At the 3rd Central Executive Committee Meeting on December 9, RENGO endorsed actions regarding revision of medical consulting fees for the peak period. These actions involve intensive movements such as a rally before the Ministry of Health and Welfare and on-the-street PR planned for the peak period of December 15 and 17 when the Central Social Insurance Medical Council (CHUIKYO) will hold its general meeting.

Circumstances surrounding the Deliberations at CHUIKYO and the Steering Committee for the Council of Health Insurance and Welfare and RENGO's action

(1)The Central Social Insurance Medical Council (CHUIKYO)

(a) Circumstances surrounding the Deliberations

Medical consultant fees are revised once every two years and the coming fiscal year will mark the next fee revision. On November 26, the Japan Medical Association, the Japan Dental Association, and the Japan Pharmaceutical Association, each submitted demands for revising their consulting fees to the Central Social Insurance Medical Council (CHUIKYO). Their demands follow: Increase Social Insurance medical consulting fees 3.6% 2.6% for fluctuations in prices and labor costs and 1.0% for technical innovations in medical treatment and advances in medicine and medical care. Increase dental consulting fees 3.9% and 7.5% 2.8% for fluctuation in prices and labor costs and 1.1% for technological advances in dental care. 7.5% for funds to raise charge points for patients' first and return dental visits to levels equal to that of medical doctors. Increase pharmaceutical fees 1.5% 1.5% for increases such as labor costs. Moreover, on December 1 at CHUIKYO, the Japan Pharmaceutical Association requested an average increase of 4.5% in consulting fees (to be shifted to technical fees) to recoup their losses from adjusting differentials in drug prices. ——Medical institutions demand that health organizations pay medical consulting fees for the portion covered by their patients' insurance. Medical institutions have replaced consulting procedures with a point system. Reimbursements for medical fees are paid in accordance with those points. Afterward treatment, health organizations bill the patient's insurance company. This is a rough sketch of how Japanese insurance medical care works. Drug prices are set under the existing drug tariff system to which the health organizations refer when they reimburse medical institutions. However, the actual market prices that medical institutions pay for drugs from pharmaceutical companies are different. This results in marginal profits that create substantial revenue for medical institutions. Since drug costs occupy the lions share of health insurance expenditures in Japan, this has been a critical problem in the movement to solve differentials.

(b) RENGO's Action

At the Central Social Insurance Medical Council (CHUIKYO) on December 1, the insurers including RENGO, the National Federation of Health Insurance Societies (KENPOREN), and Japanese Federation of Employers' Associations (NIKKEIREN) confronted the medical institution side, the Japan Medical Association and others, regarding their submitted demand to revise medical fees. According to the "survey on the state of the medical economy" published that day, the average medical practitioner's income is ¥2,355,000, an increase of ¥360,000 over levels in the same survey conducted in September 1997. In addition, revenues at general hospitals, excluding national/public hospitals, increased. Struggling with lost insurance premium revenues from wage decreases due to the flat economy on the one hand and rising medical costs, especially in contributions for health care for the elderly, on the other, the insurers emphasized the absurdity of the demand-even a 3.6% increase would total more than ¥1 trillion. ——Contribution costs for health care for the elderly that should be paid to health organizations are allocated to each individual insurance system according to the number of subscribers. As no accord was reached on consulting fee revision the last time, both claims were submitted on that report at midnight December 19, 1997. Eventually, the decision to raise fees was decided politically. Whether or not the report can be compiled is the big issue in not letting them make it a political decision this time. The peak of a decisive battle between the medical side and the insurance side will be December 15 and 17, when CHUIKYO meets, before the Ministry of Finance is scheduled to announce the preliminary budget.

(2)The Council on Health Insurance and Welfare/Steering Committee

(a) Circumstances surrounding the Deliberation

On July 29 this year, the Japan Medical Association and the LDP agreed to discontinue patient co-payments as part of drug charges. Patient co-payments for part of the drug fees were introduced in September 1997 in order to restrain drug costs which commanded a relatively high percentage of national health expenditures compared to the that of other countries. The Japan Medical Association has requested that the LDP to abolish it because it keeps patients from seeking medical consultations, resulting in a decline in revenues for medical institutions. The council enacted a temporary special measure without revising the law so that from July 1999 drug fees for the elderly were partially subsidized by national expenditures. Now there are plans to abolish the system introduced on September 1997 this coming April. Medical expenditures are anticipated to rise to ¥490 billion due to that measure and in order to cover the deficit, measures to increase individual burdens were submitted to the Steering Committee of the Council on November 15 and December 1 as items of discussion.

(b) RENGO's Response

On the paying side, RENGO, KENPOREN, NIKKEIREN and the National Insurance Society (KOKUHO) strongly opposed the Ministry of Health and Welfare's failure to introduce any radical reform while increasing patient burden as an item of discussion to the steering committee. In particular, we strongly protested that *the increased burden enacted in September 1997 was introduced on the presupposition that radical reform in 2000 fiscal year would be implemented. And that *the government's public promise, namely that by all means they would conduct radical reform of welfare system for the elderly and enforce a nursing-care insurance system, is now being thrown in the wastebasket. On November 15 and December 1 the steering committee did not enter into any concrete discussions. And with the impending year-end budget compilation, the scheduled committee on December 13 will be the decisive day.