Knowing the impact of increased out-of-pocket costs for high-cost medical care: 'Medical and Health Disparity Study Session' at Group Co-op [Kyosai-ren]
Pal-system Mutual Insurance Federation held a study session inviting Hodanren to discuss the severe impact of the government's planned increase in out-of-pocket limits for the high-cost medical care benefit system.
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- 📰 Published: April 7, 2026 at 19:10
- 🔍 Collected: April 7, 2026 at 10:30
- 🤖 AI Analyzed: April 20, 2026 at 23:48 (325h 17m after Collected)
Pal-system Consumers' Co-operative Mutual Insurance Federation (Headquarters: Shinjuku-ku, Tokyo; President: Haruyuki Shibusawa) held a "Medical and Health Disparity Study Session" at its Higashi-Shinjuku headquarters on Thursday, April 2, with 29 participants including online viewers. A lecturer was invited from the Japanese Medical and Dental Practitioners for the Improvement of Medical Care (Hodanren) (Headquarters: Shibuya-ku, Tokyo; President: Tomoo Takeda) to learn about the impact of changes to the high-cost medical care benefit system.
### Compensation for long-term patients through a burden increase on 6.6 million people
At the study session, Shogo Honnami, Deputy Secretary General of Hodanren, explained the changes to the high-cost medical care benefit system scheduled for August 2026 and 2027 and their impact. The system sets an upper limit on the out-of-pocket amount for medical expenses paid per month, with insurers such as health insurance societies covering the excess. It is an indispensable system to alleviate the financial burden of medical expenses for patients requiring long-term treatment.
In January 2025, the government decided to raise the upper limit on out-of-pocket payments to maintain the high-cost medical care benefit system into the future. Following criticism from patient groups that this "could lead to abandoning treatment," the government announced in March of the same year that it would postpone the increase. Subsequently, after nine review meetings, the Ministry of Health, Labour and Welfare decided on the contents of the new system revision in December.
Mr. Honnami explains the revised contents: "Compared to a year ago, there are some improvements in consideration for long-term patients and low-income earners, but the burden will increase for 6.6 million people, which accounts for 80% of system users." Under the high-cost medical care benefit system, if the system is used more than three times by the same household in the past 12 months, it is considered "multiple uses," and the upper limit of out-of-pocket expenses is reduced to a fixed amount from the fourth month onward. This amount will be kept the same, and lowered for those with an annual income of less than 2 million yen. In addition, in consideration of long-term patients who do not reach the threshold for multiple uses, an annual maximum limit will be introduced, exempting payment of the excess.
These financial resources will be covered by a flat 7% increase in the out-of-pocket maximum in August 2026 and an increase through the subdivision of income categories in August 2027, creating a structure where approximately 6.6 million patients who use the system 1 to 3 times a year "pay according to their ability to pay." Mr. Honnami raises questions: "Adjusting finances within the system to balance the books, without considering reductions in high drug prices or securing financial resources from the government budget, forces the burden solely onto patients."
### Right to life threatened by 117 yen a month
In response to the announcement of the revised contents, Hodanren conducted a survey of 1,700 system users in January 2026. While 47.7% answered that their income had decreased due to treatment, 68.4% of them will not see a decrease in their maximum burden amount. More than 70% responded that they would deplete their savings and cut living expenses for treatment, and around 60% would make choices that could lead to aggravation of symptoms or life-threatening situations, such as refraining from medical consultations or switching to cheaper drugs or treatments.
Furthermore, in households with children, while expenses such as mortgages and children's education costs pile up, there are situations where they must work while receiving treatment and manage to pay medical expenses. There are earnest voices saying they would not hesitate to abandon treatment if their own medical expenses force their children to endure hardships and affect their higher education choices. In some cases, long-term treatment such as the administration of expensive new drugs is necessary, and people have no choice but to divorce or separate their households to lower their out-of-pocket maximums.
Under WHO standards, a condition where medical expenses account for 40% or more of one's ability to pay is defined as "catastrophic health expenditure." There are estimates that if a person becomes unable to work due to treatment and their income decreases by about 30%, the out-of-pocket maximum will exceed the standard across almost all income brackets.
The Ministry of Health, Labour and Welfare anticipates a budget reduction of 107 billion yen due to suppressed medical consultations accompanying the revision, and estimates that the insurance premium burden per citizen can be reduced by 1,400 yen annually. Mr. Honnami points out, "The government bases its estimates on patients refraining from seeking care due to increased out-of-pocket costs. Abandoning medical care is a denial of the right to health guaranteed by the Constitution.
### Compensation for long-term patients through a burden increase on 6.6 million people
At the study session, Shogo Honnami, Deputy Secretary General of Hodanren, explained the changes to the high-cost medical care benefit system scheduled for August 2026 and 2027 and their impact. The system sets an upper limit on the out-of-pocket amount for medical expenses paid per month, with insurers such as health insurance societies covering the excess. It is an indispensable system to alleviate the financial burden of medical expenses for patients requiring long-term treatment.
In January 2025, the government decided to raise the upper limit on out-of-pocket payments to maintain the high-cost medical care benefit system into the future. Following criticism from patient groups that this "could lead to abandoning treatment," the government announced in March of the same year that it would postpone the increase. Subsequently, after nine review meetings, the Ministry of Health, Labour and Welfare decided on the contents of the new system revision in December.
Mr. Honnami explains the revised contents: "Compared to a year ago, there are some improvements in consideration for long-term patients and low-income earners, but the burden will increase for 6.6 million people, which accounts for 80% of system users." Under the high-cost medical care benefit system, if the system is used more than three times by the same household in the past 12 months, it is considered "multiple uses," and the upper limit of out-of-pocket expenses is reduced to a fixed amount from the fourth month onward. This amount will be kept the same, and lowered for those with an annual income of less than 2 million yen. In addition, in consideration of long-term patients who do not reach the threshold for multiple uses, an annual maximum limit will be introduced, exempting payment of the excess.
These financial resources will be covered by a flat 7% increase in the out-of-pocket maximum in August 2026 and an increase through the subdivision of income categories in August 2027, creating a structure where approximately 6.6 million patients who use the system 1 to 3 times a year "pay according to their ability to pay." Mr. Honnami raises questions: "Adjusting finances within the system to balance the books, without considering reductions in high drug prices or securing financial resources from the government budget, forces the burden solely onto patients."
### Right to life threatened by 117 yen a month
In response to the announcement of the revised contents, Hodanren conducted a survey of 1,700 system users in January 2026. While 47.7% answered that their income had decreased due to treatment, 68.4% of them will not see a decrease in their maximum burden amount. More than 70% responded that they would deplete their savings and cut living expenses for treatment, and around 60% would make choices that could lead to aggravation of symptoms or life-threatening situations, such as refraining from medical consultations or switching to cheaper drugs or treatments.
Furthermore, in households with children, while expenses such as mortgages and children's education costs pile up, there are situations where they must work while receiving treatment and manage to pay medical expenses. There are earnest voices saying they would not hesitate to abandon treatment if their own medical expenses force their children to endure hardships and affect their higher education choices. In some cases, long-term treatment such as the administration of expensive new drugs is necessary, and people have no choice but to divorce or separate their households to lower their out-of-pocket maximums.
Under WHO standards, a condition where medical expenses account for 40% or more of one's ability to pay is defined as "catastrophic health expenditure." There are estimates that if a person becomes unable to work due to treatment and their income decreases by about 30%, the out-of-pocket maximum will exceed the standard across almost all income brackets.
The Ministry of Health, Labour and Welfare anticipates a budget reduction of 107 billion yen due to suppressed medical consultations accompanying the revision, and estimates that the insurance premium burden per citizen can be reduced by 1,400 yen annually. Mr. Honnami points out, "The government bases its estimates on patients refraining from seeking care due to increased out-of-pocket costs. Abandoning medical care is a denial of the right to health guaranteed by the Constitution.