The Japanese government has announced that it will increase the annual limit of out-of-pocket expenses for the “high-cost medical expenses system” by up to 38% from 2026. This is to increase the burden of medical expenses for active generations as medical expenses increase.
According to the Asahi Shimbun and the Yomiuri Shimbun, Health, Labor and Welfare Minister Kenichiro Ueno and Finance Minister Satsuki Katayama agreed on a reform plan for the “high-cost medical expenses system” at a ministerial meeting. Compared to the reform plan decided by the Shigeru Ishiba’s cabinet late last year, the increase has fallen by half.
The high-cost medical expense system sets the amount of self-payment for patients who need to receive high-value treatment of 100,000 yen or more, and the government provides subsidies for the difference from the actual treatment cost.
The upper limit of patients’ burden varies depending on their annual income. Currently, the annual income of less than 3.7 million yen is 57,600 yen, annual salary of 3.7 million yen or more and 7.7 million yen or less, 80,100 yen, annual salary of 7.7 million yen or more and 11.6 million yen or less, 167,400 yen or more, and 252,600 yen or more for annual salary of 11.6 million yen or more.
In the case of long-term treatment patients who receive treatment that reaches the upper limit three times in a row, there is also a “multiple recovery application” that covers only 60% of the upper limit from the fourth treatment.
With this reorganization, the maximum amount of out-of-pocket expenses will be raised twice.
First, in August, the upper limit of out-of-pocket expenses will be increased by 4-7% for each annual income section. After that, in August 2027, the income section will be subdivided from the current 4 levels to 12 levels, excluding the non-resident tax generation, and the upper limit will be further increased.
For example, if the annual income ranges from about 5.1 million to 6.5 million yen, the monthly upper limit will rise from about 80,000 yen to about 98,000 yen.
However, the government has decided to lower the burden on patients with chronic and incurable diseases. While maintaining the upper limit for “multiple applications,” the annual upper limit of 180,000 to 1.68 million yen was newly established depending on the annual income. The figure is up to three times higher than the annual upper limit for average income (about 530,000 yen).
For the “outpatient special case,” which has reduced the burden of outpatient medical expenses for the elderly over 70 years of age, the monthly upper limit was raised by 4,000 yen to 10,000 yen.
SAM KIM
US ASIA JOURNAL
