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🏥 | Inoculation in the company, start later this month Government outlook, moderna assumption


Photo Press Conference Mr. Kono, Minister of Leather = 14th morning, Chiyoda-ku, Tokyo

Inoculation in the company, start later this month Government outlook, moderna assumption

 
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Mr. Kono also revealed that he requested economic organizations to cooperate with the inoculation of local residents by utilizing the clinics and health insurance associations in the company.
 

At a press conference on the 14th, Taro Kono, the minister in charge of administrative reform, planned about the new coronavirus vaccine as early as the end of this month ... → Continue reading

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Health insurance association

Health insurance association(Health Insurance, Society-Managed Health Insurance[1]) IsHealth insurance lawThe country does based onEmployee medical insuranceIt is a public corporation that acts on behalf of the business.Abbreviation:Health insurance

The regulatory agencyMinistry of Health, Labor and WelfareLocal welfare (branch) bureau, which is a local branch office of.As a superstructureFederation of health insurance associationsThere is.As of April 30, the number of health insurance associations that are members of the federation has reached 2018.[2].

Japanese national medical expenses(System distinction, FY2016)[3]
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%)

the purpose

Health insurance lawInsurer based on (25)[4]
InsurerNumber of subscribersNumber of unions
Subscriber totalPrincipal家族
National Health Insurance Association
(Special day insured personOther than)
34877 thousand people19631 thousand people15246 thousand peopleN/A
National Health Insurance Association
(Special day labor insured person)
18 thousand people12 thousand people6 thousand peopleN/A
Health insurance association29504 thousand people15533 thousand people13951 thousand people1443 union
Regarding the Health Insurance Law, only the number of articles is described below.

"Health insuranceInsurerNational Health Insurance AssociationAnd a health insurance association ”(Article 4), based on thisHealth insurance associationIs the member of the applicable business establishmentBusiness owner, Used for its applicable establishments被 保 険 者,as well asVoluntary continuous insuredConsists of (Article 8).In the case of specific health insurance association, furtherSpecial Retirement InsuredIs included.

It is done by the health insurance associationEmployee insuranceSystem,Union-managed health insurance(Commonly known as: Union Health Insurance).Mainly major companies and their group companies[5]Employees are subscribed.It is expected that activities that take advantage of economies of scale will be possible, such as actively carrying out activities to prevent diseases such as lifestyle-related diseases, improving the health of employees, and reducing medical expenses and insurance premiums.

Single type health insurance association
A format in which a company establishes a health insurance association independently.The insured requirement is always 700 or more.
Comprehensive health insurance association
A format jointly established by multiple companies in the same industry.The insured requirement is always 3000 or more.
There is as a superordinate organization (no basis law)Voluntary group)
Regional health insurance association
Format when health insurance associations operating in the same prefecture merge (Article 3-2 of the Supplementary Provisions).
It was newly established by the revision of the law in 2006 (Heisei 18).Established as a receiver for unions that have difficulty in stable insurance management, with the aim of reorganizing and integrating small-scale and financially distressed unions.It is possible that more than one will be established in the same prefecture.
  • If a health insurance union is established by division, all of them must meet the number requirement.

On the other hand, nowNational Health Insurance AssociationThe employee insurance system in Japan is called the Japan Health Insurance Association's health insurance (commonly known as the Japan Health Insurance Association), and until September 2008, 20, the country (Social Insurance Agency) Was operated as government-controlled health insurance (commonly known as government-controlled health insurance).

Establishment

Breakdown of increase / decrease in the number of unions of unions health insurance[6]
EstablishmentDissolutionMerger disappearedIncrease or decrease
216237X 24
2251010X 15
234712X 15
243114X 12
25101210X 12
266511X 10
27345X 4
28774X 6

When the employer of the applicable business establishment intends to establish a health insurance association, he / she must obtain the consent of more than half of the insured persons used at the applicable business establishment to create the rules.Minister of Health, Labour and Welfare OfAuthorization[7]Must be received (Article 12, Paragraph 1).In the case of co-establishment, the consent of all business owners must be obtained and at least half of the consent must be obtained for each business establishment (Article 2, Paragraph 1).In addition, the Minister of Health, Labor and Welfare may order the establishment of a health insurance association for business owners who use a certain number or more of insured persons for one or more compulsory application establishments (Article 12).If the employer does not comply with this order, he / she shall be punished by a fine of not more than twice the amount of insurance premiums to be borne during the delayed period of the procedure.A health insurance association is established when it is approved for establishment (Article 2).Similar procedures are required when the health insurance association increases or decreases the number of establishments (Article 1).

The employer of the applicable business establishment where the health insurance association is established and the insured person used for the business establishment become a member of the health insurance association even if the insured person does not agree to the establishment ( Article 17 (1)).Even when it is no longer used by business establishments, if it is a voluntary continuous insured person, it will still be a member of the relevant health insurance association (Article 17, Paragraph 2).In addition, it should be noted.Special day insured personCannot be a member of a health insurance union, even if it is used by a business establishment.

To establish a health insurance associationMinistry of Health, Labor and WelfareIt is necessary to comply with the establishment approval criteria set by the above and to expect stable business operations in the future, and the examination is strict.If you apply for a company that does not meet the standards and the government does not approve it, there is a risk that listed companies will have side effects such as a crash of the stock price of the company in the market. It is customary for us to proceed to the approval application only for those who are finally found to meet the approval criteria.For this reason, there has never been a case where the application for the ceremony was rejected.

If a day labor special insured person works at a place of business where a health insurance union is organized, the union willDay labor contributionMust be paid to the Minister of Health, Labor and Welfare.The amount is calculated by subtracting the total amount of income from the total amount of expenditure for the special day labor insured person in the same year and dividing it proportionally by the number of working days for each union in the same year.In other words, the cost for the day labor special insured person will be borne according to the usage record.Delivery deadlines are September 1th and March 9st each year.

組織

The health insurance union has one director, directors, and auditors as officers (Articles 1 and 21), and the board of directors becomes the executive body of the health insurance union (Article 22-7).

A partnership is set up as a voting body (Article 20), and the president must convene a regular partnership once a year.In addition, when more than one-third of the members of the union council are requested to convene the union in writing stating the agenda items and their reasons, the chairman shall be within 1 days from the time of the request. A union must be convened.The number of members of the union members shall be an even number, and half of them will be selected from those used at the establishment of the establishment, and the other half will be elected by mutual election of the members (Article 3, Paragraph 1).The term of office of members of the union members shall be stipulated in the bylaws within a range not exceeding three years (Article 20 of the Enforcement Ordinance).The following matters must be decided by the union.

  • Changes to the rules (except for minor matters, approval from the Minister of Health, Labor and Welfare is required)
  • Budget for income and expenditure (including cases where the amounts of each item specified in the budget are diverted to each other)
  • Business report and settlement of accounts
  • Merger / division / dissolution of unions (voting by a majority of three-quarters or more of the number of union members, approval of the Minister of Health, Labor and Welfare required)
  • When attempting to obtain approval / revocation of approval of a specified health insurance association (a majority of two-thirds or more of the members of the union council must vote and the approval of the Minister of Health, Labor and Welfare is required)
  • Other matters stipulated in the agreement

The health insurance union prepares a budget for income and expenditure every year.Before the start of the yearMust be notified to the Minister of Health, Labor and Welfare.Also, after the end of each yearWithin 6 monthsIn addition, a report on business and settlement of accounts must be prepared and submitted to the Minister of Health, Labor and Welfare (Articles 16 and 24 of the Enforcement Ordinance).The report preparation does not require the approval and approval of the minister like the Japan Health Insurance Association.When a health insurance union intends to dispose of important property, it must obtain approval from the Minister of Health, Labor and Welfare (Article 23 of the Enforcement Ordinance).The health insurance association must report the monthly business situation to the director of the competent regional welfare bureau by the 20th of the following month.

Health insurance unions (financial distress unions) whose income and expenditure in the health insurance business are not balanced and have been designated by the Minister of Health, Labor and Welfare are those.Plan for fiscal consolidation(A three-year plan with the year following the year to which the designated date belongs as the first year) was established, and the Minister of Health, Labor and WelfareApprovalMust receive.The health insurance association that has received the approval must carry out its business in accordance with the soundness plan pertaining to the approval (Designated health insurance association, Article 28).The same applies when changing the restoration plan.The Minister of Health, Labor and Welfare shall designate the union when the current account balance settlement for the three years preceding the designated year is in the red and any of the following is satisfied.

  • The insurance premium rate required for statutory benefits, etc. for 3 consecutive years is 9.5% or more, and the reserve level of the previous year of the designated year is less than 3 months.
  • The number of insured persons is less than the establishment standard

Since all administrative expenses in the health insurance business are borne by the national treasury within the budget (Article 151), the national treasury contribution is delivered to the health insurance association (Article 152).This national treasury contribution is calculated by the Minister of Health, Labor and Welfare based on the number of insured persons in each health insurance association.On the other hand, the national treasury subsidies such as insurance benefits and support for the elderly, which are provided to the Japan Health Insurance Association, are not provided to the health insurance association.

The health insurance association will use the following total amount from the surplus at the end of each business year.ReserveMust be accumulated as.And this reserve is unless it makes up for the shortage of insurance benefits.Can't be withdrawn..If there is a shortage of cash for payment and the reserve is used or borrowed temporarily, it must be returned within the relevant fiscal year.

  • Three-twelfths of the average amount of insurance benefits required for insurance benefits in the relevant business year and the two business years immediately preceding it (due to the revision in 2)12/2 for the time beingAmount equivalent to)
  • Amount of expenses required for payment of early-stage elderly payments, late-stage elderly support, daily employment contributions, retirement benefit contributions, and long-term care payments made within the relevant business year and the two business years immediately preceding it (previous period) Amount equivalent to one-twelfth of the average amount per business year (the amount after deducting the elderly grant, if any)

Dissolution

The health insurance association has one of the following reasons:Dissolution(Article 26, Paragraph 1).

  • A vote of the union by a majority of three-quarters or more of the union members (requires approval from the Minister of Health, Labor and Welfare)
  • Inability to continue business of health insurance association (approval of Minister of Health, Labor and Welfare required)
  • Dissolution order of the Minister of Health, Labor and Welfare (It is said that it can be ordered in the following cases)
    • When the health insurance association violates an order to take necessary measures to correct or improve the violation regarding the management or execution of its business or property.
    • When the designated health insurance association violates the provision that the business must be carried out in accordance with the restoration plan
    • When the designated health insurance association does not respond to the request from the Minister of Health, Labor and Welfare to change the restoration plan
    • When it is found that it is difficult to continue the business or property of the designated health insurance association specified by Cabinet Order.

When the health insurance association is dissolved, with the propertydebtIf the health insurance association cannot pay off the debt, the health insurance association will pay the debt to the business owner of the establishment.Pay offIt is possible to request the burden of the amount equivalent to all the costs required to do so (Article 26, Paragraph 3).In this case, if the business owner cannot bear the cost due to the start of bankruptcy decision procedure or other special reasons, the health insurance association will reduce it with the approval of the Minister of Health, Labor and Welfare. , Or can be exempted.

Since the rights and obligations of the health insurance association that have been extinguished due to the dissolution will be succeeded by the Japan Health Insurance Association (Article 26, Paragraph 4), the insured person who will be a member after the dissolution will be the insured person of the association.

Federation of health insurance associations

The health insurance union jointly achieves its purpose,Federation of health insurance associations(Health Insurance Federation) can be established (Article 184).In addition, the Minister of Health, Labor and Welfare may order the health insurance union to join the health insurance union when it finds it necessary to promote the joint welfare of the insured members who are members (Article 185). ).

The Health Insurance Federation will provide grants to member unions in order to adjust for imbalances in financial resources between unions.The union will make contributions to the Health Insurance Federation, and the employer / insured will bear the adjusted premium to cover the costs required for the contribution.

Special provisions of the union

The health insurance association is established for the purpose of enhancing the interests and welfare of employees and their families, insured persons and dependents.Therefore, services unique to the union, which are not permitted by the Japan Health Insurance Association, are permitted.

  • In principle, the share of insurance premiums is split between labor and management at the Japan Health Insurance Association (Article 161), but at the Japan Health Insurance Association, the share of the burden on the employer can be increased as stipulated in the regulations (Article 162).
    • However,It is not appropriate to set the insured's burden ratio to zero(No. 25 issued by Hobun on June 6, 21).
    • If the employer's burden ratio is increased, the amount equivalent to the increase ratio is not considered as "reward" under the Health Insurance Act.
  • Contribution to be paid at the medical institution window (Partial contribution) Is a 3% burden in principle at the Japan Health Insurance Association, but it is designated by the union.hospitalIn such cases, the partial contribution can be reduced or not collected according to the rules.Also,Partial contributions are not collected at hospitals directly managed by the union(It is possible to stipulate that tax withholding should be made within the legal burden ratio by the rules) (Article 84).
  • In addition to the insurance benefits stipulated by the Health Insurance Law, as stipulated in the regulationsAdditional benefitsCan be done (Article 53).In particular,出産 手 当 金,Lump-sum birth allowance,Injury and sickness allowance,Burial fee,High medical expensesThere are many health insurance associations that stipulate the addition of the amount of payment such as, etc. and the extension of the payment period.
    • The additional benefit is a part of the insurance benefit and should be provided in conjunction with the statutory benefit (February 32, 2, Hosho No. 1, November 3, 35, Hosho No. 11).Therefore, disaster relief money, family attendance money, nutritional money[8], It is not permitted to provide additional benefits that are not related to insurance accidents, such as the provision of clothing for childbirth, or that cannot be said to supplement or expand insurance benefits.In addition, there is no difference in the amount or period of payment depending on the insured period, etc., payment only when visiting a specific medical institution, or similar payment opportunities that may impair equal opportunity. , Those who have lost their insured status are not allowed.
  • In the health insurance union (approved health insurance union) approved by the Minister of Health, Labor and Welfare, the standard remuneration fixed rate system is stipulated by the regulations.Long-term care insuranceBy income stage instead of feeFlat rateThe amount of long-term care insurance premiums can be adopted (special long-term care insurance premiums, Article 8 of the Supplementary Provisions).This special long-term care insurance premium is stipulated in the bylaws so that the total amount of special long-term care insurance premiums of the relevant union in each fiscal year is equal to the long-term care payment to be paid by the relevant union.
  • The employer who establishes the union uses it for the union.National pensionPart of the affairs related to the notification of the National Pension No. 2 insured, who is the dependent spouse of the No. 3 insured, can be entrusted (National Pension ActArticle 12 paragraph 8).
    • Normally, this notification is made via the employer, but according to this regulation, the pension affairs are generally carried out by the health insurance association at the business establishments that have the health insurance association.

In the case of a health insurance association, even if the insured person is not a long-term care insurance No. 2 insured person, if the insured person has a dependent who is a long-term care insurance No. 2 insured person. By stipulating in the bylaws, the insured person can be required to bear the amount of long-term care insurance premiums (specified insured person, Article 7 of the Supplementary Provisions).

Directly managed medical institution

Task

Financial problem

Federation of health insurance associationsAccording to the report, the number of deficit unions in 30 was 866, which is more than 6% of all unions.The total deficit of the union is expected to be ▲ 1,381 billion yen.Regarding mandatory expenses (statutory insurance benefits and support / payment, etc.), there were 351 unions that could not be covered by premium income, accounting for 25.6% of the unions that responded to the federation's survey.

平成30年3月1日時点での平均保険料率は9.215%(調整保険料率含む)で、平均保険料率の増加は11年連続である。料率を引き上げた組合は172組合(回答組合の12.5%)で、平均引き上げ料率は0.622%(8.792%→9.414%)である。Association KenpoThe number of unions with an average premium rate (10.00%) or higher is 313 unions (22.8% of responding unions).[2].

As for these factors, although the increase in the number of insured persons was the biggest factor in the increase in premium income, the amount per insured person was 1 yen, an increase of 486,042 yen or 3,084% from the previous year.Medical system for elder senior citizensCompared to 19 before the enforcement, it increased by 102,430 yen, 26.70%, "There is no change in the situation where the contribution burden is squeezing the union finances."Baby boomersAs the aging of the population progresses (reaching the age of 75), it will surely become a heavier burden. "[2].

Dissolution of health insurance association

Medical system for elder senior citizensIf the insurance premium rate exceeds 10%, some unions will be disbanded due to the heavy burden of insurance, and many members will be joined by employees of small and medium-sized enterprises.Association KenpoIf you move to, the increase in the burden of national expenses will be spurred.[10].National Health Insurance AssociationNobuki Ando, ​​the chairman of the board, also pointed out in 2018 that "the burden of medical expenses for the elderly is large, and the burden on the working generation is limited."[11].

  • Seino HoldingsUnder the umbrellaSeino TransportationThe Seino Transportation Health Insurance Society (57,000 members), which consists of such members, cannot withstand the medical burden for the elderly aged XNUMX or over.2008Disbanded on August 8st and moved to Japan Health Insurance Association[12]..This Seino Transportation Health Insurance Association was dissolved without selling the recreational facilities, etc. that it had in various places, so it was practicallyBad debt(According to Article 26, the rights and obligations of the Japan Health Insurance Association, which was extinguished due to the dissolution, will be taken over by the Japan Health Insurance Association).
  • Nagoya cityEmployee health insurance was dissolved on December 2008, 12 due to an increase in medical contributions for the elderly and a decrease in staff, and shifted to local government employee mutual aid.[13].
  • Ltd.KyotaruThe health insurance association was disbanded in 10 and moved to the Japan Health Insurance Association because it was estimated that the insurance premium rate would be raised by 2008% or more due to the increase in medical contributions for the elderly.[14].
  • The Niigata Unyu Health Insurance Association was dissolved in 2009 due to an increase in medical contributions for the elderly and subscriber benefits, and moved to the Japan Health Insurance Association.[15].
  • Temporary workerThe second largest health insurance association in Japan, the "Temporary Staffing Health Insurance Association," has about 51 members from Japan and its families.2018(Heisei30 years)May 9Held a partnership in Japan, due to an increase in medical burdens for the elderly and financial deterioration.2019(31)May 4In addition, I decided to dissolve the health insurance association[16].. This is the largest number of transitions since the establishment of the Japan Health Insurance Association in 2008.

2009 yearsOECDThe report recommends consolidating insurers and reducing the total number to increase insurer efficiency due to the large number of small health insurance associations.[1].

2015 year 5 month 27 dayHouse of CouncilorsAs part of the reform of the medical insurance system under the "Medical Insurance System Reform Law" enacted at the plenary session, the total remuneration portion of the employee insurer's support for the latter-stage elderly will be borne according to their ability to bear. In 2015 (Heisei 27)1⁄2, 2016 (Heisei 28)2⁄3From 2017 (Heisei 29)Total remuneration rateWill be implemented.

At the same time, when the full-scale total remuneration discount is implemented, it will be revised to the adjustment method that takes into account the participation rate of the early-stage elderly in the support for the late-stage elderly related to the early-stage elderly in the early-stage financial adjustment, reducing the burden of the early-stage elderly contribution. It was decided to plan.However, this is likely to maintain the status quo for the Japan Health Insurance Association, which has a low average standard remuneration for insured persons, but it will increase the actual burden for health insurance associations centered on large corporations. ..

footnote

  1. ^ a b OECD Economic Surveys: Japan 2009 (Report). OECD. (2009-08-13). Chapt.3. two:10.1787 / eco_surveys-jpn-2009-en. ISBN 9789264054561. 
  2. ^ a b c Summary of 30 Health Insurance Society Budget Early Aggregation Results (Report). Federation of Health Insurance Unions. (2018-04-23). http://www.kenporen.com/include/press/2018/20180423.pdf. 
  3. ^ Overview of national medical expenses in 28 (Report). Ministry of Health, Labor and Welfare. (2018-09-21). https://www.mhlw.go.jp/toukei/saikin/hw/k-iryohi/16/index.html. 
  4. ^ 25 White Paper on Health, Labor and Welfare (Report). Ministry of Health, Labor and Welfare. Document p26. 
  5. ^ Many large companies, regardless of industry, have health insurance associations, but on the other handJRA,Japan Sumo AssociationOther organizations also have health insurance associations.
  6. ^ "Summary of FY30 Health Insurance Society Budget Early Aggregation Results (Material)" (Press Release), Federation of Health Insurance Unions, http://www.kenporen.com/include/press/2018/20180423.pdf 
  7. ^ Many of the authority of the Minister of Health, Labor and Welfare under the Health Insurance LawRegional Health BureauTo long or longDelegationHowever, the approval for the establishment of a health insurance union has not been delegated.
  8. ^ Until around 20, "payment of nutritional supplements during hospitalization" was permitted as an additional benefit (February 23, 2, Hosho No. 5), but after the 147's, "can be provided in combination with legal benefits". To that effectAdministrative guidanceHas been strengthened and is no longer recognized.
  9. ^ Summary of expected financial results of the Japan Health Insurance Association (Report). Health Insurance Federation. (2016-09-09). http://www.kenporen.com/include/press/2016/20160909-1.pdf. 
  10. ^ “Health insurance association, average rate is the highest ever Contribution to medical care for the elderly”. Asahi Shimbun(July 2018, 4). https://www.asahi.com/articles/ASL4R4R81L4RUTFK012.html 
  11. ^ Yoshiko Hashimoto (October 2018, 10). "Is the burden of 75 years or older" 2% "? "The burden on the working generation is limited" "Opposite" Medical insurance subcommittee, consideration of utilization of high-priced drug "non-insurance combined medical treatment" ". (MXNUMX). https://www.m3.com/open/iryoIshin/article/634395/ 2018th of February 10Browse. 
  12. ^ “Seino Transportation's Health Insurance Society Dissolves Increased Burden Due to Medical Reform for the Elderly”. Joint(July 2008, 8). http://www.47news.jp/CN/200808/CN2008082101000303.html 
  13. ^ "Nagoya City Health Insurance will dissolve in December XNUMX unions nationwide will shift to mutual aid". Joint(July 2008, 9). http://www.47news.jp/CN/200809/CN2008091701000388.html 
  14. ^ “Kyotaru Health Insurance Society is dissolved and the burden of medical expenses for the elderly is doubled”. Joint(July 2008, 9). http://www.47news.jp/CN/200809/CN2008090901000240.html 
  15. ^ "The" Niigata Unyu Health Insurance Society "dissolves". Niigata Daily(July 2009, 6) 
  16. ^ Keishi Nishimura (September 2018, 9). “The second largest health insurance union in Japan decides to dissolve XNUMX people join”. Asahi Shimbun digital (Asahi Shimbun). https://www.asahi.com/articles/ASL9P5Q4DL9PUTFK01D.html 2018th of February 10Browse. 

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