## Medical System for Services and Supports for Persons with Disabilities

## Overview

## Medical System for Services and Supports for Persons with Disabilities

## ○ Objective

Medical system bearing public expenses that aims to reduce the amount of co-payment of medical costs concerning medical services for persons with disabilities to ease and reduce their physical disabilities and mental disorders

* Insurance precedes medical payment for services and supports for persons with disabilities; practically this system shall cover the difference between self-pay burden prescribed by this system and thirty-percent-self-pay- burden after insurance payment. (Burden ratio: national 50%, prefectures 50%)

## ☐ Covered

• Outpatient mental medical service:

Persons with mental disease such as mental disorders prescribed in Article 5 of Act for the Mental Health and Welfare of the Persons with Mental Disorders who needs outpatient mental treatment continuously

• Medical rehabilitation service:

Persons to whom a physically disabled certificate is issued pursuant to the Act on Welfare of Physically Disabled Persons and to whom result is assured by medical service such as an operation, etc. to ease and reduce those disorders (aged 18 and older)

• Medical aid for children with potential disabilities:

Children with physical disabilities (including those deemed to become disabled in the future if not treated with disability-related medical care) to whom a result is assured from a medical service such as an operation, etc. in thereby easing and reducing any such disability (aged younger than 18)

Intended main disorders and remedial example

• Outpatient mental medical service (mental disease):

Psychotropic, psychiatry day care, etc.

• Medical rehabilitation service, medical aid for children with potential disabilities:

Physical disability ..... arthrogryposis → artificial joint replacement

Visual disability ▼ ▼ ▼ ▼ ▼ ▼ ▼ cataract → cataract extraction

Internal impediment ••• impaired cardiac function → valve replacement, pacemaker implantation kidney dysfunction → liver transplantation, dialysis treatment

## Basic Framework of Co-Payment of Medical Systems for Services and Supports for Persons with Disabilities

[1] In order to avoid the co-payments from becoming extremely large the monthly co-payment amount shall be established according to their incomes. (10% for below this amount)

[2] Further reduction measures are being taken for those requiring continued long-term high-cost treatment (serious and also continuative) and people with medium incomes covered by medical aid for children with potential disabilities.

The range of “serious and also continuative”

○ Persons covered on the ground of diseases and symptoms

[Medical rehabilitation service/medical aid for children with potential disabilities]

People with kidney, small intestine, immune system, cardiac (limited to anti-immune therapy after cardiac transplantation), or liver (limited to anti-immune therapy after liver transplantations) dysfunctions

[1] People with cerebral dysfunctions such as schizophrenia disorder, bipolar disorder/depression, epilepsy, dementia, etc., and drug-related disorders (addiction, etc.)

[2] People who have been judged by a doctor with above a certain level of experience with metal treatment

○ People covered on grounds of continuous burden of expensive cost, regardless of the disease

[Medical rehabilitation service/medical aid for children with potential disabilities/outpatient mental medical services]

Special transitional measures concerning the maximum monthly co-payment amount

The maximum monthly co-payment amount for “medium income 1” and “medium income 2” of “medical aid for children with potential disabilities” and “above a certain income level” of “serious and also continuative” are special transitional measures that will continue until March 31, 2015 (Articles 12 and 13 of the Supplementary Provisions of the Order for Enforcement of General Support for Persons with Disabilities Act)