etc. were raised to 70%, the high-cost medical care benefit system was created, and flat rates were applied to the national subsides under the government-managed health insurance.
1977	Amendment for the Health Insurance Law: The special premium which applies to bonuses was created.
1980	Amendment for the Health Insurance Law: The hospitalization benefit coverage for family members was raised to 80%, the upper limits of the Standard Remuneration Class Table were revised flexibly, and the upper limits of the premium rates were revised.
1982	The Health and Medical Service Law for the Elderly was enacted.
1984	Amendment of the Health Insurance Law, etc.: The 10% copayment for the insured was introduced, specified medical care coverage was created, the high-cost medical care benefit was improved, and the Medical Care Service Program for Retired Employees was created.
1986	Amendment of the Health 2nd Medical Service Law: The copayment was revised. The imbalance of copayment was redressed. Health services facilities for the elderly were established.
1988	Amendment of the National Health Insurance Law, etc.: Stable program operation in municipalities with high health expenditures was reinforced, the Insurance Financial Base Stabilizing Scheme was encouraged, and the Joint Program for High-Cost Medical Care Benefit was expanded.
1990	Amendment of the National Health Insurance Law, etc.: The Insurance Financial Base Stabilizing Scheme was well-established, expansion of the national subsides reinforcement of and financial adjustment function was achieved, and the National Treasury's payment for contributions to the health services for the elderly was rationalized.
1991	Amendment of the Health and Medical Service Law for the Elderly: The copayments were revised, the price indexation system was introduced, the ratio of public payments was raised, attention was paid to long-term care, and the home-visit nursing care system for the elderly was created.
1992	Amendment of the Health Insurance Law, etc.: The mid-term financial operation system for government-managed health insurance was adopted, children-related benefits were improved, the Council on Health Insurance was created, and the standard remuneration classes were revised.
1993	Amendment of the National Health Insurance Law, etc.: The Support Program for Financial Stabilization of the National Health Insurance was institutionalized and the national payments under the Insurance Financial Base Stabilizing Scheme were reviewed.
1994	Amendment of the Health Insurance Law, etc.: Benefits for nursing offered by nursing attendants and for long-term care were reformed. In-home medical care system was promoted. The inpatient dietary therapy fee, the maternity and child care lump-sum allowance were created, as well as the Council on Health and Welfare for the Elderly was created.
1995	Amendment of the National Health Insurance Law, etc.: The premium reduction system was expanded. Temporary measures were conducted on the Insurance Financial Base Stabilizing Scheme. The Joint Program for High-Cost Medical Care Benefits was expanded. The Support Program for Financial Stabilization of the National Health Insurance was extended. The upper and lower limits of the elderly's participation rates in calculating contributions for the health expenditure for the elderly were increased (health and medical service for the elderly).
1997	Amendment of the Health Insurance Law, etc.: The Council on Health Insurance was created. The copayment system for employees was reviewed. Copayment for medication for outpatients was introduced. The National Treasury copayment was incremented for the National Health Insurance Financial Base Stabilizing Scheme. State subsidy for the National Health Insurance associations was revised.
1998	Amendment of the National Health Insurance Law, etc.: Contributions for insurance health expenditure for the elderly were revised for the retired. The elderly participation rate was increased. Prevention measures against unlawful request for medical fee payment and arrangements including bed allocation for insurance medical care facilities are revised.