ASOURCE Navi

The term "medical fees" often appears in the year-end news, but many people may be wondering, "I know the term, but what exactly does it mean?" So, let's take a look at how medical fees work.

The cost incurred when a patient visits a medical institution is called medical expenses, and medical fees are paid to medical institutions as consideration for medical services such as examinations, treatments, and prescriptions provided by medical institutions. Patients pay 10% to 30% of medical fees out of pocket, and the rest is paid by insurers such as national health insurance, health insurance associations, and the Japan Health Insurance Association. In principle, the copayment is 30% for elementary school students up to age 69, 20% for age 70 to 74, and 10% for age 75 and over. A cabinet decision was made to raise the burden of late-stage elderly aged 75 and over to 20%.

Prices for medical procedures and drugs are set in detail by the national system. Medical fees are determined based on the government's "price list", and are calculated at 10 yen per point based on points determined for each medical procedure. If the initial examination fee is 288 points, it will be 2,880 yen. There are three types of medical fee points: medical, dental, and pharmacy. For example, if you are hospitalized for appendicitis, the first visit fee, hospitalization fee according to the number of days of hospitalization, surgery fee, examination fee, drug fee are added, and the insurance medical institution will deduct the patient's co-payment from the total amount. Received from the audited payment agency.

There are two types of remuneration for medical treatment: XX fee and XX addition. The first/return examination fee is the most basic score as a calculation item. There are several items that can be added to the first/return examination fee, such as an infant addition (expenses billed when a child under the age of 6 sees a doctor) and an overtime addition (extra medical hours displayed by the medical institution, holidays, etc.).・Expenses charged for late-night consultations), etc.

Medical fees received by medical institutions include personnel costs for staff working at medical institutions, purchase costs for pharmaceuticals and medical materials, costs related to medical equipment, and equipment-related costs.

Medical fees are reviewed once every two years according to social and economic conditions. This is called “medical fee revision”. The rules for medical fees are established by the Minister of Health, Labor and Welfare after consultations and reports after the Central Social Insurance Medical Council (Chuikyo) established in the Ministry of Health, Labor and Welfare deliberates on the need for revision. Chuikyo is made up of three members: public interest members (scholars), medical care members (representatives of doctors), and payment members (representatives of health insurance associations).

In the April 2022 revision of medical fees, it was decided to raise the “main body” portion, which is the labor and technical fees for doctors and nurses, by 0.43%. The official drug price will be reduced by 1.35%, and the overall medical fee will be revised downward by 0.94%.