Current Medical Technology Reimbursement System in Japan

• Published in: Value in health regional issues Vol. 34; pp. 118 - 124
• Main Authors: Matsumoto, Tomoko, Strachan, Liesl, Oyama, Shoko, Ishiguro, Yoko, Lee, Sang-Soo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023
• Subjects: Costs and Cost Analysis; Health Policy; Humans; Japan; medical device; medical technologies; pricing; reimbursement; Technology; Japan; medical technologies; reimbursement; medical device; Japan; pricing
• ISSN: 2212-1099; 2212-1102
• DOI: 10.1016/j.vhri.2022.12.002

The process for reimbursement of medical technologies in Japan is complex, and to date, it has not been well described overall. This article aims to provide an overview of the reimbursement system for medical technologies in Japan, including the reimbursement application process and the payment decision making. Conduct review for relevant health policy and regulation and gather opinion from the key stakeholders. The Japanese functional category listing system for the reimbursement of medical technologies is a unique fee-for-service payment system, and the timing for the listing is dependent on the application category. A key positive aspect of the current system is the level of transparency and the predictable pathway for reimbursement of new medical technologies. Conversely, the current reimbursement process may not capture the true extent of the innovation of new technologies, especially when creating a new functional category and/or a new medical procedure coding. There are potential areas where changes could improve access, efficiencies, and value, such as the price revision system based on the market survey, the foreign average price assessment, and the health technology assessment system. These additions and modifications in policy and regulation of reimbursement will help facilitate the effective and efficient access to new innovative medical technologies within the context of a sustainable and affordable National Health Insurance system in Japan. •Under Japan’s National Health Insurance system, medical fees for medical technologies, such as medical devices, diagnostics, and surgical procedures, are determined on a fee-for-service basis and organized into a functional category listing system. This structured functional category system and its associated processes provide a relatively efficient, transparent, and predictable pathway for reimbursement of new medical technologies.•There are 2 price calculation methods for the creation of a new functional category, and a price premium can be requested regardless of the calculation method, only during the creation of a new functional category. To obtain a price premium, the manufacturers have to demonstrate reasonable evidence that meets the evaluation criteria.