[EDITORIALS]Merged Health Plans Not NeededThe Ministry of Health and Welfare has in effect postponed the financial merger of the workplace and regional health insurance plans, which had been slated for January next year, by deciding to keep separate account books. Even if the two are financially merged by law, their accounts would be managed separately and premiums imposed separately.
We have pressed continuously for a delay in the merger by noting the reality. Whereas the income of workplace insurance policyholders is crystal clear, only 28 percent of regional insurance policyholders' income is known. In that sense, we welcome the government's separate bookkeeping. A health ministry official said, "Premiums for workplace insurance are based on total income, whereas those of regional insurance plans are based on income, assets, age, family members and the number of cars in possession. Further, the standards for support are also different. The government pays 50 percent of regional insurance cost, whereas management pays 50 percent of the workplace insurance cost. The two plans must therefore be kept financially separate." The separation is understandable, because if this distinction between workplace and regional plans is not made, premiums would have to be raised equally for both.
However, the government hitherto has not been open and square about the financial merger. At the end of last month, when it devised comprehensive measures to stabilize the health insurance finance, the government did not actively publicize its decision to keep the accounts of the two insurance plans separate. Questions were therefore raised on whether the government may have tried to let the issue slip by when the financial merger became highly contentious. Also, because the separate bookkeeping is a compromise between the opinions of those for and against the merger, criticism is mounting that it was a stopgap measure. Further, the existing law on national health insurance states that "the finances of workplace and regional health insurance policyholders [except for finances necessary for the maintenance and management of the national health insurance corporation] should be kept in separate accounts until 31 December 2001." This means that the finances of the two schemes will not be kept separate starting next year. Therefore, if the national health insurance uses separate bookkeeping without revising the law, disputes over its legality could surface.
The initial intention behind the financial merger of the two insurance plans was to charge premiums commensurate with income and the ability to pay. However, the health ministry has announced that premium raises will be determined separately based on the amount spent this year and the amount to be expended next year. In addition, a government official explained that because the standards for premium charges differ for the two schemes and the government supports only the regional scheme, it cannot help but maintain separate management systems after year 2006 - the year it aims to have achieved sound health insurance finances. In other words, the original justification for the financial merger is long gone. Nonetheless, the government is arguing, poorly, that the merger will take place next year, as both insurance finances will be pooled. The government should not feel obliged to go through with the financial merger. It should instead draw up measures that would return both plans to financial health. It should also amend the law governing the national health insurance so as to legally support the separate bookkeeping of the regional and workplace insurance plans.