As the consumption tax is raised from 8% to 10% in October this year, the initial and re-examination fees for insurance medical treatment will be raised. We sought to find out the problem of concern as to whether the compensation for medical institutions would be sufficiently eliminated by responding to such consumption tax increases.
Since insurance medical care is exempt from consumption tax, the consumption tax paid when a medical institution purchases goods cannot be passed on to the patient / insurer, and the medical institution is the final bearer. For this reason, the increase in the consumption tax rate scheduled for October 2019 will increase the burden of the amount equivalent to the purchase tax amount (non-deductible consumption tax) of medical institutions, which will put pressure on management, so special medical fees It is a carry to make up for it with a plus revision.
Regarding the consumption tax, regarding the compensation situation due to the increase from 5% to 8% in 2014, the medical fee in July 2018 that the data released by the Ministry of Health, Labor and Welfare in November 2015 was incorrect. The report was made at the research organization "Subcommittee on Consumption Tax Burden in Medical Institutions, etc." and caused a great deal of controversy. The compensation rate for the entire hospital was 102.36%, but a new survey revealed that the coverage was insufficient at 82.9%. In particular, hospitals with special functions had a large shortage of compensation at 61.4%. It is said that the background to this was that there was a discrepancy between the forecast and the actual results regarding the taxable expense ratio and the number of times medical fees were calculated, and that the ratio of hospital charges to revenue was not taken into consideration.
For this reason, in the revision of the consumption tax increase response in October this year, the previous revision of the consumption tax increase response in 2014 was reset, and the score was increased from 5% to 10%. We refined the basic data, refined the classification of medical institutions, considered the ratio of hospital charges to medical practice revenue, and adjusted the allocation of financial resources between clinics and hospitals.
In the medical fee revision in response to the consumption tax increase in October this year, for drugs and specified insurance medical materials that can be reimbursed, except for raising the tax increase by 2%, not individual points, but basic medical treatment such as initial / re-examination fee and basic hospitalization fee. We will respond by raising the fee. The main points of the revision are that the initial consultation fee will be increased by 6 points from the current 282 points to 288 points, and the re-examination fee for clinics and small and medium-sized hospitals will be increased by 1 point from 72 points to 73 points. The basic charge for acute general hospitalization in large hospitals will be increased by 50 to 59 points. The basic admission fee for 7: 1 special function hospitals will be increased by 119 points (Table 1).
The revision rate of all medical fees due to the consumption tax increase was decided to be + 0.41% in the budget preparation process for FY2007. The revision rate for each department is medical department plus 0.48%, dentistry plus 0.57%, and dispensing plus 0.12%.
When purchasing expensive medical equipment, the consumption tax burden of medical institutions is also high, and support measures for capital investment are taken against corporate tax and income tax. However, medical institutions of public interest corporations such as public university corporations, school corporations, and national public / public hospitals are not subject to support measures because corporate tax is exempt. In addition, "special depreciation of equipment / equipment and software for promoting work style reforms of doctors and medical workers" and "special depreciation of hospital buildings and their ancillary equipment for the realization of regional medical plans" Two new items will be introduced, and special depreciation will be expanded and reviewed for three items, including the extension of the "expensive medical equipment special depreciation system". This is expected to promote capital investment by medical institutions.
Under these circumstances, it has been pointed out that there is a possibility that compensation will be insufficient at medical institutions where the proportion of surgery with high medical material costs is high. According to a survey by the Association of Social Insurance Committees of the Surgical Society (Gaihoren), of the 3,581 surgical procedures used in the surgical tentative plan, "20,000 to 40,000" is the most irreparable medical material cost among 1,157 surgical procedures. It was found that there are few surgical procedures that include high medical material costs in the surgical fee, with 304 surgical procedures of "200,000-400,000" and 10 surgical procedures of "1 million yen or more" (Fig.).
Examples of irreparable medical material costs in general surgery include endoscopic nasal and sinus surgery type II (sinus surgery). The medical fee points are 12,000 points, but the expenses that cannot be reimbursed are 184,783 yen, and when the consumption tax amount of 18,478 yen (tax increase amount of 3,696 yen) is added, the total expenditure is 203,261 yen, minus 83,261 yen. (Table 2).
Robot-assisted surgery is an example of a surgical procedure in which non-reimbursable medical materials are expensive. In the case of laparoscopic cardia gastrectomy / malignant tumor resection (robot-assisted surgery), the medical fee is 75,730, but the non-reimbursable cost is 730,69 yen, and the consumption tax is 73,069 yen (). Adding the tax increase of 14,601 yen), the total consumption will be 803,138 yen. With a deficit of 45,838 yen, the labor cost of surgical staff cannot be covered by the surgical fee alone.
In recent years, medical materials have been replaced by disposable ones from the viewpoint of medical safety, and the proportion of them is increasing, so the impact of the consumption tax increase is expected to be large.
The Gaikoren is requesting the Ministry of Health, Labor and Welfare to increase the medical fee points for the surgical procedure when the material cost that cannot be reimbursed exceeds the medical fee amount.
On the other hand, as the management of medical institutions becomes more difficult due to the consumption tax hike, there are movements by multiple hospitals to jointly purchase medical materials, which account for a large part of medical expenditure as a cost reduction. Forty-two hospitals of national universities started group purchasing of medical consumables in 2016, and by unifying the purchase, they have achieved an annual reduction of 300 million yen. In addition, private hospitals are also moving to organize purchases by medical corporations and to consolidate procurement of medical materials using a joint purchasing scheme.
The 8% to 10% consumption tax increase will be covered only by medical fees, but it is highly possible that the compensation will not be sufficient for medical institutions that perform many surgeries that use non-reimbursable medical materials. Detailed verification work is desired in the future.
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