Running head: JAPAN HEALTHCARE SYSTEM 1

HealthCare System of Japan

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HealthCare System of Japan

Introduction

Two opposing elements can describe the Japanese health care system. On one end, Japan

boasts remarkable achievements of its health care system over five decades while at the same

time struggling to sustain the system because of an aging population and large government

deficits (UCHIDA, 2012).

The success of the health care system is evident from the health indexes of both infant

mortality (less than 3 per 1,000 births) and life expectancy at birth (78.4 years for males and 85.3

for females), making it among the best in the world (UCHIDA, 2012).

History

The health care sector has been a key component of the contemporary economy of Japan

as it absorbs a significant proportion of the GDP.

According to (Sato et al., 2012), as the income of the citizens rises, they choose to

allocate more to health care services because of the direct contribution of health care services to

prolonged life expectancy and reduced morbidity, among other benefits.

The first form of public healthcare in Japan began in 1927 with an employee health plan.

By 1961, it had evolved into a system of universal coverage available to locals, foreigners, and

expatriates.

Structure

The public health insurance system (PHIS) comprises more than 3,400 insurers and is

mandated to provide primary health coverage (Mossialos et al., 2016). Citizens are required to

enroll in one of the PHIS plans based on employment status and/or place of residence.
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Insurance premiums and the basis upon which they are charged vary between types of

insurance funds and municipalities. Government employees are covered by their own insurers, as

are some groups of professionals (Mossialos et al., 2016). Citizens and noncitizens enrolled in

PHIS and over 40 years of age are mandatorily enrolled in long-term care insurance.

Financing

All PHIS plans provide the same benefits package, which is determined by the national

government, usually decided by the Central Social Insurance Medical Council, a government

body (Mossialos et al., 2016). The package covers hospital, primary and specialist ambulatory,

and mental health care, approved prescription drugs, home care services by medical institutions,

hospice care, physiotherapy, and most dental care.

All enrollees have to pay a 30 percent coinsurance rate for services and goods received,

except for children under the age of 3, adults between 70 and 74 with lower incomes, and those

75 and above with lower incomes (Mossialos et al., 2016).

Some employer-based health insurance plans offer reduced cost-sharing. Providers are

prohibited from charging extra fees except for some services stipulated by the Ministry of Health

(Mossialos et al., 2016).

Interventional

The catastrophic coverage allocates a monthly out-of-pocket threshold, which varies

according to member age and income. There is a ceiling for low-income people who do not pay

more than JPY35,400 a month (Mossialos et al., 2016).

Subsidies reduce the burden of cost-sharing for people with disabilities, mental illness,

and specified chronic conditions. Enrollees in Citizen Health Insurance with low income are
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eligible for reduced premium payments (Mossialos et al., 2016). In addition, interventions are

accorded to patients with one or more of the 306 designated long-term diseases.

Preventive

The Japanese health care system focuses on offering preventative care as opposed to

reactive care. It provides free screening tests for certain illnesses and better prenatal programs

(Sakamoto et al., 2018).

Resources

Regulation of the health care system has two dimensions: human and capital resources

are regulated by the Medical Care Act, and financing is regulated by the Health Insurance Act of

1922 (Sakamoto et al., 2018).

Financing is regulated solely by the Central Government, while human and capital

resources are regulated through inspection by the government at the prefecture and major city

levels through public health centers (Sakamoto et al., 2018).

Major Health Issues

Japan is the world’s most aged nation. Aging does not only increase the demand for

medical care and Long-term Care (LTC) but also causes a variety of novel and interrelated social

phenomena. (Hirata et al., 2021).

Japan’s three major diseases are cancer, heart disease, and cerebrovascular diseases

(CVD), for which a high number of deaths have occurred and have been the nation’s leading

causes of death since the 1950s. Each disease is strongly associated with aging (Hirata et al.,

2021).
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Health Disparities

Reducing health disparities has been the goal of the health care system since 2012. The

two explicit targets are a reduction of disparities in healthy life expectancies between prefectures

and an increase in the number of local government entities that make efforts to solve healthy

disparity issues (Mossialos et al., 2016).

There is another plan to reduce disparities among prefectures in cancer treatment

delivery, with each prefecture setting treatment targets.

Health care variations between socioeconomic groups and variations in health care access

are occasionally measured and reported by researchers, some of them funded by the Ministry of

Health, Labor and Welfare (Mossialos et al., 2016).

Conclusion

Despite the Japanese health care system being better than those in other developed

countries, there are challenges that threaten its previous successes: sustainability of health care

financing, increasing inequity within the population, and multiple challenges mainly due to the

aging society (Sakamoto et al., 2018).

Therefore, Japan needs a paradigm shift to the new system as proposed in Japan Vision:

Health Care 2035, a report for the health minister by young Japanese health leaders (Sakamoto et

al., 2018).
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References

UCHIDA, Y. S. (2012). The health care system in Japan. In Health Care Systems in

Europe and Asia (pp. 95-116). Routledge.

Sato, R., Grivoyannis, E., Byrne, B., & Lian, C. (2012). Health Care Systems in Japan

and the United States: A Simulation Study and Policy Analysis (Vol. 2). Springer Science &

Business Media.

Mossialos, E., Wenzl, M., Osborn, R., & Sarnak, D. (2016). 2015 international profiles

of health care systems. Ottawa, ON, Canada: Canadian Agency for Drugs and Technologies in

Health.

Sakamoto, H., Rahman, M., Nomura, S., Okamoto, E., Koike, S., Yasunaga, H., ... &

Ghaznavi, C. (2018). Japan health system review.

Hirata, K., Matsumoto, K., Onishi, R., & Hasegawa, T. (2021). Changing social burden

of Japan’s three major diseases including Long-term Care due to aging. Public Administration

and Policy.