High-cost medical care expenses payment system

Japanese: 高額療養費支給制度 - こうがくりょうようひしきゅうせいど

Medical expenses continue to rise due to advances in medicine and medical techniques, developments in medical equipment, etc., and the burden on patients for medical expenses is also on the rise. In order to reduce this burden on patients, high-cost medical care payment systems have been established in each medical insurance. Under health insurance, (1) the maximum self-payment limit is set at 63,600 yen per month (35,400 yen for low-income households), and any amount exceeding this limit, (2) if there are two or more patients in the same household who pay more than 30,000 yen per month (21,000 yen for low-income households), the combined amount exceeds 63,600 yen (35,400 yen for low-income households), (3) if the same household pays 63,600 yen per month (35,400 yen for low-income households) four or more times in a year, the maximum self-payment limit from the fourth payment onwards is set at 37,200 yen (24,600 yen for low-income households), and any amount exceeding this limit will be paid in full as high-cost medical expenses in cases where long-term treatment is required due to high costs, such as hemophilia, and the maximum self-payment limit is set at 10,000 yen per month.

Source: Heibonsha World Encyclopedia, 2nd Edition Information

Japanese:

医学･医術の進歩，医療機器の開発等により医療費の上昇が続き，医療費の患者負担も増加傾向にある。この患者負担を軽減するために高額療養費支給制度が各医療保険に設けられている。健康保険では(1)自己負担限度額を1ヵ月6万3600円(低所得者は3万5400円)としこれを超えた額，(2)同一世帯で1ヵ月の支払が3万円(低所得世帯は2万1000円)を超える患者が2人以上生じた場合，それを合算して6万3600円(同3万5400円)を超えた額，(3)同一世帯で1ヵ月6万3600円(低所得世帯は3万5400円)の支払が1年間で4回以上になった場合，4回目からの自己負担限度額を3万7200円(同2万4600円)とし，その超過額，(4)血友病等，高額で長期療養が必要な場合には自己負担限度額を1ヵ月1万としその超過額を高額療養費として全額支給することになっている。

出典　株式会社平凡社世界大百科事典第２版について　情報

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