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EDITORIAL | COVID-19: How Much is Patients' Fair Share in Treatment Cost?

Japan begins increasing individual contributions to the cost of COVID-19 treatment. Is 10% enough? The search is on for a fair balance.



Lagebrio (Molnupiravir), is an oral treatment drug for COVID-19. It was photographed in July 2023. (© Sankei by Ataru Haruna)

Beginning October 1, changes in public financial support are coming to medical expenses related to COVID-19. Patients will now be required to contribute to the cost of COVID-specific treatments, which were previously fully covered by the government.

The maximum out-of-pocket expense for these medical treatments will be set at ¥9,000 JPY (about $60 USD). Many of the treatments are relatively costly, with some medications reaching around ¥90,000 JPY (about $600 USD) per treatment. 

To provide a benchmark for patient contributions, a cap has been set at 10% of this cost, or ¥9,000 JPY. This arrangement is expected to continue until March 2024.

The active generation is typically responsible for covering 30% of regular medical costs under a normal cost-sharing scenario. Limiting out-of-pocket expenses for this group to just 10% (¥9,000 JPY) for COVID-19 treatments has been made to ease the financial burden in the rapidly changing situation. 

Similarly, those who typically bear 20% of the costs will have a maximum limit of ¥6,000 JPY ($40 USD). Meanwhile, individuals responsible for 10% will pay a maximum of ¥3,000 JPY ($20 USD) for COVID-related treatments.

A Ministry of Health, Labor and Welfare subcommittee discusses how to treat COVID-19 from FY 2024 onward. On September 8, 2023. (©Kyodo)

Rationale for the Changes

COVID-19 has already been recategorized under Class 5 of the Infectious Diseases Control Law. In that sense, it is similar to seasonal influenza. Fully covering the cost of COVID-19 treatments with public funds alone isn't practical. It therefore necessitates a certain level of patient contribution. Implementing a gradual increase in this burden seems reasonable.

In the meantime, the number of COVID-19 cases remains high. ​​To successfully navigate this transitional period towards normalcy, the government should make a concerted effort to explain these increased contributions and seek understanding from the public.

Starting in October, both patient medical expense support and public financial assistance to healthcare institutions will be curtailed. The bed-securing fee, typically provided to healthcare institutions when they secure hospital beds or similar accommodations for COVID-19 patients, will primarily target severe cases. 

Japan's national government will provide prefectures with guidelines for the number of beds based on the infection situation. It will then change the disbursement method to occur when infections spread.

Preventing Fraud in the System

Regarding the bed securing fee, there have been instances of incorrect claims and excessive payments. Therefore, the Board of Audit has been highlighting inappropriate expenditures. Pursuing efficiency in this regard is a natural course of action.

Of course, it is imperative that this change should not hinder the securing of required hospital beds during periods when the infection is spreading. Furthermore, the government must thoroughly assess whether cooperation between prefectures and healthcare institutions is proceeding smoothly. And it must ensure that the new framework functions effectively. Avoiding a shortage of hospital beds is also a national responsibility.

The new COVID-19 autumn vaccination season begins at a nursing care health facility in Osaka. (© Sankei by Miyako Nagumo)

Balancing Priorities: Vaccinations and Costs

Vaccines have also received public financial support as COVID-19 medical expenses. On this, the new policy creates another challenge from fiscal year 2024 onwards. 

Up until now, the cost of vaccinations, including the ongoing autumn vaccination campaign, has been fully covered by national funds. However, starting from the fiscal year 2024, this will shift towards a system similar to influenza vaccinations. Those are primarily implemented by municipalities.

This transition could raise the possibility of individuals having to share some of the vaccination costs. If that happens, the government must thoroughly consider strategies to ensure it does not hinder public participation in timely and appropriate vaccinations.


(Read the editorial in Japanese.)
Author: Editorial Board, The Sankei Shimbun


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