Japan does not allow ‘coverage + non-coverage’ mixed treatment… In most cases, fixed-rate insurance instead of actual expenses [의료 망치는 비급여]

Anatomy of a non-benefit republic

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Patients waiting in front of the outpatient reception desk at the University of Tokyo Hospital in Tokyo, Japan. Tokyo = Reporter Jeong Jong-hoon

Private health insurance is as different from Korea as the management of non-covered medical care in foreign medical systems. In Korea, actual loss insurance is mainly used, which refunds medical expenses based on the amount used within a certain limit. On the other hand, in countries such as Japan, most products are fixed-rate products that only pay a pre-determined amount. Since it is a fixed-rate product, it does not lead to medical abuse.

“In Japan, there are no cases where private health insurance is used for unnecessary medical abuse. Mixed treatment (mixing health insurance treatment with non-covered treatment) is not allowed because a situation like (abuse) in Korea may arise.”
Naoki Ikegami, professor emeritus at Keio University, has repeatedly mentioned that Japan’s private health insurance “plays a supporting role in health insurance.” We met at his home near Tokyo, Japan on September 5th.

Japan’s private health insurance mainly covers out-of-pocket costs incurred during medical treatment. There is little opportunity to abuse insurance due to the ban on combined medical treatment between benefit and non-coverage. Professor Ikegami explained, “In many cases, the insurance payment is a flat amount (not the actual cost), such as 10,000 yen (about 90,000 won) per day of hospitalization.” Kanako Katayama, deputy director of planning at the National Health Insurance Association, said, “The subscription rate for private health insurance in Japan is not low, but most people subscribe to it in preparation for hospitalization in a single room or cancer treatment that requires a large out-of-pocket cost.”

There is virtually no government regulation of the private health insurance market. Naohiro Yashiro, a special professor at Showa Women’s University, said, “There is no need for the government to intervene because almost everything is covered by health insurance.”

A view of the treatment room at the Kobe Aesthetic Plastic Surgery Clinic in Japan. Kobe = Reporter Jeong Jong-hoon

Taiwan is similar. Although there is private medical insurance separate from health insurance, it does not provide comprehensive coverage like Korean actual cost insurance. Insurance companies also strictly manage claims review and payment. It is difficult to find medical institutions indiscriminately inducing uncompensated treatment. Therefore, the loss ratio of insurance companies is around 40%, which is lower than in Korea (75%, actual loss 103%).

Chen Ji-yun-liang, chairman of the Taipei City Traditional Chinese Medical Association, said, “In Taiwan, treatment methods do not vary depending on private insurance, but are judged based on the patient’s needs.” Yang Han-chuan, honorary chairman of the Taiwan Medical Association, also said, “Taiwan has a high private insurance subscription rate. It’s not a side. “The scope of benefit coverage is different,” he said, adding, “The method of treating patients does not change depending on whether or not they have insurance.”

Germany also has private insurance. Subscribing to this product is not mandatory, but a consumer choice. It does not cover plastic surgery for cosmetic purposes, but provides support for upper-class (single) hospital room fees, nursing fees, and dental prosthetics costs. Compared to Korea’s actual loss insurance, the scope of coverage is narrow.

※This project was supported by the Press Promotion Fund raised through government advertising fees.

◇Special reporting team = Berlin, Bonn (Germany) = Reporter Nam Soo-hyun, Tokyo and Kobe (Japan) = Reporter Jeong Jong-hoon, Taipei (Taiwan) = Welfare reporter Shin Seong-sik [email protected]