Who decides the price for health care?

The Japan Times has a interesting article, Who is paying the price for health care? about the slow reform of the health care system in Japan. If you live in Japan, you have to pay a monthly health insurance, and the benefits are quite good, in case you need medical care. However, the decisions made by Chuikyo, the Central Social Insurance Medical Council, about the actual costs for a hospital visit, or a treatment, can be almost impossible to understand. Critics say the Japan Medical Association and the drug industry have enormous influence over the Chuikyo. Excerpt:

Chuikyo has made efforts to become more open. This was partly reflected in the committee appointment last spring of Hisashi Katsumura, a high school teacher from Kyoto who is free of medical-industry ties.

Katsumura, who lost his newborn daughter due to malpractice 16 years ago, has campaigned for the mandatory disclosure of billing records by doctors. Previously, it was difficult for patients to receive detailed records of treatment expenses, and therefore submit them as evidence in malpractice suits.

It would appear that Katsumura scored a small victory on Feb. 15 when Chuikyo decided that hospitals must give patients receipts with rough breakdowns of the services provided, following a six-month grace period beginning in April. At the same time, the panel requested hospitals to "strive to give 'detailed expenditures' when patients request them."

This wasn't enough for Katsumura, however. He had fought the JMA representative, who claimed that such requirements would mean more costs, in the form of new printers, for hospitals.

"Supermarkets or convenience stores give you receipts showing exactly what you've paid for," he said in an interview last week. "I've never heard of convenience stores that say that they can't afford to buy a cash register. . . . The promise made by Chuikyo to give priority to patients views has been broken."

Wow, I had no idea it was this bad:

Katsumura, on the other hand, believes that no matter how open the committee is, the receipt issue is crucial. "The complete disclosure of the bills to the public would be good enough to empower patients," he said. "As it is, they have no way of knowing for sure what medical procedures have been performed on them."


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