2023 Volume 72 Issue 2 Pages 134-142
Introduction: Poverty is a well-established determinant of health. Equity in health care access for the impoverished is an important public health issue. People in poverty refrain from necessary health care visits due to financial reasons despite their need for medical care. In Japan, several welfare systems support health care access for people in poverty. The Free/Low-Cost Medical Care program (FLCMC) is one of the major systems which had a total of 2.70 million users in fiscal year 2020, which can exempt patients in poverty from out-of-pocket medical expenses. Although FLCMC may remove the financial barrier to health care access for patients in poverty, the backgrounds of users and the potential issues of the FLCMC have not been well-described.
Method: An online FLCMC Research Forum was held to share the descriptive data of patients on the FLCMC using data from the FLCMC Registry Study that have been collected from medical facilities providing FLCMC across Japan. Furthermore, medical social workers reported cases of FLCMC and its potential challenges. The opportunities and challenges of FLCMC were discussed quantitatively and qualitatively.
Results: A total of 249 people attended the FLCMC Research Forum. Data including 138 patients on the FLCMC Registry Study indicated that approximately 40% of the FLCMC users had refrained from health care visits due to financial reasons in the past year. This proportion was not alleviated by the users’ knowledge of FLCMC. Approximately half the users had never consulted anyone about their difficulties, suggesting that there were cases whose social needs were identified and whose social support began in health care facilities. Medical social workers presented several strategies to provide FLCMC services more effectively. They also shared several difficulties and limitations of FLCMC, including the fact that FLCMC cannot cover livelihood expenses, home nursing care, and long-term care services. Furthermore, they shared difficulties in applying FLCMC, especially for uninsured people from foreign countries, from the perspective of medical facilities’ financial management.
Discussion: Three points regarding the opportunities and challenges of FLCMC were identified. First, the FLCMC Registry Study should continue to describe more detailed backgrounds of FLCMC users to support accesses to FLCMC among the impoverished. Second, the financial balance of medical facilities related to FLCMC was required. Third, the role of the FLCMC in the contemporary social security system should be further discussed.
