The provision of home-based medical services by regular family doctors should be strengthened, an advisory body to the health, labor and welfare minister proposed on Wednesday in a report on planned revisions to medical treatment fees in fiscal 2018.
The Central Social Insurance Medical Council submitted the report to Health, Labor and Welfare Minister Katsunobu Kato on the day.
Its recommendations include establishing a system to pay additional fees to local family doctors. In preparation for 2025, when the baby boomers will be 75 or older, the ministry aims to shift its health care measures to center mainly on family doctors instead of medical institutions.
In December last year, the government decided to raise the main portion of medical costs, which includes the technical fees of doctors and pharmacists, by 0.55 percent, and lower the "charge for medicine" by 1.74 percent. This will lead to an overall cut of 1.19 percent. Based on this, the panel then decided on medical remuneration points in each case.
In keeping with the nation's aging society, the health ministry estimates there will be over 1 million patients using home-based medical services in 2025.
To strengthen the role of family doctors who provide home-based medical care, the panel proposed creating a system to add 800 yen to the remuneration of such doctors at the time of the patient's first consultation with a medical facility. This system is meant for clinics and other institutions where doctors can provide such services as helping patients over the phone even at night or on holidays.
The panel also proposed clarifying the role-sharing between such clinics and major hospitals that provide specialized medical services. It recommended the size of major hospitals capable of charging patients an additional fee for their first examination without a referral should be changed from the current definition of hospitals with "500 beds or more" to facilities with "400 or more."
Separately from out-of-pocket costs, patients are charged 5,000 yen or more for their initial visit and 2,500 yen or more for a follow-up visit to such hospitals.
The report also included reorganizing the basic fees of hospital beds for acute-stage patients preparing for operations and emergency care. In light of the growing number of hospitals that adopt a careful nursing system of "one nurse for seven patients," the panel called for further dividing the phases of the basic fees into seven from the current five, to create a better remuneration structure appropriate to the severity of patients' conditions and the necessity of medical treatment and nursing. Up to 15,910 yen in remuneration is currently paid per day, and the panel suggested strenghtening a mechanism to lower remuneration along with a decline in the percentage of patients in severe condition.
In the field of remote consultations using information and communication technology (ICT), the panel proposed establishing an "online medical fee" system whereby 700 yen is paid per month to a medical institution when it uses a combination of face-to-face treatment and online treatment via ICT devices that allow patients to communicate quickly with doctors.
Facilities must meet several requirements to be eligible for the system, such as providing face-to-face medical care every month for six months from the patient's first visit and also compiling a medical treatment plan with consent from the patient.
The panel called for cutting basic pharmaceutical fees for major pharmacies that dispense drugs primarily based on prescriptions issued by specific hospitals. Regarding cooperation between health care and nursing care, the panel proposed that higher remuneration be paid to doctors who are at patients' bedsides in their final moments at special nursing facilities for the elderly.
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