First meeting of the Expert Working Group on the Integration of My Number Card and health insurance card

Overview

Date and Time: Monday, December 12, 2022 (2022) from 12:00 to 13:00
Location: Online
1. Opening
2. Proceedings
  1. Review Meeting
    - Review Meeting
    - Expert Working Group
  2. Matters to be discussed at the Review Meeting
  3. How to proceed in the future
3. Adjournment

Materials

Summary of proceedings

Date

December 12, 2022 (2022) (Monday) from 12:00 p.m. to 1:00 p.m.

Location

Held online

Participants

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

Observer

Nobuki Ando (President of Japan Health Insurance Association)
Yasuhiro Senda (Director of the Second Investigation Department of the National Governors' Association)
Shigehito Kimura (Director of the Department of Social and Educational Affairs, Japan Association of City Mayors
Taro Koide (Executive Director of the National Association of Towns and Villages) * Deputy: Ryuzo Tanaka (Deputy Director of the Administrative Department)
Toshihiko Yokoo (Chairman of the National Council of medical care Area Association for the Elderly People)
Hiroshi Shimonaka (Director of the Personal Identification Number Center, local governments Information Systems Institute)

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

NAGASHIMA Kimiyuki (Executive Director of the Japan Medical Association)

First of all, safety and security should be the main principles. Health insurance treatment is the foundation that protects the lives and health of the people, and I would like to have two main principles: Do not leave anyone behind, and do not place an excessive burden on the people and the medical care site.
It is extremely important that there are no people who cannot receive health insurance treatment. It is important to have a system in which even people who do not have a My Number Card can receive health insurance treatment properly, and a system that does not impose a burden.
Various efforts to eliminate the time lag are also necessary.
It is necessary to work on the premise that disasters and system failures will always occur. I would like you to consider a system that is safe even if a failure occurs. In addition, since the people and medical care sites feel uneasy about cybersecurity, I think that the government should prepare measures.
I think that it is necessary for My Number Card sites to firmly cooperate in deepening and expanding the understanding that the realization of medical care and health using medical care is truly useful to the people.
I would also like to consider applying for a business trip at a place where the card is useful, such as a medical institutions, a venue for a health checkup, or a venue in vaccinations.
I think that business trip applications at medical institutions and dispensing pharmacies are very effective, but since it is necessary to make decisions according to the area and the time, I would like to see environmental improvements such as discussions between the medical association of area and the municipality.
The Japan Medical Association (JMA) would like to hear the voices of people in medical care and provide information on the need for responses in various situations.
Since there is a concern that the proxy Issue will be misused without the confirmation of the identity of the person or the intention of the person, it is necessary to consider from the viewpoint of how to secure.
In addition, for medical care assistance and local independent publicly funded medical care, it is necessary to expand the response so that it can be confirmed with one My Number Card, but it is not possible to introduce a mechanism that increases the burden on the medical care site, so such a perspective is also important.

Hideki Endo (Vice President, Japan Dental Association)

The medical DX is also a very important initiative for the construction of a high-quality and efficient medical care provision system and the development of new medical care in the future, and the Japanese Dental Association fully cooperates in the promotion. The Online Qualification Confirmation Promotion Council, established jointly by the three associations, is engaged in promotion efforts.
In order to promote it smoothly, the understanding of promotion of My Number Card and the people is necessary, and more careful explanations to the people are necessary.
In some cases, family members bring their health insurance cards on behalf of patients who have difficulty attending hospital, and in other cases, family members come to pick up their medicine. The use of cards requires the authentication of the person himself / herself, and some ingenuity may be necessary in these cases.
In order to obtain the understanding of the people, it is necessary to take detailed measures even for exceptional events, and it is considered that it takes a certain amount of time for all the people to become familiar with the digital environments of My Number Card and the like.
Since there is a risk that the entire medical care will be stopped in the event of some troubles, mistakes, and various obstacles, consideration for such events is also required.
The time lag in changing the status may become apparent due to the introduction of insurance cards in My Number Card.
There are parts that require exceptional responses due to various circumstances both on the people and patients side and on the medical care provider side, and it is considered that medical DX will be promoted and further developed by responding to them.
The number of patients who can bring their My Number Card has increased, and the data can be checked on the screen, so we are using it conveniently. Now, there are people who understand and can visit the hospital, but I think the whole system will not work well if we cannot cover exceptional cases in the future.
If the response to the problem of the card reader reading does not go smoothly, the burden on the medical care site will increase, so we would like to ask for your cooperation.

Shohei Mori (Vice President of the Japan Pharmaceutical Association)

In promoting card acquisition and integration with health insurance card, it is necessary to fully inform the public of the significance, content, benefits, security, etc., so that it can be promoted with peace of mind.
As the number of opportunities to carry cards increases, many people feel uneasy. It is necessary to make the safety and safety measures of cards known again, such as the fact that they are difficult to misuse and that measures are taken to make it difficult to steal information, so that people can use them with peace of mind.
It is also necessary to make it easier for people to obtain the card. Many elderly people have difficulty in applying and receiving the card, so it is essential to make it easier for such people.
Pharmacies are taking steps to respond to the medical DX, such as developing a system for online certification. About 97% of pharmacies subject to the obligation have applied for card readers, and about 65% have already started using them. We will continue to strive to introduce them to all pharmacies, but we would like to understand that there are pharmacies that are delayed in introduction or cannot be introduced due to unavoidable circumstances, etc., and it is necessary to ensure a mechanism that can respond to requests for dispensing from patients who bring their cards to such pharmacies.
As a Issue after the abolition of the insurance card, if a person does not possess a My Number Card due to loss, etc., it must not become impossible or difficult for the people to receive the necessary medical care.
It is necessary to take measures so that the people, medical institutions, and pharmacies will not be troubled in cases where data such as credentials and drug information cannot be confirmed due to system failures or errors. Since the information can be confirmed on the face of the insurance card, it is possible to present the face of the insurance card at the time of online drug administration guidance. However, in the case of My Number Card, it is difficult to confirm the credentials from the face of the insurance card. In addition, there are cases where families and caregivers can come to the pharmacy to receive drugs, and it is Issue how to confirm the credentials in such cases.
Regarding the reissue of the My Number Card in the event of loss, etc., some National Health Insurance will reissue the insurance card on the same day, and we would like to request the establishment of a system that can issue a temporary insurance card quickly in addition to the limited express issuance of the card.
We would like you to consider measures so that there is no time lag between the occurrence of a blank period at the time of change of status due to job change or retirement.
It is thought that there will be many people, mainly elderly people, who will be worried and confused by changing to My Number Card, so we would like to ask for a careful response, including sufficient awareness.
Regarding the integration of the My Number Card and the insurance card, we would like to provide careful support to the patients who come to the pharmacy.

Etsuro Ito (Managing Director of the Federation of Health Insurance Societies)

In the medical care field, I think it is important to improve the quality of medical care and utilize it for health management through data health reform or medical DX. In order for the people to obtain the effect of improving the quality of medical care, I would like to steadily advance this initiative so that it will be a matter of course to use the Maina Health Insurance Card. In addition, I believe that there are various benefits for the people concerned, so I would like to make the scheme created this time have potential.
By equipping Android smartphones with My Number Card's E-Certificate, we are promoting efforts to enable people to receive medical care on their smartphones without carrying a card. However, we believe that one of the reasons why the acquisition of cards has been delayed is that it is necessary to physically acquire cards. If it becomes possible to consider that people have acquired cards through smartphone apps, it will become common for people to use cards. We would like to ask the government to consider newly providing an app for insurance cards that has a function to display the minimum necessary information for health insurance treatment, such as the name of the insurer and the symbol number of the insurance card, on the screen of the smartphone. However, it is necessary to consider a separate response so that people who do not have a My Number Card and cannot respond to the app can properly receive health insurance treatment.
In addition to conveying in an easy-to-understand manner the convenience of being able to view medical care information and medical examination information on smartphones, we believe that incorporating additional new services into smartphones will contribute to the further spread of cards.
There are various reasons for the time lag in the entry of the information for confirming the qualifications of the insurers, such as the delay in notifying the insurers and the delay in notifying the My Number. We will make it known to business owners the need to promptly notify employees and their families so that they can receive appropriate medical care covered by health insurance. In addition, we think that the insurer will make inquiries to the J-LIS and acquire the My Number as a basic rule, but there are problems such as the registration method of foreign names, external characters, and the non-uniformity of address notation, so we would like to consider standardization. The Health Insurance Society is in a difficult financial situation, and there is a recall of the core system for utilizing the J-LIS. From the viewpoint of promoting the My Number society, financial support, such as free inquiry fees, will make things go smoothly.
In order to promptly notify, it is important to promote the use of online application and to quickly realize a one stop, one time-only system for applications by business operators using Mynaportal.
We believe that it is important for the working generation, who are accustomed to using apps, to promote this initiative as promoters of DX in Japanese society.
It is important to crush the small Issue toward the autumn of 2024, but I would like to ask you to consider the medium - and long-term parts when you consider digital society or medical DX in the future.

Katsunori Hara (President of the National Health Insurance Central Association)

Since it has a wide impact on the people, the Government of Japan requests the Government of the United States to make efforts to disseminate information in a careful and detailed manner, and to take care so that confusion does not occur at the site of insurers and medical institutions.
With regard to matters related to the acquisition and loss of insured status and responses to persons delinquent in payment of insurance premiums, these efforts should not be regressed due to the integration of My Number Card and health insurance card, and the Government of Japan requests the Government of the United States to pay attention to the on-site practices of insurers and proceed with discussions.
Although the insurer is expected to take various measures and incur large expenses, it is necessary to provide financial support at the responsibility of the national government due to the severe financial situation.
For those who do not have a My Number Card in hand for some reason, a mechanism for confirming eligibility in the medical institutions is necessary so that those who pay premiums can receive the necessary insured medical treatment. In order to confirm eligibility, it is possible to charge some documents to the insured. However, I am aware that whether or not to collect the costs required for Issue and charge them is being discussed in the Diet deliberations. Regarding the collection of costs, local government national health insurance offices are strongly opposed to the collection of costs because it is difficult to explain to the insured and the Assembly that Issue, such as documents for confirming eligibility, which have been free until now, will be charged even though the acquisition of a My Number Card is not mandatory. In addition, it may be interpreted as a penalty for not collecting a My Number Card from the people. In order to ensure that those who pay premiums can receive the necessary insured medical treatment as before, it is requested that consideration be given to not collecting such costs when introducing a new mechanism for confirming eligibility. Issue
The National Health Insurance Central Association is engaged in the operation of the online qualification confirmation system in development, and we would like to actively work on the digitalization of medical care premised on 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 resolving each Issue one by one. We would appreciate if you could listen to the opinions of the field.

Nobuki Ando (President of Japan Health Insurance Association)

We believe that the online credential verification system will be the foundation of Japanese medical DX, so we ask for your continued efforts to enable the rapid introduction of the system in medical institutions.
The method of confirming eligibility in the case of non-possession of a My Number Card and the treatment of an issued insurance card are important, so I would like to have them thoroughly covered in the future.
In addition, it is very important to introduce an online qualification confirmation system such as flexible education and medical examination institutions.

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

I believe that many of the opinions I received today are related to Ministry of Health, Labor and Welfare, but I would like to take them one by one and respond to them. I would like to make sure that medical care does not impose a burden on cybersecurity sites, that Issue works even in the event of disasters or system failures, and that we respond to the concerns of Okinawa.
On the other hand, we also received a reassuring opinion that digitalization in 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 should be implemented at medical institutions and health examination sites. We would like to consider to what extent it is possible.
There were many cases in which family members went to pick up the medicine, and there was also talk about whether it was realistic to bring a My Number Card at that time. I think it is necessary to consider how to respond to such cases.
He said that rather than using a physical card called My Number Card, using an app on a smartphone owned by many people will expand smoothly. In Digital Agency, smartphones with the My Number Card function are being installed, and I would like to consider how to use it well to expand at the field level while consulting with you.
Regarding the problem of time lags due to delayed entry by insurers, we believe that it is necessary to further strengthen efforts to have business operators register as soon as possible and to have insured persons submit their My Number to insurers, in addition to the efforts of insurers. We would like to discuss this matter together. We have received requests such as responses to the J-LIS, but we would like to make efforts because we need to create a situation in which patients can receive medical care at a My Number Card immediately when they change insurers.
We received several opinions on the responses of insurers. One of them is the issue of charging fees for documents for confirmation of eligibility in Issue. There is certainly discussion on charging fees at the Diet deliberations and other forums. Today, we heard that there are opposing opinions because it is difficult to explain to the insured or the Diet as the voices of the local governments. What should be done is a big theme, and we would appreciate if you could discuss it at this review meeting.

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

Ministry of Internal Affairs and Communications is in a position to issue and Issue cards, and we are currently saying that we would like to encourage municipalities to actively accept business trip applications. Members told us that they would like to accept business trip applications in medical institutions. Ministry of Internal Affairs and Communications wants to use vaccination sites to accept business trip applications, and we recognize that many organizations have responded. If medical institutions can accept business trip applications in medical institutions, we would like to encourage municipalities to do so, so we would be grateful if we could exchange opinions and information. It would be very good if we could accept business trip applications while explaining various advantages at the medical care site, which uses My Number Card as a health insurance card, so we would like to proceed.
There was also a proposal to use smartphones instead of cards. It is true that there are such cases in other countries, but I believe that there is a tradeoff relationship with the certification strength of cards. I believe Digital Agency has an idea, but we would like to participate in the discussion.
We also received requests for inquiry fees for J-LIS. I think Issue will consider it while consulting with financial authorities and others.

Keisuke Murakami (Digital Agency For the public Group Director-General)

You pointed out two points in common, benefits and security, and I once again felt that it is important to create benefits both in medical care and outside medical care, and that we must work hard to obtain understanding about security, which is still a matter of concern, including misunderstandings.
In order to ensure that the site works well, we will respond by carefully listening to your opinions one by one. Therefore, I would like to receive your opinions without hesitation, and I would like to take measures carefully so as not to omit them one by one.