일본 의료보험 수가체계 현황 및 시사점 = The current status and implications of the medical insurance fee schedule in Japan

다국어 초록 (Multilingual Abstract)

Background: Korea has the most rapidly aging population in the world. Medical costs for the elderly are quickly increasing, which raises concerns about the sustainability of health insurance finances. Accordingly, the need to allocate limited medical resources efficiently has increased, with improving the fee schedule seen as an effective way to achieve this. Japan has experienced a super-aging society for at least 20 years prior to Korea and has been successful in improving its fee schedule. Korea’s fee schedule, however, needs to overcome the challenge of being relatively limited in type and simplicity.
Current Concepts: The new patient consultation fee in Japan is the same regardless of the type of medical institution and is approximately 40% higher than found in Korea. In the case of established patient consultations, the fee for medical institutions with fewer than 200 beds are substantially higher than for large medical institutions, thereby suppressing re-examination at large hospitals. Japan’s additional points consist of 71 types of items, which is more diverse than Korea’s 28 types, and the additional points for children under six years of age, holidays, and late nights are set significantly higher than that found in Korea.
Discussion and Conclusion: Japan designed its fee schedule to structurally reduce the consumption of medical resources and to effectively compensate for the behavior of medical providers. This policy is a standard which Korea’s fee schedule should aim for. In the future, it will be necessary to prepare measures to respond to the super-aging environment through detailed research concerning Japan’s fee schedule.

참고문헌 (Reference)

1 All-Japan Federation of National Health Insurance Organizations, "The form of National Health Insurance"

2 Ministry of Health, Labour and Welfare of Japan, "Regarding reporting of referral rate and reverse referral rate in outpatient function report"

3 Igakutushinsya, "Medical treatment fee schedule quick reference table 2022" Igakutushinsya 2022

4 Michiko A, "Medical treatment fee claim work that you can learn on your own" Natsumesha 2022

5 National Health Insurance Service, "Key health insurance statistics for 2022"

6 Bae JH, "Japan social security system" Korea Institute for Health and Social Affairs 2018

7 Ministry of Health, Labour and Welfare of Japan, "Comparison of new and old guidelines regarding reporting of outpatient functions, etc"