[Problems of national health insurance reimbursement revision, especially for laboratory tests].

The reimbursement fees for laboratory tests are lowered at every revision of Health Insurance Reimbursement (HIR), carried out every 2 years. This leads to the financial trouble for laboratory operation in university hospitals as well as general hospitals. Medical care costs in Japan account for 6% of GNP and is not as high as that in advanced countries such as USA, Canada, and Germany. The Central Pharmaceutical Affairs Councils gives manufacturing and sales approval for in-vitro diagnostics after examination of the applied documents. The Committee on Application of Medical Care Remuneration in the Japan Medical Association decides the following; Propriety of reimbursement establishment for new in-vitro diagnostics, reimbursement fees for new in-vitro diagnostics, propriety of reimbursement establishment for medical devices and propriety of reimbursement for new drugs. The MOSS (Market-Oriented, Sector-Selective) approach was initiated also in the in-vitro diagnostics field in January 1985 the target of which is to abolish the economic barrier and relax regulations in Japan. The Ministry of Health and Welfare lowered the reimbursement fees based on actual prices in commercial laboratories, which is very low because of price dumping through excess competition. In future, we would like to propose additional reimbursement fees for in-house emergency tests. Furthermore, we would like to request the judgment fee for diagnosis of myelogram, immunoelectrophoresis and isoenzymes for which clinical laboratory physicians play a role.