Unpopular medical-care law in Japan could help Nakasone in reelection bid

In a bitterly disputed, highly significant move away from welfare-state philosophy, millions of Japanese face higher medical bills under a revised health-insurance program approved by the Diet (parliament).

The plan is possibly the most unpopular action taken by the 22-month-old government of Prime Minister Yasuhiro Nakasone. But it has strengthened Mr. Nakasone's chances of being reelected as head of his ruling Liberal Democratic Party in November by showing he can hang tough in pushing through vital legislation.

The new law will increase the burden for regular consultations with the family doctor and hospitalization for an estimated 30 million contributors to private health-insurance programs, mainly company employees.

The Health and Welfare Ministry estimates it will increase the medical bill of a typical family of four by one-fourth. Opposition groups insist the cost will be much higher, hurting many ordinary workers already struggling with thinner wage packets and higher tax rates amid low economic growth.

Analysts say Nakasone has demonstrated to his Liberal Democratic colleagues that he can bite the bullet and make unpopular decisions in the interest of the long-term benefit of Japan's national finances. At present the country is reeling under chronic budgetary deficits that require the mortgaging of Japan's future through national bond issues.

The government is committed to holding down spending in every sector. This year's budget showed virtually no increase over 1983, and the same will apply next year.

But medical expenses have been growing here at alarming rates in the past few years. The government says this imposed an intolerable burden on the health-insurance system, which faced imminent bankruptcy. And looming on the horizon was the so-called ''graying of Japan,'' a rapidly aging population expected to require even more medical care than now.

In February 1983, the government amended the Health Insurance Act to place a larger burden of medical expenses on senior citizens, who had been receiving free care. Making up 9.6 percent of the population, they accounted for one-third of all medical expenses.

Medical spending in fiscal 1982, for example, totaled almost $58 billion, up 7.7 percent from the previous year (while the economy grew only 4.3 percent). It was estimated that each Japanese on average required almost $500 worth of treatment during the year.

The cost to the individual, however, was low. After an initial fee of just over $3, all subsequent visits to the family doctor were free. Only about $2 a day was required toward the cost of hospitalization for up to one month.

Hospitalization will also be more expensive. Under the old system, hospitalization beyond two months was free. Now, the bills will keep coming for the duration of the treatment.

The Japan Medical Association, representing most doctors and medical institutions, bitterly fought the legislation, contending it would pose an intolerable burden on millions of poor families and on elderly people living on limited incomes. But some cynics said the association was more concerned about losing patients.

Critics say a surfeit of doctors and hospitals competing for patients has led doctors to encourage patients to visit them more than is necessary - especially when doctors also dispense the medicines at profit.

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