TOKYO — With the fragility of Japan’s health care system exposed by two years of combating the coronavirus, Nikkei and the Japan Center for Economic Research have crafted proposals to restructure the system, promote medical innovation and reform social security benefits.
The proposals, developed by a joint research group with input from outside experts, target those three areas in an effort to improve care and service during emergencies and in normal times.
The restructuring of the care system includes giving Japan’s central and local authorities more power to direct institutions that provide services under Japan’s health insurance system to set aside medical personnel and beds when necessary.
During the pandemic, a clear divide has emerged between health care providers that proactively accept COVID-19 patients for treatment, and those that avoid them. Surges in infections have led to shortages of medical staff and hospital beds in certain areas, sometimes leaving patients with no choice but to recover at home.
Some people have died as a result, an outcome that the Nikkei-JCER proposals are intended to prevent in the future.
“The bulk of the profits earned by medical institutions and pharmacies that accept health insurance comes from central and municipal government funding, derived from insurance premiums and taxes,” the research group said. “It stands to reason that the central government and local authorities should have a degree of control over the health care system.”
The researchers also criticize the government’s handling of a sector that enjoys a privileged position under Japanese law, which gives health care providers broad leeway to establish treatment facilities and choose their own specialties.
“The Ministry of Health, Labor and Welfare has neglected reform for many years out of deference to medical industry groups,” the group said.
The proposals urge broader use of digital technology in health care, recommending a system to track medical staffing and resources in different areas in real time. Seeing snapshots of conditions at individual medical facilities would help in sending patients to hospitals with room to accommodate them.
On COVID-19 specifically, once the surge driven by the omicron variant ends and effective treatments are widely available, Japan should downgrade the classification of the virus to put it alongside common infectious diseases like seasonal influenza, the researchers said.
That would mean working-age patients pay 30% of the cost for their treatment, rather than the government footing the entire bill.
“It would be appropriate to ask for payment out of pocket from the standpoint of reining in the damage to our national finances,” the research group said.
The group recommends creating a new body to oversee medical and public health responses to pandemics and natural disasters. The leader should be a specialist who can clearly explain the science behind its decisions to the public and provide information in an easily digestible way.
As for promoting innovation, the researchers call for enabling speedy approval of treatments and vaccines during crises. They propose more government-led medical trials and a U.S.-style system for emergency use authorization.
Japan also has a duty to play a leading role in global vaccine distribution, the research group said, noting only about 10% of Africa’s population has received two doses of a COVID-19 vaccine.
Social insurance premiums for Japanese workers have risen to nearly 30% of their income, split between employees and employers — a share that the researchers said cannot rise much further. The group wants Japan to lay the groundwork for raising the consumption tax again beyond the current 10% to secure a stable source of funding.
The swelling debt incurred from coronavirus countermeasures is the current generation’s responsibility, and the government should move toward repaying it, the group said. Cooperation between Japan’s ruling coalition and the opposition to agree on a stable funding source for this purpose will be crucial.