Written request for securing medical care system after reclassification of Covid-19 as class 5, for continuation of public support and guarantee of right to receive medical care

September 19, 2023
Prime Minister Fumio Kishida
Health, Labor and Welfare Minister Keizo Takemi

Tsuyoshi Masuda
President, Japan Federation of Democratic Medical Institutions

Although the government reclassified Covid-19 as a Class 5 disease under the Infectious Diseases Control Law on May 8, we are now seeing its spread comparable to the sixth, seventh, and eighth waves. The reason for this is the serious disruption in healthcare services and financial measures caused by the government over the last three years, which has drastically reduced or suspended financial compensation and shifted infection control responsibilities from administrations to medical institutions without reflecting the loss of more than 74,000 precious lives.

When the Japan Federation of Democratic Medical Institutions received an explanation from the Health Ministry (on July 6, 2023) on the government’s notification regarding changes in healthcare delivery systems and public financial support in accordance with the reclassification (last revised on May 16, 2023), it became clear that prefectural governments interpreted the notification in various ways and that appropriate responses were not being taken.

The current spread, which is believed to be in the ninth wave, could create the worst possible situation for the public, medical institutions, and nursing care facilities.

A Covid-19 patient with pneumonia took too long to be admitted to a hospital and died the next day due to rapid worsening of symptoms. Patients were kept in elderly care facilities as they could not be sent to hospitals. Medical institutions have been coordinating hospitalization since May 8, but it has not been functioning very well. As clusters have emerged across the country, there has been a sharp increase in the number of cases of reduced general treatment and difficulty in emergency transport. Medical and nursing care workers continue to be exhausted and retire. Coupled with soaring prices, medical and nursing care facilities that were cut off from financial support face an unprecedentedly difficult environment. Without appropriate public support, many of them might have to suspend their operations.

Aiming at securing a medical care system capable of dealing with Covid-19, ensuring that all citizens can receive medical care without anxiety, and protecting the lives and health of medical and nursing care workers, the Japan Federation of Democratic Medical Institutions makes the following requests to the government:

– Present a detailed summary of the medical care system and financial arrangements during the Covid-19 pandemic over the past three years and review the purpose and contents of its “transition plan”.

– Analyze the causes of the spread of infection from May 8 to the present, strengthen risk communication to the public, assess and release the accurate infection situation, and have administrations coordinate hospitalization again.

– Instruct prefectural governments to give special arrangements to guarantee the right to receive medical care for low-income earners who have difficulty paying their medical expenses, such as those eligible for a short-term insurance certificate. Instruct hospitals to remind patients that if they do not wish to use an amenity bed but need it for their treatment, they are not obliged to cover the cost.

– Subsidize costs of infection tests (screening, PCR, antigen), personal protective equipment, and necessary facility renovations, considering that responses in medical and nursing care facilities to highly contagious Covid-19 infections are mostly the same even after the reclassification. Continue to cover the cost of oral antiviral drugs.

– Financial support for medical and nursing care facilities that provide treatment for Covid-19 is necessary and must be continued to protect the lives and health of the public. Maintain fees to secure hospital beds and special measures to increase reimbursement for treatment after October and compensate facilities for revenue loss during the spread of infection, including the transition period. Review support for facilities identified as priority facilities.

– Increase basic reimbursement for both inpatient and outpatient services in the reimbursement system for medical expenses scheduled to be revised and incorporate Covid-19 responses in 2024.

– Keep temporary medical facilities (such as housing care facilities for the elderly and pregnant women), which are available for use until September with prefectural governments’ approval.

– Strengthen consultation programs such as prefectural and municipal telephone services, #7119 (firefighting), #8000 (pediatric), and emergency apps. Provide the public with clear information and necessary financial support for self-testing with antigen test kits and preparation of antipyretics.

– Reestablish functions of public health centers to strengthen infectious disease control.