Editorial: It's fair and necessary for high-income seniors to pay more for medical system

Medical and nursing care expenses paid by elderly people with relatively high incomes are set to be raised. A growing number of elderly people are required to shoulder greater social security service costs, including pensions, while the benefits they receive have been reduced, stirring protests from senior citizens affected.

However, Japan's social security system could collapse unless uniform preferential treatment for the elderly is reformed such that people must take on financial burdens in proportion to their income.

In fiscal 2015, 41.5 trillion yen was spent on medical services, and the amount is estimated to snowball to 52.3 trillion yen by fiscal 2025. The ratio of medical expenses for those aged 75 or over to the country's total medical outlays is expected to surge from the current 36 percent to 46 percent over the same period.

Under the high-cost medical expense system, the upper limit on outpatient treatment that those aged at least 70 years old with an annual income of at least 3.7 million yen are required to shoulder will be raised from 44,400 yen to 57,600. While there are a growing number of senior citizens who face hard living, the planned medical service reform targets elderly people with relatively high incomes.

The ratio of nursing care expenses that those with an annual income of at least 3.7 million yen are required to foot will be raised to 30 percent. Previously, those who use nursing care services had been required to foot a uniform 10 percent of the costs, but the rate was raised to 20 percent for those with an annual income of 2.8 million yen or more in August 2015. The ratio will be further raised for those who have a higher income.

Public medical expenses have kept increasing. This is because the number of elderly people, who get medical treatments more frequently and whose per capita medical expenses are higher than younger people, has been growing, in addition to the development of high-priced pharmaceuticals and medical equipment.

Premiums that elderly people aged 75 or over pay to the system account for only about 10 percent of total expenditures, and 40 percent are funded with money contributed by those still in the workforce, while the reminder comes from the government purse.

Health insurance associations for employees of major companies are required to extend higher contributions to the medical insurance system for those aged 75 or over. Many of these organizations have run into the red and some of them have disbanded, forcing their policyholders to join those for smaller businesses, which are required to contribute less to the medical insurance system for the aged.

The government also intends to review how it calculates the amounts of premiums paid by those in working generations aged between 40 and 64 by the middle of fiscal 2017, and transform the current system into one under which the premiums are calculated based on not the number of policyholders but on their income. As a result of the reform, employees of major companies will see their premiums rise.

Still, full-time workers have an advantage. About 70 percent of non-regular workers earn less than 2 million yen a year, and 13 percent of these workers were unable to get medical treatment even when sick, according to a recent survey conducted by a labor union. Members of the public cannot feel secure in their post-retirement lives unless Japan creates a society in which children grow healthily.

Health insurance premiums for employees are footed evenly by employers and workers. However, the national health insurance program, which covers non-regular workers, does not receive any financial contributions from companies. Moreover, each family member is required to pay premiums for the program. Therefore, national health insurance policyholders who have multiple children are required to shoulder a heavier financial burden. The program also contributes 1.7 trillion yen a year to cover medical expenses for elderly people.

It is clear that if working generations who support medical and nursing care services were to be worse off, the social security system could not be maintained. It is reasonable to require elderly people with higher incomes to take on a heavier financial burden for the social security system.

It has been pointed out for many years that preferential treatment for elderly people needs to be rectified. However, politicians have evaded doing so for fear of a backlash from those affected.

Opposition to reform has been voiced from within the ruling coalition. The upper limit on outpatient treatment expenses for regular income earners, on whom residential taxes are levied, was to be doubled. However, the increase was trimmed due to opposition from junior ruling coalition partner Komeito, which fears the potential impact on the summer 2017 Tokyo Metropolitan Assembly election.

Many people fear that they cannot receive necessary medical treatment because they are required to pay more. They say they are afraid of being hit with higher medical bills should their conditions worsen.

However, there are many elderly people who visit hospitals and receive excessive checkups and medication even though their conditions are not serious. It has also been pointed out that there are some cases of drug reactions causing dementia. Therefore, the problem of excessive medication needs to be addressed.

Fraudulent medical expense claims by some underhanded hospitals have also repeatedly been pointed out.

It has also been pointed out that patients who need less medical care are staying in hospital wards with high fees. The situation in which those who should be looked after at home or nursing care facilities are staying at high-priced medical institutions should be rectified.

To prevent medical expenses from snowballing, it is necessary for medical and nursing care facilities to cooperate with each other and clarify the division of their roles.

Moreover, considering the need to maintain the system over a long period, it is necessary to take specific measures to secure stable financial resources. Currently, the ratio of taxpayers' money to the total cost of public medical and nursing care insurance programs has been rising year by year.

To make sure that people can receive necessary medical and nursing care services at any time, members of the public cannot continue to avoid shouldering an extra burden.