The Tokyo Medical Practitioners Association has filed a lawsuit challenging a Ministry of Health order that will require people to use a national identification card instead of health insurance cards to access medical care.  The national identification card can be used in the form of a physical ID card or digital ID.

Soon after taking office in September 2020, Prime Minister Yoshihide Suga made digitalisation in government a top priority. As the social security and tax number system – dubbed My Number – are crucial for Japan’s move to digitalisation, the government also pledged to better utilise My Number and expand the use of My Number cards (individual identification cards).

One such expansion in use was in January 2023, when it was proposed My Number cards were required to access free day care and school lunches. The government of the Japanese city Bizen was set to require families to obtain My Number cards for all household members as a precondition for benefiting from fee exemption programs for childcare facilities and free lunches at elementary and junior high schools. 

The My Number system allocates a 12-digit number to every resident of Japan to be used for matters related to social security, taxation and disaster response to improve administrative efficiency and accuracy via information sharing. Since the number remains the same even after marriage, moving or changing jobs, it serves to identify an individual throughout that person’s life.

The My Number card bears the person’s number and photo. It likewise carries an IC chip that contains an electronic certificate and basic information, such as the individual’s name, address, date of birth and gender. It can be used as an ordinary identification card to be presented in person, as well as digital certificates when accessing various public and private sector services online.

In September 2022, the government amended a health ministry ordinance to stipulate that medical institutions must establish a system to check My Number cards for health insurance statuses from April 2023.

A month later, the Japanese government announced that health insurance cards would be abolished in the autumn of 2024 and incorporated into the government’s My Number identity card system. This basically made it mandatory to obtain a My Number card because it would be needed to obtain medical treatment covered by insurance.

Previously the government had offered points to encourage people to use My Number cards, but seven years after introducing the system only 50% of the population had signed up. The hassle involved in obtaining a card was not the only reason for the lower than-hoped-for uptake – there is deep-rooted distrust and uneasiness regarding the government’s management of personal information and its application of data.

The government’s digitalisation drive has been marked by a top-down approach with its method of setting a deadline and trying to force the process forward. So, the policy that health insurance cards would be abolished in favour of My Number cards appeared to be driven by the government’s desire to increase the use of these identity cards.

Last week, the Tokyo Medical Practitioners Association and others, 274 plaintiffs in all, filed a lawsuit with Tokyo district court claiming that to require medical institutions to accept My Number cards, the government needed to amend the Health Insurance Act and not a health ministry ordinance.  By amending a health ministry ordinance, the government was violating Article 41 of the Constitution.

The plaintiffs also argued that the My number identity system is expensive to deploy. It costs about 700,000 yen (roughly $5,190) to install the system, and medical practitioners including elderly doctors are apparently considering closing as a result.  The plaintiffs also demand the government pay 100,000 yen (approx. $740) per plaintiff in compensation, claiming that their freedom to engage in medical activities had been infringed upon.

After filing the suit, Tokyo Medical Practitioners Association head Akio Suda called for other Japanese medical practitioners’ associations to join the legal action. He said: “If elderly doctors who know their community well close their doors, local medical care will deteriorate. What the government is doing is destroying medical care.”

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