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The story
It has emerged that Japan’s Ministry of Health, Labour and Welfare is considering new standards for outpatient visits by welfare recipients. Under the proposal, seeing any clinic other than the ones designated in advance by the local welfare office would, in principle, require a referral letter, with the aim of curbing excessive visits and reining in medical costs. On 5ch, some pointed to elderly recipients who resell their medication or treat hospitals as a “place to hang out,” while others worried about emergencies and the burden on rural residents whose designated hospital is far away, leaving opinions split. Some also noted that the existing medical voucher system has become a mere formality.
Welfare Recipients to Need Referrals for Non-Designated Hospitals in Principle, Health Ministry Considers
Economy
The Ministry of Health, Labour and Welfare is working to clarify the standards for outpatient visits by welfare recipients. It is considering a proposal under which local welfare offices would designate in advance the medical institutions recipients regularly use, and visits to any other institution would, in principle, require a referral. The goal is to reduce excessive visits and help curb medical costs.
Source: nikkei.com / Original article here
What people said
Because it's full of people like the "Toyoko kids" (young runaways who hang around Kabukicho's Toyoko area, often linked to drug misuse).
That, and stopping doctors from running up unlimited medical costs on welfare recipients.
If it's a Pharmaceutical Affairs Act violation, that should mean an instant cutoff of benefits though.
They'll probably fight this just as hard as they fought the My Number health insurance card.
Medical care's free for them, so it's a free-for-all.
I saw an article recently about people selling off their meds, that's probably part of it.
And for elderly recipients, some just treat the hospital as a place to relax or get some attention.
Normally there's a cap on how much you can be prescribed, so they hop between multiple hospitals to rack up a big stash of meds and sell it off.
By the time the Ice Age Generation (Japan's "lost generation" who job-hunted during the 1990s–2000s recession) reaches old age, the whole system might not even exist anymore.
There are 8 million people with nothing but the basic national pension, so most of them will end up on welfare eventually anyway.
Don't you need to tell your caseworker beforehand and get a medical voucher issued before going to the hospital? Just don't issue the voucher, problem solved.
That rule's become a total dead letter though.
Since that rule exists, excessive visits shouldn't even be possible in theory.
If you tried enforcing that, the doctors would come at you with threats, you know?
This is a mess, Japan.
Since the goal is cutting down excessive visits, I'd guess there'll be some kind of exception for that.
The government won't lift a finger — hospitals can't refuse treatment, so basically "eat the loss yourselves."
A single underlying condition can cause symptoms in multiple different places,
so I think this is asking for something pretty unreasonable.
Just go to the primary doctor who can issue you the medical vou—
You go to the primary doctor who issues your medical voucher, and if you need another institution, you get referred there with a referral letter (a medical information document).
No problem at all.
They'll just amend the Constitution then — the public's in favor of that anyway.
So you're admitting it's unconstitutional under the current Constitution? lol
Re: #101
In rural areas, that designated hospital could end up being incredibly far away too.
Meant Re: #109. My bad, my bad.
If it's officially recognized that you need to get there by taxi or the like, transport costs get covered.
What happens if you fall ill while on a hot spring trip?
Can people on welfare ("namapo") even afford to travel?
If you can afford a trip, you can support yourself — meaning you wouldn't need welfare in the first place.
Every time I go it's a multi-hour wait and I'm sick of it.
I want to stay away from hospitals till the day I die.
Nah, no way — they're only about 2% of the population.
Doctors' salaries could be cut way more —
you don't need tens of millions of yen just to live.
It's wasteful.
To keep universal health insurance afloat (which favors the elderly), medical fees have already been slashed to the bone — 70% of hospitals are running in the red. Hospitals are shutting down one after another. Great job, huh lol
Seriously, this.
Being a doctor is a sacred calling, so they shouldn't be making money off it — unpaid service is fine.
Just pay them living expenses on par with welfare and they can still have a "healthy and cultured" life.
Oh really? First I'm hearing of that.
Though the requirements sound pretty strict lol
For elderly people or those with physical disabilities, transport costs get approved in a lot of cases.
I wonder if it'll actually hold up in an emergency though.
It just feels like the paperwork's so complicated there's no way it could handle anything urgent lol
Background and Key Points of This Topic
Medical assistance under Japan’s welfare system is, in principle, provided as an in-kind benefit with no out-of-pocket cost, and this has long been pointed to as something that encourages “excessive visits.” A system already exists for regular health insurance holders whereby visiting a large hospital without a referral incurs an extra fee, but because welfare recipients pay nothing out of pocket, that deterrent has no effect on them — hence this separate proposal to restrict where they can be seen. The thread split over two things: how common medication reselling or “hanging out at the hospital” visits actually are in practice, and whether the plan adequately accounts for emergencies and rural residents. A medical voucher system already exists, though some say it has become a dead letter, and it’s easy to miss from the article alone that this proposal is still only under consideration and would apply solely to routine outpatient visits. Beyond simple criticism of recipients, the thread also raises practical issues like pushback from medical institutions and how transport costs would be handled.
*This article is compiled and summarized from the 5ch (Breaking News Plus) thread “Welfare: To Reduce Excessive Visits, Referral Required to Go Anywhere Other Than a Designated Hospital.”
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