“Evaluation for improving nursing staff’s treatment” brings disunity and division to medical institutions We demand its thorough revision that satisfies every healthcare professional

October 4, 2022
Tsuyoshi Masuda
Japan Federation of Democratic Medical Institutions


In the revision of the medical reimbursement system implemented in October 2022, a new evaluation program was introduced, aiming at improving working conditions of nursing staff in hospitals designated as playing certain roles in response to the covid-19 infections. Based on “economic measures to overcome covid-19 and pioneer a new era” approved by the cabinet on November 19, 2021, it uses subsidies to raise monthly wages of nurses at designated hospitals by 4,000 yen from February to September 2022 and then adds points for reimbursement of individual medical activities to raise them by about 3% (equivalent to an average of 12,000 yen per month) from October 2022. The program limits the number of eligible medical institutions and workers by setting requirements, such as providing more than 200 emergency transports per year and advanced emergency medical care services.

Although the latest revision has made a certain improvement in raising nurses’ wages, it has not fully satisfied many medical institutions and professionals. Furthermore, it has created disunity and division within medical facilities and in community healthcare as it lacks rationality. Its cursory arrangements bring inconsistency and confusion to medical services.

1. All nurses’ treatment should be improved

The new system has no reasonable grounds for covering only “medical institutions that have played certain roles in responding to covid-19”. Nursing staff who have confronted the covid infections in hospitals, clinics and home healthcare services that were not covered by the program have a very different view. If nursing staff who worked hard to cope with inpatients during the surge of infected patients are to be appreciated, they should be given a lump-sum payment. Using the reimbursement system makes a difference in patients’ burdens depending on whether their hospital is covered by the system or not. The difference in medical costs cannot be rationally explained.

As the increase in monthly wages is a permanent measure and will continue even after the covid outbreak becomes under control, it will fix the wage gap. Only about 35% of 1.65 million nurses are eligible for the wage increase. Even assuming limited financial resources, all nursing staff should be covered even if the wage increase for each person does not reach 3%. Efforts to secure financial resources to improve their treatment should be made as well. Also, it is impossible to provide a rational explanation that satisfies medical professionals, such as why eligible hospitals are limited and why pharmacists and others are not covered by the program.

2. Raise medical reimbursement to improve treatment of nurses and other healthcare workers and to increase their number

The revision widens wage gaps among local medical facilities by limiting hospitals and occupations it covers. In addition to that, corporations operating more than one medical facility will have different wage structures in different facilities. This creates difficulties in transferring and hiring staff within the corporations.

Only a handful of medical institutions are able to alleviate the gaps by raising wages with their own funds for staff and pharmacists who are not covered by the program. Many facilities had difficulties in management even before the covid pandemic due to low medical reimbursement.

The most serious challenge posed by the pandemic is the poor nursing system. Revising the reimbursement scheme is urgent in order to increase the number of nurses. Many institutions manage to maintain their nursing staff by paying high referral fees to private agencies out of reimbursement. We demand an increase in medical reimbursement that allows for better compensation for healthcare workers, including nurses, and an increase in their number.


As described above, the system has various contradictions. It is inconceivable that it was designed by taking seriously the realities of medical institutions and workers who have worked hard during the covid-19 pandemic and by carefully listening to their opinions and requests.

About 10% of the eligible medical institutions have decided not to receive the subsidy available until September 2022. It is likely that some hospitals will make a similar decision after October. They have to make such difficult decisions because of the many contradictions in the system.

We demand that this system not continue aimlessly but be promptly revised in order to improve the treatment of nurses and other healthcare workers and to secure stable management of medical institutions.