Japan, like South Korea, is a country with universal health insurance. Various systems reduce the cost burden for dialysis patients in Japan, and they can receive dialysis treatment almost free of charge. Medical fees in Japan are reviewed once every two years. It was also reviewed in April 2022. Basically, Charge for Hemodialysis treatment is the sum of medical examination fees (re-examination fees), Hemodialysis fee, Dialyzer, Injection drugs (e.g., Iron, Vit D, Calcimimetic.), examination fees. The re-examination fee is 760 yen, common to all departments. Hemodialysis fee is the main dialysis fee, which includes anticoagulants, saline and dialysate. ESA has been bundled with hemodialysis fee since 2006, and HIF stabilizer was also bundled in this 2022 fee revision. Hemodialysis fees are set for nine prices due to