Portal field news

Portal field news

in ,

💴 | "Money system" that can be used for illness or injury, "10 checklists" that you do not know


写真 

"Money system" that can be used for illness or injury, "10 checklists" that you do not know

 
If you write the contents roughly
However, if you don't have enough money, you may consider medical insurance.
 

In the "Most Anxious Items for Everyday Life and Future" of the Life Insurance Culture Center, "(I and my family) are sick or have an accident ... → Continue reading

 MONEY PLUS

MONEY PLUS is an economic media that conveys financial and economic information in an easy-to-understand manner for people who are not good at talking about money.


Wikipedia related words

If there is no explanation, there is no corresponding item on Wikipedia.

medical insurance

medical insuranceWhat is (Health Insurance)?Medical institutionSuch as hospitalization costs and surgery costs incurred by the consultationMedical billsInsurer pays part or all of theinsurance.

Due to high medical expensespovertyThe purpose is to prevent illness and stabilize life.In order to avoid the high medical expenses associated with long-term hospitalization and treatment with advanced medical care, which are directly borne by the insured, the insured's upper limit is set, and conversely, insurance claims are paid. In order to prevent the insurer's financial resources from being overwhelmed by the swelling of the amount, the insured's out-of-pocket ratio and out-of-pocket payment are often set, or the coverage is limited in advance.

Type

It can be divided into two types: compulsory public medical insurance and voluntary private (private) medical insurance.

Public medical insurance is a medical insurance system in which the scope of insured persons is set in advance by the government.多くのmanyDeveloped countryHas prepared a public medical insurance system, but the scope of target persons and the financial resources method differ depending on the country.[1]..Even in public medical insurance, the underwriter is not limited to government agencies, and in some countries private companies underwrite (Netherlands, Switzerland, etc.).

On the other hand, private medical insurance is voluntary, and it is possible to select a plan from a menu prepared by multiple insurance companies according to the property and income of the policyholder.The expected role of private health insurance varies greatly from country to country.なお任意加入の医療保険では、自己の健康状態に不安がある人ほど保険加入のインセンティブを持つため、いわゆるWith voluntary medical insurance, people who are worried about their health condition have an incentive to take out insurance, so it is so-called.Reverse selectionMay form an insured group with poor health.This tendency is especially strong with guarantees such as surgical benefits that allow participants to choose to undergo a medical examination.また、保険金Also, insurance moneyscamTo take out insurance for the purpose ofMoral riskThere is also the problem of.

System of each country

  • United States medicalPrivate medical insurance is common.マネージド・ケアは大きく分けてManaged care can be broadly dividedHMO, POS, and PPO.Voluntary subscription in many states,MassachusettsThen, it is obligatory to take out some kind of medical insurance.
  • Dutch medicalSo, short-term medical insurance is compulsory insurance, but it is underwritten by a private insurance company with public risk adjustment.
  • German medicalThe insurance is compulsory insurance, but you can choose between public insurance and private insurance.
  • Singapore medicalInsurance isPay-as-you-go systemNot taken, individual unitFunding method.

Japanese system

Number of Japanese medical insurance subscribers (2013)[3]
InsurerNumber of subscribers (XNUMX)
National Health Insurance3,831
Association Kenpo3,502
Health insurance association, mutual aid, etc.3,869
Medical system for elder senior citizens1,473
(reference) Private medical insurance[4]1,586 million contracts

In Japan, it is called "national insurance"WelfareAll citizens who have an address in Japan except some of the beneficiaries, and have a status of residence of 1 year or moreJapanese foreignerIs required to take out public medical insurance in some way (≠Compulsory insurance).

The first health insurance system in JapanWorld War IAfter1922(TaishoIt was first enacted in 11)1927(ShowaIt was employee insurance for occupations that was enforced in 2 years).This system, which originally started with a union of workers engaged in dangerous businesses such as mining labor, has gradually expanded its scope, and with the development of the national health insurance system operated by municipalities, etc.Universal insuranceWas achieved1961(Showa 36).

Japanese public medical insurance

Japanese national medical expenses(System distinction, FY2016)[5]
Publicly funded medical carePayment3 billion yen (007.5%)
Medical care for the elderlyPayment14 billion yen (033.6%)
medical insuranceEqual payment
19 billion yen
(45.7%)
Employee insurance
9 billion yen
(22.2%)
Association Kenpo5 billion yen (012.1%)
Health insurance association3 billion yen (008.4%)
Seafarers insurance195 billion yen (000.0%)
Mutual aid association1 trillion0583 billion yen (002.6%)
National Health Insurance9 billion yen (022.6%)
OtherLabor accidentな ど3049 billion yen (000.7%)
Patient burden5 billion yen (012.2%)
Special mitigation measures1119 billion yen (000.3%)
the amount42 million yen (1381%)

Employee insurance

Regional insurance

Persons who are not insured by employee insurance (individual business owners, unemployed persons, workers who cannot take out employee insurance, etc.) will join.

  • National Health Insurance(National Health Insurance) --With municipalitiesTokyospecial areaIs going.
  • National Health Insurance Society - self employedEven so, it is legally permitted to form a national health insurance union by coalition of people of the same type.
    • National health insurance generally has a higher premium (insurance tax) than employee insurance, and the method of calculating insurance premiums differs greatly depending on the municipality.
(Reference) Livelihood protection (medical assistance)
WelfareFor those who are not covered by public medical insurance among the beneficiaries, the public assistance system is used regardless of the insurance system.WelfareMedical care is provided as a kind of.Recipients of welfare protection cannot be covered by the National Health Insurance (National Health Insurance ActArticle 6).

Medical system for elder senior citizens

With people over 75 years oldAssociation of Medical Care for the ElderlyIt is a medical insurance system for persons with disabilities aged 65 and over (excluding welfare recipients) certified by the government, 2008 (Heisei 20).May 4It started from.

The insurer is a wide-area federation of medical care for the elderly in the latter half of the year, consisting of all municipalities in each prefecture. It is covered by municipal subsidies and contributions.

Injuries and illnesses caused by third-party acts

In case of a traffic accidentIndustrial accidentUnless it falls under the above, it will be covered by public medical insurance (if it is covered by work-related accidents, the treatment of work-related accidents will be prioritized and public medical insurance will not be applied).In this case, if there is a perpetrator (see below), a third party will be sent to an insurer such as the National Public Health Insurance Division of the municipality, the National Public Health Insurance Association, the Corporate Public Health Insurance Association, or the National Public Health Insurance Association. You must submit a report of injury or illness due to the act without delay.The form is available at each insurer's window.In addition, at the medical institution window, you have to pay the personal contribution once, just like ordinary public medical insurance.

If the traffic accident is not your own accident but a partnerReceiptIt must be stated in the (medical fee bill) that it is a "third party act".Without this statement, the insurer will not be able to charge the perpetrator for the medical expenses incurred according to the accident rate of the traffic accident.

In addition, if you make a settlement without permission, you may not be able to receive benefits from public medical insurance, so it is better to contact the insurer in advance.

Circumstances of medical institutions

Benefits of using public health insurance
Traffic accidents have complicated procedures and complicated interests, and if a patient has trouble, payment may be delayed or delayed depending on the insurance company.In that respect, if you use public medical insurance, you will be paid by the insurer without delay, just like regular medical fees.
Difficulties in using public medical insurance
If you use public medical insurance, the total cost of treatment will be kept low.From the standpoint of running a medical institution, it is natural to want free medical care that can be expected to generate high income.In addition, one of the drawbacks is that it does not generate as much income as the labor required for various procedures, so it deprives medical institutions of their enthusiasm for treatment.

Patient circumstances

Benefits of using public health insurance
Automobile liability insuranceSince the upper limit of (automobile liability) is 120 million yen, it costs treatment costs that exceed the upper limit due to hospitalization costs, etc.If the other party does not have voluntary insurance,When the victim's negligence is largeFor example, using public medical insurance can reduce the burden on the victim.
Difficulties in using public medical insurance
Treatment by free medical treatment has less restrictions on various treatments than treatment by public medical insurance.In addition, since the amount of free medical treatment is high, even if some treatment costs are cut due to the same treatment restrictions as public medical insurance, it is easy to cover the total treatment costs.Patients who are victims will not be able to receive excessive initial medical care, which is a merit of free medical care.

Insurance company circumstances

Benefits of using public health insurance
On the insurance company side, the total amount of compensation can be kept lower than free medical care by using public medical insurance.
Difficulties in using public medical insurance
If the patient's recovery is unsatisfactory, a proceeding may develop between the patient, the medical institution, and the insurance company.This also happens in free medical care, but the possibility increases as much as you cannot receive excessive initial medical treatment.

Insurer circumstances

Benefits of using public health insurance
This will lead to improved services for the insured.
Difficulties in using public medical insurance
Insurers of association-managed insurance / public medical insurance associations and some national public medical insurance may not be able to claim perpetrators who do not have voluntary insurance, or the cost of claiming will be high, so public medical insurance will be used for traffic accidents. I don't want you to use it.

When visiting a medical institution due to illness or injury in a foreign country

Japan's public medical insurance cannot be used in foreign countries, but if you get injured or sick in a foreign country and consult a local medical institution, you will be billed to the insurer who has taken out the medical expenses paid overseas after returning to Japan. Can beOverseas medical expensesThere is a system called.However, the procedure includes a medical statement (a doctor's certificate stating the medical details, disease name, medical condition, etc.), a receipt (a receipt issued by a medical institution with a breakdown), and a Japanese translation of this. In addition, the amount paid by public medical insurance is calculated based on the medical expenses (standard amount) for similar illnesses and injuries in Japan and the foreign exchange conversion rate on the payment decision date, so it costs in foreign countries. If the medical expenses are high, the rate of return from public medical insurance may be low.

In addition, ambulance charges (basically ambulances are charged in foreign countries) are not covered, and medical expenses need to be paid in advance temporarily, so overseas travel accident insurance is contracted (Credit cardDepending on the case, it is often set as standard) so that medical expenses can be billed to the insurance company, and in major countries, local support in Japanese is often available.海外旅行傷害保険から医療費が保険金の形で降りても、公的医療保険の海外療養費の支給額が減額されることはないとのことEven if medical expenses are dropped from overseas travel accident insurance in the form of insurance money, the amount of overseas medical expenses paid by public medical insurance will not be reduced.[6].

Status of private medical insurance in Japan

Private medical insurance in Japan is intended to cover the out-of-pocket medical expenses, miscellaneous expenses such as differential bed charges and transportation expenses, and cash benefits to cover the decrease in income due to leave, that is, to supplement public medical insurance. is there.In addition, there is also a so-called "sympathy money" when a person is diagnosed with a malignant disease.There are many plans in which a fixed amount of benefits is paid according to the diagnosis result, the degree of injury, the type of surgery, and the number of days of hospitalization or hospitalization.民間の保険会社により販売されるものであり、直接の公的助成はないものの、支払った保険料は一定の条件のもとでIt is sold by a private insurance company and there is no direct public subsidy, but the premiums paid are under certain conditions.income taxIt can be recorded in the calculated deduction amount (life insurance premium deduction).

"Third sector insuranceIn this field, small and medium-sized domestic life insurance companies and foreign-affiliated life insurance companies have been the mainstays, and sales of life insurance companies in the United States have increased.結果、一例としてAs a result, as an exampleSpecific illness insuranceIs a representative ofCancer insuranceIn the field,1974Started business in (49)American family life insurance(Currently Aflac Life Insurance Co., Ltd.) launched the first cancer insurance in Japan and has maintained the top position for many years.

2001(13), liberalization of the third sector insurance field was approved based on an agreement with the United States, and in JapanLife insurance company-Non-life insurance companyHas been able to make a full-scale entry into the market, and many insurance companies have since entered this market.2006(18) In November, many insurance companies, including foreign-affiliated companies, were involved in third-sector insurance centered on medical insurance.Unreasonable non-payment of insurance moneyIt came to light that was being done in large numbers.

Task

注 釈

  1. ^ 1.6% of salary is deducted from salary in advance instead of health insurance premiums paid by civil servants and citizens. There is a burden.なお、自衛官診療証を使用して医療を受給する場合、予め所在If you use the SDF medical certificate to receive medical care, you will be located in advance.Garrison OfBusiness corpsReport to the head of the health department (for garrison where no business unit is set up, the head of an organization equivalent to the department of hygiene in the core unit of the garrison, the person in charge of hygiene, etc.), or report by a certain period after the consultation. There is a rule that if you fail to report after a certain period of time, you will have to refund the medical expenses paid from public expenses.

footnote

References

Related item


 

Back to Top
Close