社会保障改革:预算后共同支付额上调和药品覆盖限制详情

在2026财年预算为社会保障拨款创纪录的39.06万亿日元后,日本政府敲定了两项关键改革措施,以遏制医疗费用飙升,包括提高患者共同支付额和对某些药品实施保险限制。官员们强调需要清晰解释以获得公众理解。

日本政府已敲定社会保障改革两大核心要素的具体方案,此前于12月27日批准的2026财年预算在老龄化人口导致医疗和护理费用上升的背景下,将社会保障支出定为创纪录的39.06万亿日元。

在高额医疗费用负担减轻制度下,该制度对昂贵治疗的自付费用设上限,根据年收入将共同支付比例提高4%至38%,将于2027年8月前分阶段实施。对于年收入在650万至770万日元之间的人群,每月上限将从约8万日元提高至11万日元,并新增年度上限53万日元,以避免过度负担。

此举继去年前任政府提议上限提高高达73%引发反对党及患者团体批评,认为会阻碍就医之后,总理大臣高市早苗内阁旨在更有效地与利益相关者沟通。

第二项措施是将类似于非处方药的处方药部分排除在公共保险之外。在约7000种此类药品中,约1100种继续纳入保险覆盖,患者自付25%。日本维新会曾要求全部除名,但通过妥协解决了日本医师会关于就医减少和漏服药物问题的担忧。

这些改革预计通过药品调整节省900亿日元,通过高额医疗制度节省1600亿日元,尽管相对于每年50万亿日元的医疗支出而言规模不大,但实现可持续变革仍需更广泛的审查。

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Japan approves 8.56 trillion yen stopgap budget for fiscal 2026 amid upper house delays

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The Japanese government approved an 8.56 trillion yen stopgap budget on March 27 to fund operations for the first 11 days of fiscal 2026 starting April 1, due to stalled upper house deliberations on the main 122.31 trillion yen budget passed by the lower house earlier this month. This is the first such provisional measure in 11 years, backed by ruling and main opposition parties, and expected to pass parliament on March 30.

Japan's House of Representatives passed the fiscal 2026 budget proposal on March 14, supported by the ruling Liberal Democratic Party and Japan Innovation Party's majority, sending it to the House of Councillors. The budget totals a record 122.3 trillion yen, drawing criticism from opposition parties over the short deliberation time. The ruling coalition aims for passage by the fiscal year-end despite uncertainties in the upper house.

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Following Chancellor Merz's announcement that the bill was practically ready, the German government finalized its health reform draft on April 28, targeting 16.3 billion euros in savings from 2027—down from an initial 19.6 billion—to address a 15.3 billion euro deficit at statutory health insurers. The Greens decry it as a burden on insured people and companies, while Health Minister Nina Warken calls it balanced. Cabinet approval is set for Wednesday.

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