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Health Care

Japan plans subscription model to promote primary care

Aim is to reduce frequent hospital visits while encouraging regular checkups

The concept of primary care is just beginning to take hold in Japan, where a universal health care program guarantees access to all care providers.

TOKYO -- Japan is considering adopting a flat monthly fee system for visits with primary care doctors, seeking to rein in the overuse of big hospitals that has contributed to ballooning medical spending.

Patients would register with a particular provider and pay a fixed amount for regular services, similar to the direct primary care model emerging in the U.S. Consultations with other doctors, such as visits to hospitals or specialists, would cost extra.

The idea of primary care providers is just starting to gain traction in Japan, which offers open access to all medical care under a universal health care system. On average, patients saw doctors 12.8 times a year in 2015, compared with 10 visits in Germany and 6.2 in France, according to the Organization for Economic Cooperation and Development.

The hope is that a monthly fee system would cut down on expensive hospital visits and excessive tests and prescriptions, while also giving patients an incentive to see primary care doctors more frequently, helping to prevent health problems and more quickly discover issues that do arise.

The Ministry of Health, Labor and Welfare will set prerequisites for clinics that can become primary care providers that patients can register with. Requirements may include partnerships with larger hospitals and ensuring patients can access care outside office hours.

For patients, seeing a primary care provider could prove cheaper than the current system, under which they must pay each time they seek medical care. Those who choose not to register would be charged as normal.

The additional fees for visiting outside facilities -- a proposal recommended by the Finance Ministry -- are meant to curb the common practice of going to hospitals for even minor ailments, which can lead to unnecessary tests. The government aims to have primary care providers refer patients to hospitals when needed.

Japan already has a flat-fee system for those with multiple chronic conditions such as diabetes or dementia. It costs about 15,000 yen ($140) per month, with the patient covering 10% to 30%. The health ministry is considering how much to charge if it expands this framework.

Primary care providers are commonplace in other countries. U.K. residents are required to register with a general practitioner in their area and cannot see a specialist without a referral from this doctor. Compensation for primary care physicians is based on the number of registered patients, combined with a fee-for-service model like that used in Japan.

While the government looks to revise the relevant legislation as early as fiscal 2021, it may need to proceed carefully. The Japan Medical Association firmly opposes a registration system, concerned that it could undermine patients' freedom to choose their own care providers, as well as squeeze small clinics.

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