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🏛 | Declaration canceled "1 metropolitan area and 3 prefectures agree"


Photo Governor Kuroiwa = Prefectural Office attending a video conference with the minister in charge of economic revitalization Nishimura

Cancellation of declaration "1 metropolitan area and 3 prefectures respond in unison" Governor Kanagawa and Kuroiwa

 
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At the meeting, the governor requested the government to increase medical fees for a new Kanagawa model in which a community medical team watches over home care workers.
 

Governor Yuji Kuroiwa of Kanagawa Prefecture said on the 2nd that the state of emergency, which will expire on the 1th in 3 metropolitan area and 7 prefectures, said, "The number of Kanagawa ... → Continue reading

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Medical fee

Medical fee(Shinryohoshu,English: Health care fee) IsInsurance medical treatmentAt the time ofMedical practiceCalculated as consideration for etc.RemunerationRefers to.

Not "doctor's reward"Medical practiceWentMedical institution-pharmacyMeans the sum of medical practice income.For medical practice incomeDoctor(OrDentist) Andnurse,Otherhealth care workerTechnical fee, which is the compensation for medical practicepharmacistIncludes dispensing technical fees for dispensing activities, drug costs for prescribed drugs, medical material costs used, and inspection costs associated with medical practices.

In the case of medical insurance in Japan, it is calculated based on the medical fee schedule and expressed in points.患者はこの一部を窓口で支払い(いわゆるPatients pay part of this at the counter (so-calledSelf-pay), The rest is publicmedical insuranceWill be paid in.保険を適用しないNot covered by insuranceFree medical careIn this case, the medical fee is not defined by the medical fee points, the medical institution sets the price arbitrarily, and the patient bears the full cost.

Payment system

System of each country

米 国

The public health system in the United StatesMedicareandMedicaidIs a federal agency(English edition)(CMS) is in charge.それらの診療報酬は、CMSがCMS will pay these medical fees(English edition)Priced by (PPS) and applies to outpatient, inpatient and other services[1]..Medicare is the largest purchaser of healthcare services in the United States and is a major price leader in the market.The price is determined by the CMS by analyzing the labor and resource costs of various medical services.

Taiwan

Taiwan medicalThen.Bundled payment system, And a total budget payment system has been introduced, and the government determines the total annual medical expenses and adjusts the medical fee amount per point within the budget.

Japan

The insurance medical institution will give you a medical fee statement based on the details of the medical treatment you have provided.Receipt) And publicmedical insuranceHowever, each item in the statement is scored instead of the amount.診療報酬点数はThe medical fee points areMinistry of Health, Labor and Welfare noticeDo (Health insurance lawArticle 76).

1 point = 10 yen[2]..Get a diagnosis and treatment using insurance at a medical institution (Insurance medical treatment) Sometimes usedMedical billsIt is a calculation system.診療報酬点数には医科・歯科・調剤の3種類があるThere are three types of medical fee points: medical, dental, and dispensing.[3]..急性期病院で用いるUsed in acute care hospitalsDiagnosis-related group classification score (DPC score table) is also available.Patients are 3% calculated by medical fees (payment in principle.Publicly funded medical care(There are exceptions), pay at the medical institution window.

  • From April 2006, insurance medical institutions have announcedReceipt that shows the contents of medical expenses"FreeThe patient can know the points for each medical fee category from this receipt.
  • Medical fees areOfficial priceIs.In insurance medical treatment, medical treatment is performed by an insurance doctor at an insurance medical institution, observing the medical treatment standards such as medical fee points and medical treatment rules.Payment fund,National Health FederationIs a medical fee statement (Receipt), The medical content and score calculation will be examined.An assessment (increase / decrease in the billed medical fee) will be made at the receipt examination, and if there are any deficiencies, it will be returned (the medical fee details will be returned to the medical institution).It has the role of equalizing the burden on patients in the diagnosis and treatment of diseases, and also has the role of preventing soaring medical costs.
  • Medical servicesAnd medical materials can be procured from the market by medical institutions, and the price difference between medical fees and market procurement contributes to the management of medical institutions as a margin.

History in Japan

Problems in Japan

Reward price

JapanThen,Central Social Insurance Medical CouncilThe medical fee will be determined by the report ofHealth insurance lawArticle 82).As a general rule, revisions are made once every two years.

It is often talked about by the overall rate of increase in medical fees.しかし増額は患者窓口負担や健康保険保険料上昇になるので、増額より配分の見直しが先決ではないかとの意見があるHowever, there is an opinion that the revision of the allocation may be the first decision rather than the increase because the increase will increase the burden on the patient window and the health insurance premium.[8]..The idea is to correct the shortage of doctors by focusing on low-income clinical departments and working doctors.厚生労働省による医療経済実態調査によれば、診療科ごとの報酬の格差や開業医と勤務医の収入の格差が存在するAccording to the Health Economics Survey by the Ministry of Health, Labor and Welfare, there are disparities in remuneration for each clinical department and income disparities between practitioners and working doctors.[1][9][10]However, the survey has pointed out many problems in statistical processing, such as the definition of income and expenditure, the survey period, and the fairness of selecting survey objects.[11], There are many criticisms that it is inappropriate to discuss based on this data.

In the current medical fee system, even if the medical fee is raised, there is no distinction between "doctor fee" and "hospital fee", so we will go to the maintenance (business management) (hospital fee-like) of the hospital and the technical part of the doctor There are reports and discussions that it is difficult to lead to evaluation (doctor fee-like)[12][2].

Drug price margin

Prescribed at a medical institutionMedicineThe price of medical feesDrug priceIt is defined as.

Previously[When?], The actual delivery price of the drug is cheaper than the drug price on the medical fee, which was called "drug price margin".In an era when in-hospital prescriptions were the mainstreamMedical institutionThe more medicines he prescribed, the more profitable he was.Especially at that time, it was called "Zoro" or "Zoro medicine".Generic drugThen.Significant discountWas carried out, and the drug price margin was large.This isCombined use of multiple drugs(So-called "medicine pickled medicine")社会 問題It was also accompanied.

After that[When?],Ministry of Health and WelfareDue to this policy, drug price margins have been reduced due to repeated drastic drug price reductions.AlsoDivision of laborWas introduced,Insurance pharmacyDue to the maintenance ofDispensing feeWas separated from hospital management.

Now[When?] OfPrescription medicinesThe delivery price of the original drug (new drug) is around 88-90% based on the drug price standard, after the patent expires.Generic drugBut it is around 80-85%.consumption taxIncluding, it is 95% and 85%, respectively.[Source required].

Considering drug inventory management costs and borrowing rates, some say that there is a “drug price loss”.[By whom?]

Inspection margin

Medical fees are set for each test of samples collected from patients at medical institutions.医療費配分で効率化の余地がある領域の項の中で、医薬品、医療材料、検査等は「もの代」として市場実勢価格を反映して診療報酬が決められるIn the section of areas where there is room for efficiency in medical expense allocation, medical fees are determined by reflecting the actual market price as "things" for pharmaceuticals, medical materials, tests, etc.[13].

Many tests are performed within the medical institution, but registrationSanitary laboratoryOften, tests are outsourced to a contract research organization such as a medical association or a medical association inspection center. In the case of outsourcing tests, if the contract research organization discounts the examination fee, the insurance medical institution will make a profit.これがThis isInspection margin.

"Request for handling of sample tests in medical system reform" from the 6-group council related to clinical tests including the Japanese Society of Clinical Laboratory Medicine[14](December 13, 12) has been issued, and it has been pointed out that the role of the drug price margin, which is stated in this request form, may have shifted to the inspection margin as it became smaller. ..一種のゴム風船効果(balloon effect)であるIt is a kind of rubber balloon effect.[15].

Fraudulent billing

Increase medical fees due to consumption tax increase

2019 years(Reiwa10st year) October 1stconsumption taxDue to the revision of medical fees due to the tax increase (tax rate of 10%), the initial consultation fee will increase by 60 yen to 2880 yen, and the re-examination fee will increase by 10 yen to 730 yen, which will increase the burden on the patient's window.

Ministry of Health, Labor and Welfare 2019 (Heisei31 years) October 2Central Social Insurance Medical CouncilPresented a proposal to review medical fees at the general meeting.The increase in the initial re-examination fee and hospitalization fee was approved.The hospitalization fee will also be increased by 230 to 590 yen for the basic hospitalization fee for general wards.医療機関が医療機器や医薬品や用度を仕入れる際には、消費税10%がかかるが、患者が窓口で払う料金はWhen a medical institution purchases medical equipment, medicines, or usage, a consumption tax of XNUMX% is charged, but the fee paid by the patient at the counter isTax exemptTherefore, the medical institution will bear the tax increase.そのため消費増税に際しては、医療機関の経営負担を減らすため、診療報酬の引き上げが行われたTherefore, when the consumption tax was raised, medical fees were raised in order to reduce the management burden on medical institutions.[16].

footnote

  1. ^ Medicate
  2. ^ Fuji Television Trivia Dissemination Committee "Trivia Fountain: Hee no Hon 6" Kodansha, 2004.
  3. ^ "Calculation method of medical fees" Appendix 2008-Appendix XNUMX, XNUMX Ministry of Health, Labor and Welfare Notification No. XNUMX, XNUMX
  4. ^ Publication of OECD Health Data 2007
  5. ^ Japan Medical Association"Japan Medical Association's approach to revision of medical feesOctober 2005
  6. ^ Sankei ShimbunSunday Economics "Allocation of medical fees between practitioners and working doctorsAugust 2009, 6
  7. ^ Japan Medical AssociationRegular press conference "For the Sankei Shimbun "Distribution of medical fees between practitioners and working doctors-review from the perspective of taxpayers"'
  8. ^ November 2009, 11 Nihon Keizai Shimbun morning edition
  9. ^ 09/10/30 Minutes of the XNUMXth Central Social Insurance Medical Council General Meeting
  10. ^ "About" salary of working doctors "and" balance of practitioners "" Ministry of Health, Labor and Welfare website
  11. ^ “If the response rate goes up, does the practitioner's reward go down?”. Lohas Medical(July 2009, 5). http://lohasmedical.jp/news/2009/05/27020711.php 
  12. ^ Asahi Shimbun (Tokyo), morning edition November 2009, 11
  13. ^ Ministry of Health, Labor and Welfare "20 Medical Fee Revision Basic Policy(December 19, 12) pp3
  14. ^ 6 group council related to clinical examination "Request form regarding the handling of sample tests in the reform of the medical system(December 13, 12)
  15. ^ "Market Roles and Limitations in Healthcare and Welfare" p.157 Seigakuin University Press
  16. ^ "Increase in initial and re-examination fees in response to consumption tax increase Ministry of Health, Labor and Welfare presents a plan: Asahi Shimbun Digital". Asahi Shimbun digitalAsahi Shimbun (February 2019, 2). 2019/2/7Browse.

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