The ruling Liberal Democratic Party (LDP) has almost fully accepted requests presented by the coalition partner, the Ishin-no-kai (the Innovation Party of Japan=IPJ) in the recent concluded agreement. Even under the previous coalition of the LDP-Komei-to, medical services had been aggravated due to the reduced budget and the bigger burden imposed on the sick. This trend will be accelerated under the new regime.
THE SICK WILL HAVE LESS BENEFIT AND BIGGER PAYMENT
Prime Minister Takaichi Sanae has referred to health services in her policy speech delivered October 24; she said that ‘on the basis of the agreements concluded by political parties, we will review the current payment scheme for medicines on the side of patients, including drugs similar to those classified as ‘over-the-counter medicines’ and ‘curb premium payment to be made by working generation.’ Her comment is hazardous as it encourages ‘less benefit and bigger payment’.
Higher-price medicines to be imposed on patients
The Ministry of Health, Labor and Welfare will review the current practices, including a medicine price. One of the steps is to remove insurance coverage from medicines similar to those classified as over-the-counter=OTC medicines. They are drugs that can be bought in the market without prescription of doctors.
For example, they are cold relief medicine, compress and medication for stomach and they can be bought, too, with a doctor’s prescription (covered by insurance). The new idea is to remove these medicines from insurance coverage and let patients purchase them. OTC medicines are expensive and a sufferer will buy drugs with his/her own judgment without doctor’s consultation. Thus, disease may be overlooked or may get more serious.
A review will be made further; a choice of a new medicine. If a patient prefers to be prescribed a newly developed medicine while available are generic drugs, he/she will have to pay a quarter of the difference of prices as an additional cost.
The Ministry is to raise this rate of 1/4 on the ground that the patient does not want to take generic drugs. This is like a penalty.
Meanwhile, ‘a measure to heighten the limit of high-cost medical care benefit for individual patients’, which is frozen under the previous Ishiba administration, will be resolved before the year-end. The plan should be withdrawn.
30% payment for elderly over 70 years of age
The Council on Financial Systems of the Ministry of Finance announced November 5 a reform program on the social service systems, proposing ‘a surge in payment for medical treatment up to 30% for patients who are older than 70 years of age’ with the objective to ‘cut burden of social insurance premium payment of working generation.’
The measure is well shared by the LDP and its partner, the IPJ in the agreement, which specifies ‘curbing insurance premiums of working generation.’ The government has begun to expose its posture clearly: to shift medical expenses to the elderly, alleviating insurance premium payment of working generation. Reportedly, from the fiscal 2026, an additional medical premium will be collected in order to secure a financial source for policies for children.
To reduce social service insurance premium is good, but it should be implemented on the basis of higher progressivity or through an improved split ratio of premium payment between the labor and the management, for instance, to be 4:6 from the current ratio 5:5. A financial source for the reduced premium should not be sought in aggravating healthcare services.
自民党は、日本維新の会との連立政権合意で維新の要求した政策をほぼ丸のみした。自公政権でも医療費の抑制、患者負担増が行われてきたが、自維合意で更に拍車がかかることが必至だ。
高市早苗首相は、10月24日の所信表明演説で、「これまでの政党間合意も踏まえ、ＯＴＣ類似薬を含む薬剤自己負担の見直し」、「現役世代の保険料を抑える」などと、医療制度について触れた。維新との合意を踏まえた、「給付の抑制と負担の強化」を促進する危険な内容だ。
薬剤費の負担増
厚労省が掲げる見直しには、薬剤費がある。その一つにＯＴＣ類似薬の保険適用除外がある。ＯＴＣ医薬品とは、薬局やドラックストアで処方箋なしに購入できる市販薬（ＯＴＣはO v e r T h e Counterの略でカウンター越しに販売されること）
風邪薬や湿布、胃腸薬などがあるが、医師の処方でも出してもらえる（保険適用）。これを、保険適用から外し、市販薬で購入するようにさせるものだ。市販薬は高い上に、医師の受診なしの自己判断では、病気の発見が遅れ病状の悪化も懸念される。
また、長期収載品（先発医薬品）の選定療養の更なる見直しも掲げられている。ジェネリック医薬品（後発医薬品）があるのに先発医薬品を処方してもらうと、薬価の差額の４分の１を自己負担する制度で、長期収載品を希望すると選定療養費として患者負担が増える。
この差額の４分の１を引き上げることを考えている。安いジェネリック医薬品を希望しない患者へのペナルティだ。
更に、石破政権で凍結された「高額療養費の自己負担限度額の引上げ」問題は、年内に結論を出すことになっているが、撤回すべきだ。
70歳以上３割も
財務省の財政制度等審議会は11月５日、社会保障制度の改革案を示し、「現役世代の社会保険料負担の軽減」を柱とし、「70歳以上の医療費の自己負担を原則３割に引き上げる」ことを提案した。
「現役世代の保険料を抑える」との自維合意と軌を一にする。露骨に医療費の自己負担を強め、現役世代の保険料を抑えると言い出した。子ども施策の財源確保のために、26年度から医療保険料に上乗せ徴収も予定されている。
現役世代の社会保険料引下げは、保険料の累進性を高めるとか、５対５の労使折半を４対６に改善するなどすべきで、医療費削減が原資であってはならない。
英訳版↓
No. 1428 New Developments in Healthcare Services
The ruling Liberal Democratic Party (LDP) has almost fully accepted requests presented by the coalition partner, the Ishin-no-kai (the Innovation Party of Japan=IPJ) in the recent concluded agreement. Even under the previous coalition of the LDP-Komei-to, medical services had been aggravated due to the reduced budget and the bigger burden imposed on the sick. This trend will be accelerated under the new regime.
THE SICK WILL HAVE LESS BENEFIT AND BIGGER PAYMENT
Prime Minister Takaichi Sanae has referred to health services in her policy speech delivered October 24; she said that ‘on the basis of the agreements concluded by political parties, we will review the current payment scheme for medicines on the side of patients, including drugs similar to those classified as ‘over-the-counter medicines’ and ‘curb premium payment to be made by working generation.’ Her comment is hazardous as it encourages ‘less benefit and bigger payment’.
Higher-price medicines to be imposed on patients
The Ministry of Health, Labor and Welfare will review the current practices, including a medicine price. One of the steps is to remove insurance coverage from medicines similar to those classified as over-the-counter=OTC medicines. They are drugs that can be bought in the market without prescription of doctors.
For example, they are cold relief medicine, compress and medication for stomach and they can be bought, too, with a doctor’s prescription (covered by insurance). The new idea is to remove these medicines from insurance coverage and let patients purchase them. OTC medicines are expensive and a sufferer will buy drugs with his/her own judgment without doctor’s consultation. Thus, disease may be overlooked or may get more serious.
A review will be made further; a choice of a new medicine. If a patient prefers to be prescribed a newly developed medicine while available are generic drugs, he/she will have to pay a quarter of the difference of prices as an additional cost.
The Ministry is to raise this rate of 1/4 on the ground that the patient does not want to take generic drugs. This is like a penalty.
Meanwhile, ‘a measure to heighten the limit of high-cost medical care benefit for individual patients’, which is frozen under the previous Ishiba administration, will be resolved before the year-end. The plan should be withdrawn.
30% payment for elderly over 70 years of age
The Council on Financial Systems of the Ministry of Finance announced November 5 a reform program on the social service systems, proposing ‘a surge in payment for medical treatment up to 30% for patients who are older than 70 years of age’ with the objective to ‘cut burden of social insurance premium payment of working generation.’
The measure is well shared by the LDP and its partner, the IPJ in the agreement, which specifies ‘curbing insurance premiums of working generation.’ The government has begun to expose its posture clearly: to shift medical expenses to the elderly, alleviating insurance premium payment of working generation. Reportedly, from the fiscal 2026, an additional medical premium will be collected in order to secure a financial source for policies for children.
To reduce social service insurance premium is good, but it should be implemented on the basis of higher progressivity or through an improved split ratio of premium payment between the labor and the management, for instance, to be 4:6 from the current ratio 5:5. A financial source for the reduced premium should not be sought in aggravating healthcare services.
November 26, 2025