Senior citizens aged between 65 and 74 will have to cover 20 to 30 percent of their medical expenses depending on their income starting fiscal 2008, according to a draft plan for medical insurance reform released Wednesday by the Health, Labor and Welfare ministry. 

The Ministry announced three reform proposals aiming at cutting 7 trillion yen in medical benefits in fiscal 2025 by increasing patient contributions, especially as the population of senior citizens swells as baby boomers start retiring in the coming years. 

Medical expenditure is expected to reach 56 trillion yen in fiscal 2025 if the current system continues. The ministry says it can cut that cost to 49 trillion yen with any of the three proposals. 

The government and Liberal Democratic Party-New Komeito ruling coalition are expected to wrap up their debates by the end of the year based on Wednesday's draft plan and submit medical insurance reform bills to the regular Diet session early next year. 

Currently, people aged between 65 and 69 pay 30 percent of their medical costs and those who are 70 or older pay 10 percent. Those who are 70 or older with annual income of at least 6.2 million yen--about 6 percent of that age group--pay 20 percent. 

In one version of the ministry's proposal, people aged between 65 and 74 with an annual income of 5.2 million yen or more would pay 30 percent, while those earning less than that would pay 20 percent as of April 2008. 

By lowering the threshold from 6.2 million yen to 5.2 million yen, an additional 800,000 people would be defined as earning "the same level as working-age generations" and would be required to pay a greater proportion of their medical expenses, according to the draft. 

The second proposal says everyone aged 65 or older would have to pay 20 percent, but those on incomes below a threshold would only have to pay 10 percent. 

In the third proposal, people aged between 65 and 69 would pay 30 percent, but that share would be reduced to 20 percent at age 70 and 10 percent for low-income earners. 

In the second and third proposals, those who earn 5.2 million yen or more would pay 30 percent of their medical costs, regardless of their age. 
Meal and accommodation expenses for senior citizens who are hospitalized for a long time would no longer be covered by insurance after October 2006, the ministry draft said. 

Under the ministry proposal, a 70-year-old being treated as an inpatient at a hospital would pay an additional 32,000 yen a month on top of the 64,000 yen he or she currently is required to pay. 

Other than charging patients more, the ministry draft suggests the government enhance measures to prevent diabetes and other lifestyle-related diseases among middle-aged and older people by setting a goal of reducing the number of such patients by 25 percent by 2015. 

The ministry also proposed creating a new medical insurance scheme exclusively for people aged 75 or older. 

The health reform debate is expected to be stormy over the coming months among the government and ruling parties as the powerful and influential doctors lobby, the Japan Medical Association, is fiercely opposed to the ministry draft.