The Myna insurance card reached clinical settings earliest among Medical DX measures—and drew the most debate. For clinic directors, the biggest question is likely "why is utilization scrutinized to this extent?" This article explains the Myna insurance card from a policy perspective and organizes how utilization was built into fee schedule facility standards, along with the design thinking behind it. For the migration timeline and practical EMR/rececon measures, see The Transition to the Myna Insurance Card and EMR Support.
Disclaimer: This article is general information. Facility standard figures, transitional measures, and regulatory treatment may change through revisions and notices. In practice, always confirm the latest primary sources (MHLW, Regional Bureaus of Health and Welfare, the Comprehensive Portal Site for Medical Institutions, and others).
For the overall map of Medical DX, see What Is Medical DX? The Government Roadmap and Its Three Pillars.
Why Online Eligibility Verification Is the "Entry Point"
When discussing the Myna insurance card, what actually underpins Medical DX is the online eligibility verification network—a common network connecting medical institutions and pharmacies nationwide for querying eligibility information.
The key point is that this network was not built solely for eligibility checks.
| Measure | Relationship to the online eligibility verification network |
|---|---|
| Electronic prescriptions | Operates on the same network foundation |
| EMR Information Sharing Service | Operates on the same network foundation |
| Viewing medication and specific health checkup information | Retrieved via the same path as eligibility checks |
In other words, online eligibility verification is the plumbing of the National Medical Information Platform itself. Unless that plumbing is laid nationwide, none of the subsequent measures can run. The strong policy push behind the Myna insurance card was not simply about digitizing an insurance card; it was a precondition for all of Medical DX.
Structurally this is authentication—confirming who someone is. Patient eligibility is verified via the Myna insurance card, and physician credentials via JPKI and the national qualifications database; the care delivered is then reviewed through claims (authorization). See What Is Social Security DX?.
Why Utilization Became a Facility Standard
Installing card readers alone does not bring the network to life. The mechanism functions only when patients actually use the card and eligibility and medication information are referenced.
But a large gap opened between installation and actual use. Even as installation progressed, patients kept presenting conventional certificates at reception and readers went unused. The response chosen to close that gap was steering through the fee schedule.
Utilization of the Myna insurance card has been built into facility standards on the fee schedule side. Under the former medical DX promotion system development fee, thresholds were raised in stages—40% from October 2025 and 50% from March 2026, with levels rising at set intervals.
Note that the fiscal 2026 revision abolished that fee and reorganized it into the electronic clinical information coordination fee (billable from June 1, 2026). The new fee also incorporates a utilization rate into its facility standards, but the threshold is set anew—confirm current requirements in the official notices. The reorganization is covered in Medical DX-Related Fees in the 2026 Revision.
This is demanding for institutions, but the policy logic is consistent: a shift in emphasis from subsidizing equipment (initial) to evaluating actual use (ongoing).
Where Diffusion Stands and What Remains
New issuance of conventional health insurance certificates has ended, and the system has formally shifted to one based on the Myna insurance card. Utilization has risen to nearly 70% nationwide (about 68% as of April 2026), climbing sharply around the December 2025 expiry of the transitional period for conventional certificates and rising one to two points per month since.
Challenges remain:
- Slow growth among older patients: anxiety about managing the card and entering PINs means reliance on eligibility certificates persists
- Regional variation: utilization differs between urban and rural areas and across specialties
- Burden on institutions: handling trouble at reception and explaining to patients weighs on frontline staff
- Uneven device and environment support: support for newer methods such as smartphone use varies by facility
Because utilization is a facility standard, a structural problem has been noted: low utilization driven by patient-side circumstances feeds directly into an institution's revenue. That the difficulty of hitting the threshold varies with the local patient population is a genuine operational headache.
What Clinics Can Do to Raise Utilization
Utilization depends on patient behavior, but there is room to move it from the institution's side.
1. Standardize the Prompt at Reception
Simply asking "Do you have your Myna insurance card?" changes utilization. A certain share of patients carry one but do not present it, so building a confirmation step into the reception flow is effective.
2. Convey Concrete Benefits
Patients are more receptive when you name the practical upside: "we can see medications from other clinics and check for interactions," or "you can complete high-cost medical expense procedures without a separate eligibility certificate."
3. Decide Procedures for Problems
Prepare procedures for when facial recognition fails or a patient forgets a PIN. Fumbling at the counter pushes patients back to the old method next time.
4. In-Clinic Signage and Guidance at Booking
Beyond waiting room signage, giving notice at the web booking or questionnaire stage makes it easier for patients to come prepared.
Where This Is Headed
The online eligibility verification network will carry more information over time—electronic prescriptions, the EMR Information Sharing Service, and municipal data via PMH. The Myna insurance card is likely to remain positioned as the entry point.
For institutions, treating utilization not merely as "work for an addition" but as the foundation for staying able to use subsequent Medical DX measures keeps investment decisions steadier.
With AI Karte
The AI-native EMR "AI Karte" links with online eligibility verification and is designed so retrieved eligibility and medication information can be referenced within the clinical flow. With its integrated rececon, eligibility checks, care, and billing are handled on one foundation. We are also happy to discuss satisfying the requirements of the electronic clinical information coordination fee at adoption.
Conclusion
The Myna insurance card was never merely the digitization of an insurance certificate; it was the measure that laid the plumbing for all of Medical DX. Building utilization into facility standards was the policy answer to the reality that installing equipment alone does not make the mechanism work. The requirement is burdensome for institutions, but parts of it move with frontline effort—revisiting the reception flow and explaining benefits to patients. Given that it underpins subsequent measures, it is realistic to treat it as an ongoing commitment.
Through providing AI Karte, Pottech aims to be the ideal business partner for clinics—improving the working environment for physicians, nurses, and medical clerical staff, and supporting clinics in fully realizing what they want to achieve.
For more details, please feel free to contact us.