(First) Expert Working Group of the Study Group on the Integration of My Number Card and Health Insurance Cards

Last Updated:: Feb 22, 2023

Overview

Date and time: December 12, 2022 (Monday) 12:00 p.m. to 13:00 p.m.
Location: Online
1. Opening
2. Agenda
  1. About the Investigative Commission
    - About the Investigative Commission
    - About the Expert Working Group
  2. Matters to be considered by the study group
  3. On the way forward
3. Adjournment

Material

Summary of the Proceedings

Date and

Monday, December 12, 2022, from 12:00 p.m. to 13:00 p.m.

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Held online

Attendee

Keisuke Murakami (Director-General, Group of Service for Citizens, Digital Agency)
Hirotami YOSHIKAWA (Director-General of Local Administration Bureau of Ministry of Internal Affairs and Communications)
Kazuhito Ihara (Director-General of the Ministry of Health, Labor and Welfare Insurance Bureau
NAGASHIMA Kimiyuki (Executive Director, Japan Medical Association)
Hideki Endo (Vice President, Japan Dental Association)
Shohei Mori (Vice President, Japan Pharmaceutical Association)
Etsuro Ito (Managing Director of Health Insurance Association Federation)
Seiya Okazaki (Chairman of the Japan National Health Insurance Association) * Alternate: Katsunori Hara (President of the Japan National Health Insurance Association)

Observer

Nobuki Ando (President of Japan Health Insurance Association)
Yasuhiro Senda (Head of the Second Research Department of the National Governors' Association)
Shigehito Kimura (Dean, Faculty of Education, Japan Association of City Mayors)
Taro Koide (Director of Administrative Department, National Association of Towns and Villages) * Deputy: Ryuzo Tanaka (Deputy Director of Administrative Department)
Toshihiko Yokoo (Chairman of the National Association of Medical Care Systems for the Elderly Aged 75 and older and Industry Council)
Hirotaka Shimonaka (Director of Japan Agency for Local Authority Information Systems Number Center)

Proceedings (Opinions from members, etc., and questions and answers)

NAGASHIMA Kimiyuki (Executive Director, Japan Medical Association)

First of all, safety and security should be the main principles. Insured medical care is the foundation that protects the lives and health of the people, and it is fundamental that no one is left behind. I would like to see the two major principles of not placing an excessive burden on the people and medical facilities.
It is extremely important that there are no people who cannot receive insured medical treatment. It is important to have a system in which even people who do not have a My Number Card can receive insured medical treatment properly, and it is also important to have a system in which it is not a burden.
Various efforts to eliminate the time lag are also required.
It is necessary to work on the assumption that disasters and system failures will definitely occur. I would like you to think about a system that is safe even if a failure occurs. In addition, since the people and medical facilities feel uneasy about cybersecurity, I think that the national government should develop measures.
It is necessary to deepen and expand the understanding that the realization of medical care and health using My Number Card is truly useful to the people. I think that this requires the medical field to cooperate well.
We would like to consider applying for business trips at medical institutions, health checkup venues, vaccination venues, and other places where the card is useful.
Application for on-site visits by medical institutions and dispensing pharmacies is considered to be very effective, but decisions need to be made according to the region and timing. Therefore, it is hoped that the environment will be improved through discussions between local medical associations and municipalities, etc.
As the Japan Medical Association, we would like to listen to the voices of the medical field and provide information on what needs to be done in various situations.
Since there is a concern that the delivery by proxy may be abused if the intention of the identity verification or the person is not confirmed, it is necessary to consider from the viewpoint of how to secure it.
In addition, regarding medical assistance and local independent publicly funded health care, it is necessary to expand measures so that they can be confirmed with one My Number Card, but it cannot be introduced with a mechanism that increases the burden on medical sites, so this perspective is also important.

Hideki Endo (Vice President, Japan Dental Association)

The Japanese Dental Association is also fully cooperating in the promotion of medical digital transformation, which is an extremely important initiative for the construction of a high-quality and efficient medical care delivery system and the development of new medical care in the future. Efforts are being made at the Online Qualification Confirmation Promotion Council, which was launched jointly by the three associations.
In order to promote it smoothly, My Number Card dissemination and public understanding are necessary, and more careful explanations to the public are necessary.
There are cases in which family members bring insurance cards instead of patients who have difficulty going to the hospital, or family members come to pick up medicines. In the use of cards, authentication of the person is required, so isn't it necessary to devise some way in these cases?
In order to gain the understanding of the people, detailed responses to exceptional events are necessary, and it will take some time for all people to become familiar with digital environments in My Number Card and other places.
Since there is a risk that the entire medical care will stop if some kind of trouble, error or various failures occur, consideration for such events is also required.
The time lag in changing qualifications may become more apparent with the conversion of this My Number Card to an insurance card.
There are areas where exceptional measures are necessary due to various circumstances on both the public / patient side and the medical care provider side. By responding to these areas, medical DX will be promoted and further developed.
The number of patients who can bring a My Number Card has increased, and it is convenient because the date can be checked on the screen. At present, there are people who understand and can go to the hospital, but if we cannot cover exceptional cases in the future, I think the entire system will not work well.
I would like to ask for your cooperation, as it will increase the burden on medical sites if we cannot respond smoothly when card readers fail to read.

Shohei Mori (Vice President, Japan Pharmaceutical Association)

When promoting the acquisition of cards and integration with health insurance cards, it is necessary to fully inform the people of the significance, contents, advantages, safety, etc. so that they can proceed with it without worry.
There are many people who feel uneasy about the increased opportunities to carry cards. It is necessary to make people aware of the safety and security measures of cards so that they can use them with peace of mind. For example, cards are difficult to misuse, and measures are taken to make it difficult to steal information.
It is necessary to take measures to make it easier for citizens to obtain cards. There are many elderly people who have difficulty in applying and receiving cards, and it is essential to take measures so that such people will not be troubled.
Pharmacies are preparing for the digital transformation of medical care, including the development of a system for online qualification confirmation. About 97% of pharmacies subject to the obligation have applied for card readers, and about 65% of pharmacies have already started using them. We will continue to make efforts to introduce them to all pharmacies, but we would like you to understand that there are pharmacies that have been delayed in introducing them or cannot introduce them due to unavoidable circumstances. It is necessary to secure a system that can respond to patients who bring their cards to such pharmacies and request dispensing.
After the abolition of the health insurance system, it should not become difficult or impossible for people without a My Number Card to receive necessary medical care due to loss or other reasons.
It is necessary to take measures so that citizens, medical institutions, and pharmacies will not be in trouble if their credentials and drug information cannot be confirmed due to system failures or errors. Since the information on the insurance card can be confirmed on the ticket, it is possible to present the ticket at online medication guidance, but in the case of My Number Card, it is difficult to confirm the credentials from the ticket. In addition, there are cases where family members or caregivers come to the pharmacy to receive drugs. In such cases, how to confirm the credentials is a challenge.
Regarding the reissuance of the My Number Card when it is lost, the National Health Insurance is reissuing the insurance card on the same day. It is requested to establish a system that can quickly issue a temporary insurance card as well as an express issuance of the card.
GOJ requests USG to consider measures so that there will be no time lag in the change of status due to a change of job or retirement.
It is expected that many people, especially the elderly, will be worried and confused by the change to My Number Card, so I would like to ask you to respond in a courteous manner, including providing sufficient information.
Regarding the integration of the My Number Card and the insurance card, we would like to provide careful support to patients who visit the pharmacy.

Etsuro Ito (Managing Director of Health Insurance Association Federation)

In the medical field, I think it is important to improve medical care and use it for health management through data health reform or medical digital transformation. Health insurance federations will firmly promote this initiative so that using My Number Card as the Health Insurance Certificate will become a matter of course so that the people can enjoy the effects of improving medical care. In addition, I think that there are various benefits for related parties, so I would like to make the scheme created this time more expandable.
One of the reasons for the delay in obtaining a card is that it is necessary to physically obtain a card. If it becomes possible to regard a card as having been obtained with a smartphone application, a world in which citizens use cards will become the norm. I hope that the government will consider providing a new insurance insurance-compatible application with a electronic certificate that displays the minimum information necessary for insured medical treatment, such as the name of the insurer and the symbol number of the insurance card, on the smartphone screen. However, it is necessary to consider separate measures so that people who do not have a function and cannot use the application can receive medical treatment covered by the My Number Card properly. My Number Card
In addition to conveying the convenience of being able to view medical information and health checkup information on smartphones in an easy-to-understand manner, it may also contribute to the further spread of cards by promoting the installation of new services on smartphones.
There are various reasons for the delay in the entry of information to verify the qualifications of insurers, such as delays in submitting notifications to insurers or submitting My Number notifications. We will inform business owners of the need to promptly submit notifications so that employees and their families can receive insured medical care in an appropriate manner. In addition, it is thought that insurers will basically refer to the J-LIS to obtain My Number, but there are problems such as non-uniform registration methods for foreign names, non-Japanese characters, and address notation, so I would like you to consider standardization. The Health Insurance Society is in a difficult financial situation and will collect the core system to utilize the J-LIS. From the perspective of promoting the My Number society, if there is financial support such as free reference fees, it will proceed smoothly.
In order to promptly submit the notification, it is important to promote the use of online application and to realize Mynaportal and One Only as soon as possible in relation to the application of the business operator utilizing one-stop.
I think it is important for the working generation, who are used to using apps, to play a role in promoting DX in Japanese society.
It is important to address detailed issues toward the autumn of 2024, but when considering the future digital society or medical DX, I would like to see mid - and long-term discussions.

Katsunori Hara (President of the National Health Insurance Association)

As this will have a wide impact on the public, the Government is requested to make efforts to disseminate information in a careful and detailed manner as well as to take care so that there is no confusion on the site of insurers and medical institutions.
The integration of My Number Card and health insurance cards should not set back these efforts regarding the acquisition and loss of insured status and the handling of defaulters of insurance premiums. We would like to ask the government to listen to the actual work of insurers and proceed with consideration.
Insurers are expected to take various measures and incur large costs, but due to the severe financial situation, it is necessary for the government to provide financial support on its own responsibility.
For those who do not have a My Number Card at hand for some reason, a system to confirm eligibility at medical institutions is necessary so that those who pay insurance premiums can receive the necessary insured medical treatment. It is conceivable to issue some kind of document to the insured person to confirm eligibility, but I understand that it has been discussed in the National Assembly etc. whether or not to charge the cost required for the issuance. Regarding the collection of costs, there are strong objections from the field of municipal National Health Insurance, because it is difficult to explain to the insured and the Assembly that the issuance of documents to confirm eligibility, which was free until now, will be charged even though it is not mandatory to obtain a My Number Card. In addition, it may be interpreted by the public as a penalty for not taking a My Number Card. In order for those who pay insurance premiums to be able to receive the necessary insured medical treatment as always, I request you to consider not collecting such costs when introducing a new system to confirm eligibility.
The National Health Insurance Association of Japan is engaged in the development and operation of an online eligibility verification system, and we would like to actively engage in medical digitalization assuming the spread of My Number Card.
Since the National Health Insurance is a project that is difficult to operate, we would like to proceed while solving problems one by one. We would be grateful if you would listen carefully to the opinions of the field.

Nobuki Ando (President of Japan Health Insurance Association)

As I believe that the online qualification verification system will be the foundation of medical DX in Japan, I ask for your continued support so that it can be introduced quickly at medical institutions.
It is important to know how to check your qualifications if you do not have a My Number Card, and how to deal with your health insurance card. I would like you to take up these issues in the future.
It is also very important that online qualification verification systems, such as Medical Examination and Rehabilitation Centers, are introduced.

Kazuhito Ihara (Director-General of the Ministry of Health, Labor and Welfare Insurance Bureau

I believe that many of the opinions you gave us today were related to Ministry of Health, Labor and Welfare, but I would like to take them one by one and answer them. I would like to do my best on issues such as reducing the burden on medical facilities, function even if disasters or system failures occur, and responding to cybersecurity's concerns.
On the other hand, we also received reassuring opinions that the digitalization of medical care is extremely important for the health of the people.
Regarding the acquisition of My Number Card, we received a positive proposal that it could be implemented at medical institutions and health checkups sites, and we would like to consider to what extent it is possible.
There are many situations in which family members go to pick up drugs, and there was talk about whether it would be realistic to bring a My Number Card with them. I think it is necessary to consider how to deal with such cases realistically.
He said that rather than a physical card called My Number Card, it would be easier to spread by using the smartphone app that many people have. In Digital Agency, they are installing the My Number Card function on smartphones, but I would like to discuss well how to make good use of it in order to spread it at the field level.
Regarding the time-lag issue caused by the delay of data entry by insurers, we believe that it is necessary not only for insurers to make efforts, but also to further strengthen efforts to have business operators register as soon as possible and have insured persons submit their My Number to insurers, so we would like to discuss it together. We would like to make efforts to create a situation where people can immediately receive medical care at a My Number Card when they change insurers, although we received requests such as response to J-LIS.
We received several opinions on the response of insurers. One of the issues was the issue of charging for documents, etc. to confirm eligibility. There are certainly discussions on charging at the Diet deliberations, etc. Today, there were voices on the ground in municipalities that there are opposing opinions because it is difficult to explain to insured persons or the Diet. What should be done is a big theme, and I would appreciate it if you would discuss it at this review meeting.

Hirotami YOSHIKAWA (Director-General of Local Administration Bureau of Ministry of Internal Affairs and Communications)

Ministry of Internal Affairs and Communications is in a position to issue and issue the card, and we are currently saying that we would like municipalities to actively accept business trip applications. We heard from a member that business trip applications should be accepted at medical institutions. Ministry of Internal Affairs and Communications has said that we would like medical institutions to accept business trip applications using vaccination sites, and I believe that a considerable number of organizations have responded. If medical institutions accept business trip applications, we would like to encourage them to do so, so we would appreciate it if we could exchange opinions and information well. It would be very good if we could accept business trip applications while explaining the various benefits of using My Number Card as a health insurance card at medical sites, so we would like to proceed.
We received a proposal to use smartphones instead of cards, and we are aware that there are certainly such cases in other countries, but I think it is a matter of tradeoff with the certification strength of the card. I think Digital Agency also has its own idea, and we would like to participate in the discussion.
We received a request for an inquiry fee for the J-LIS. I think it is an issue to be considered while consulting with fiscal authorities and others.

Keisuke Murakami (Director-General, Group of Service for Citizens, Digital Agency)

All of you pointed out the two points of benefit and safety in common, and I felt anew that it is important to firmly create benefits in both medical and non-medical aspects, and that we must firmly work on seeking understanding of safety, which is still a matter of strong concern, including misunderstanding.
In order for things to go smoothly on the ground, this is an operation in which we will respond while carefully listening to each and every opinion. Therefore, I would like to receive opinions without reserve and carefully take response measures one by one without omission.