Social security policy should leave no one behind

The Democratic Party of Japan (DPJ)-led administration has called for a “shift from concrete to people” — spending taxpayers’ money on people’s livelihoods, rather than public works projects. This is reflected in the fiscal 2010 budget draft, but it suggests that the government desperately secured financial resources to carry out its election campaign pledges, rather than show a clear vision on how Japan should be reformed. What will threaten people’s livelihoods are problems with medical and nursing care services in the short term, and raising children in the longer term.

Japan’s failure to find a way out of the child-care, medical and nursing-care crises is attributable largely to Japan’s traditional social security philosophy, in which fathers are the traditional breadwinners, and insurance and pension programs at the companies they work for support their entire families’ livelihood. In other words, Japanese people tend to believe that families should be responsible for raising children and nursing care, and that the national government should supplement such practices only in exceptional cases, such as those in which the fathers have lost their jobs or fallen ill.

However, single-parent families and households comprised of only elderly members are common now, while a growing number of people do not marry, forcing traditional family values to adapt.

Moreover, part-time and temporary workers now account for one-third of the entire workforce. If the government continues to address problems involving the outdated system only with deficit-covering bonds and reserve funds, taxpayers will be forced to pay for that in the end. The social security and employment systems should be reformed in response to changes in family values and Japan’s society.

New pension body opens for business

Japan Pension Service, an organization set up to succeed the scandal-plagued Social Insurance Agency, started full operations Monday with a pledge to restore public trust in the public pension system.

The names of 312 social insurance offices nationwide have been changed to pension service offices.

The entity has drawn up 10 pledges to improve customer service and restore public trust, including “Pick up the phone within three rings,” and “Don’t make visitors wait more than 30 minutes.”

Handouts listing the pledges were distributed to everybody at the opening ceremony.

Employers denying jobs to applicants based on medical histories, gov’t study finds

Some Japanese companies demand job applicants provide personal medical histories and deny employment based on their content, a Ministry of Health, Labor and Welfare (MHLW) research group has discovered.

The ministry has directed employers not to ask for medical information unrelated to the positions in question, citing a risk of employment discrimination, while the research group will distribute an awareness-raising booklet based on its findings.

“Should medical information on completely recovered former patients be required for employment screening, even if that information is not used as a basic employment criterion, the request itself puts pressure on childhood cancer survivors, and can become a barrier to reintegrating into society,” says Keiko Asami, head of pediatrics at the Niigata Cancer Center Hospital.

There are no laws regulating the demand for medical histories on job application forms. However, according to the MHLW, “There is a risk of influencing employment decisions, and is thus connected to employment discrimination,” putting medical histories in the same category as personal beliefs and ancestry as information that “should not be considered” for employment purposes.

Pensions body faces tough test

Japan Pension Service, an organization set up to take over the work of the Social Insurance Agency, will start operations Friday. Though the new entity will attempt to regain trust of the public by tackling problems such as the pension records fiasco, it faces many hurdles.

Prime Minister Yukio Hatoyama met the 13 people chosen to be directors of the new entity at the Prime Minister’s Office last Friday.

“One of the driving forces behind the shift of power [the election of the DPJ-led government] was the pension record fiasco,” Hatoyama said. “I want this entity to be one that gives priority to the interests of subscribers.”

Ministries joust over whether to up medical fees

The issue is one of the focal points in the compilation of the fiscal 2010 budget. If the government decides to raise the amount of medical remuneration in fiscal 2010, it will be the first such increase since fiscal 2000.

“To restore the nation’s ailing health care system, we need to consider increasing government expenses for health care. We can’t reduce the medical remuneration [paid to doctors and medical facilities],” Shinya Adachi, parliamentary secretary of the Health, Labor and Welfare Ministry, said at a press conference last week.

Medical treatment fees are the payments doctors or recognized medical facilities receive from the national health insurance system for rendering medical services to insured patients. A certain number of points are allocated to each category of medical service, with each point worth 10 yen. Every two years, the Cabinet decides whether the fees should increase or decrease, and then the Central Social Insurance Medical Council, an advisory body of the health, labor and welfare minister, decides how many points to credit for each medical service.

If medical remuneration is reduced by 1 percent, the government could cut health care expenses–which totaled about 34 trillion yen paid by the government in fiscal 2008–by 340 billion yen. Such a cut also would reduce the amount of money citizens must pay after receiving services at medical institutions.

Considering the Finance Ministry’s stance, Nagatsuma implied the possibility of a slight increase in the medical service fee, or of increasing the government subsidy to the health insurance system along with raising the medical remuneration by a large margin. “We need to consider a way [to raise medical remuneration] that won’t increase the expenses paid by the citizens at medical institutions or hike the health insurance premium,” Nagatsuma said.

Brace for a possible spring shock

When spring approaches next year, many foreigners in Japan could be in for a rude awakening: From April 1, all those who apply to extend their visa in Japan will be asked to show proof of enrollment in one or other of Japan’s main national health systems, the shakai hoken (social health insurance and pension) or kokumin kenko hoken (national health insurance).
When that time comes, it won’t help to present details of your own private health plan, or to argue about the inefficiencies of the system for foreigners. Japan has had a mandatory universal health care system in place since 1961, meaning that any resident over 20 must be enrolled, whether employed or unemployed, Japanese or non-Japanese.

If you are working for a company in Japan, chances are that you are (or need to be) enrolled in shakai hoken, in which you pay half of your health insurance premiums and your company pays the rest. There isn’t much ambiguity about shakai hoken: If a company employs more than five people, and an employee is working more than 30 hours a week for a period longer than 2 months, the company is obligated to submit paperwork for an employee’s health insurance and pension to the Social Insurance Agency within five days of hiring. With shakai hoken comes the kosei nenkin, or pension plan; the two are a set, and enrollment is mandatory whether you plan to retire in Japan or not.

Meanwhile, people who are unemployed, self-employed, employed by a small firm or retired should be enrolled in kokumin kenko hoken (national health insurance). People paying into this system have to sign up on their own for kokumin nenkin (the national pension) at their city ward office.

On the positive side, the new guidelines will at least force the issue into the open so that there are fewer people … blindsided by back payments, says Yujiro Hiraga, president of [Zenkoku Ippan Tokyo General Union’s predecessor] the National Union of General Workers, Tokyo Nambu. “I think it will be a good source of pressure for employers to enroll their staff.” But, he adds, “The negative effect is that it might encourage more secrecy among people and companies without it.”

He notes that the number of employers who enroll their staff in insurance is shrinking with the economic downturn, and that things could get worse: A labor ministry survey last year found that over 100,000 companies had not enrolled their staff in shakai hoken as of March 2008.

Seizures rising over unpaid health insurance premiums

Municipal governments increasingly are seizing assets of individuals who are behind in their national health insurance premium payments, an Asahi Shimbun survey shows.

The survey showed such asset seizures rose an average 1.7-fold from fiscal 2001 to 2005 in the nation’s 15 largest cities and Tokyo’s 23 wards.

National health insurance programs cover self-employed people, farmers, job-hopping “freeters,” retirees and the unemployed. They are administered by municipal governments.

Health insurance programs are in the red in 64 percent of municipalities nationwide.

Legal action taken against delinquents, including seizures of bank accounts and properties, has risen as the collection ratio has fallen.

The collection rate has dropped to close to 90 percent nationwide on average and is hovering below 90 percent in large cities.

Health ministry statistics also showed that seizures of assets from nonpayers rose from 44,112 cases worth 15.6 billion yen in fiscal 2001 to 68,488 cases worth 24.5 billion yen in fiscal 2004.

Municipalities resorting to assets seizures jumped from 39 percent nationwide to 55 percent in the same period.

But some local entities remain cautious about taking such forcible steps because national health insurance typically covers more low-income earners than other programs, such as for salaried workers.

The ratio of self-employed people and those working in farming, forestry and fisheries fell to 21 percent of those in the insurance program in fiscal 2004, from about 70 percent 40 years earlier.

In contrast, the ratio of unemployed people jumped from less than 10 percent to 52 percent over the same period.