TOKYO -- Public nursing care insurance premiums paid by corporate and other health insurance unions to municipal governments across the country could be up to 20 billion yen short due to miscalculations by a welfare ministry affiliate, officials said.
The Health Insurance Claims Review & Reimbursement Services reported the possibility that it had miscalculated the premiums to the Health, Labor and Welfare Ministry, but the ministry failed to take any action to deal with the matter. As a result, corporate and other health insurance unions cannot compile their budgets based on the correct premium amount they are supposed to collect from policyholders.
"We regret such a simple mistake. We'd like to instruct staffers to confirm the accuracy of their calculations," said an official of the ministry's nursing care insurance planning division.
Health insurance unions collect premiums for the public nursing care insurance program from policyholders and, through the ministry affiliate, pay the funds to municipal governments that manage the insurance. Each union calculates benefit amounts to be paid to policyholders based on a coefficient calculated by the affiliate.
The affiliate reports the estimated figure for the coefficient at the end of each year to facilitate work by health insurance unions to compile their budgets before releasing the final figure in March the following year.
According to the welfare ministry, the Health Insurance Claims Review & Reimbursement Services notified the ministry in January 2019 that the estimated coefficient may be inaccurate. Nevertheless, the ministry only instructed the affiliate to correct the figure when releasing the final coefficient in March.
However, health insurance unions had compiled their budgets by the time the final figure was released, after which the unions are supposed to pay premiums. Preliminary calculations made recently by the Health Insurance Claims Review & Reimbursement Services show that the combined amounts allocated in all the concerned health insurance unions' budgets could be up to 20 billion yen short.
On April 1, the welfare ministry notified health insurance unions concerned about the mistake. In the notice, the ministry asked unions to try to pay the proper amounts within the current fiscal year by using their reserve funds and other financial resources. Unions will also be allowed to defer the payment of any shortfall until the end of fiscal 2020.
However, reserve funds are designed to help unions prepare for their futures, and the minimum amounts are set by law. If health insurance unions were to use some of their reserve funds, they might not be able to meet this legal requirement.
Furthermore, it is difficult to raise premiums for fiscal 2019 because the fiscal year has already started. Therefore, it is likely that some health insurance unions will not be able to cover their contribution shortfalls.
The welfare ministry is poised to take measures to prevent the public nursing care insurance program from being adversely affected, even if the funding shortage cannot be made up for.
(Japanese original by Hiroyuki Harada and Masahiro Sakai, Lifestyle and Medical News Department)