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Health care system in Japan

type of health care system in japan, health care system in japan pdf
The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70% Payment for personal medical services is offered by a universal health care insurance system that provides relative equality of access, with fees set by a government committee All residents of Japan are required by the law to have health insurance coverage People without insurance from employers can participate in a national health insurance programme, administered by local governments Patients are free to select physicians or facilities of their choice and cannot be denied coverage Hospitals, by law, must be run as non-profit and be managed by physicians For-profit corporations are not allowed to own or operate hospitals Clinics must be owned and operated by physicians

Japan's system is now being revamped by the current Prime Minister Shinzo Abe1 as popularized by Abenomics

Medical fees are strictly regulated by the government to keep them affordable Depending on the family income and the age of the insured, patients are responsible for paying 10%, 20%, or 30% of medical fees, with the government paying the remaining fee2 Also, monthly thresholds are set for each household, again depending on income and age, and medical fees exceeding the threshold are waived or reimbursed by the government

Uninsured patients are responsible for paying 100% of their medical fees, but fees are waived for low-income households receiving a government subsidy Fees are also waived for homeless people brought to the hospital by ambulance


  • 1 Cost
  • 2 Provision
    • 21 Quality
  • 3 Access
  • 4 Insurance
  • 5 History
  • 6 See also
  • 7 Bibliography


Healthcare financing of Japan 20103
14,256B JPY381%
Government 9,703B JPY 259%
Municipalities 4,552B JPY 122%
Social Insurance
18,1319B JPY 485%
Employer 7,538B JPY 201%
Employee 10,5939B JPY 283%
Out-of-pocket 4,757B JPY 127%
etc 274B JPY 07%
Total JPY 37,420B

In 2008, Japan spent about 85% of the nation's gross domestic product GDP, or US$2,873 per capita, on health, ranking 20th among Organisation for Economic Co-operation and Development OECD countries That amount was less than the average of 96% across OECD countries in 2009, and about half as much as that in the United States4 In 2013 expenditure was $479 billion, 103% of GDP - about the midpoint of OECD countries5

The government has well controlled cost over decades by using the nationally uniform fee schedule for reimbursement The government is also able to reduce fees when the economy stagnates6 In the 1980s, health care spending was rapidly increasing as was the case with many industrialized nations While some countries like the US allowed costs to rise, Japan tightly regulated the health industry to rein in costs7 Fees for all health care services are set every two years by negotiations between the health ministry and physicians The negotiations determine the fee for every medical procedure and medication, and fees are identical across the country If physicians attempt to game the system by ordering more procedures to generate income, the government may lower the fees for those procedures at the next round of fee setting8 This was the case when the fee for an MRI was lowered by 35% in 2002 by the government8 Thus, as of 2009, in the US an MRI of the neck region could cost $1,500, but in Japan it cost US$989 Japan has had "catastrophic coverage" since 1973 Once a patient's monthly copayment reaches a cap, no further copayment is required10 The threshold for the monthly copayment amount is tiered into three levels according to income and age611


Practising physicians per capita from 1960 to 2008

People in Japan have the longest life expectancy at birth of those in any country in the world Life expectancy at birth was 83 years in 2009 male 796 years, female 864 years4 This was achieved in a fairly short time through a rapid reduction in mortality rates secondary to communicable diseases from the 1950s to the early 1960s, followed by a large reduction in stroke mortality rates after the mid-60s12

In 2008 the number of acute care beds per 1000 total population was 81, which was higher than in other OECD countries such as the US 274 Comparisons based on this number may be difficult to make, however, since 34% of patients were admitted to hospitals for longer than 30 days even in beds that were classified as acute care13 Staffing per bed is very low There are four times more MRI scanners per head, and six times the number of CT scanners, compared with the average European provision The average patient visits a doctor 13 times a year - more than double the average for OECD countries14

In 2008 per 1000 population, the number of practicing physicians was 22, which was almost the same as that in US 24, and the number of practicing nurses was 95, which was a little lower than that in US 108, and almost the same as that in UK 95 or in Canada 924 Physicians and nurses are licensed for life with no requirement for license renewal, continuing medical or nursing education, and no peer or utilization review15 OECD data lists specialists and generalists together for Japan4 because these two are not officially differentiated Traditionally, physicians have been trained to become subspecialists,16 but once they have completed their training, only a few have continued to practice as subspecialists The rest have left the large hospitals to practice in small community hospitals or open their own clinics without any formal retraining as general practitioners6 The first general practitioner course was established in Saga Medical University in 1978


Japanese outcomes for high level medical treatment is generally competitive with that of the US A comparison of two reports in the New England Journal of Medicine by MacDonald et al17 and Sakuramoto et al18 suggest that outcomes for gastro-esophageal cancer is better in Japan than the US in both patients treated with surgery alone and surgery followed by chemotherapy Japan excels in the five-year survival rates of colon cancer, lung cancer, pancreatic cancer and liver cancer based on the comparison of a report by the American Association of Oncology and another report by the Japan Foundation for the Promotion of Cancer research19 The same comparison shows that the US excels in the five-year survival of rectal cancer, breast cancer, prostate cancer and malignant lymphoma Surgical outcomes tend to be better in Japan for most cancers while overall survival tend to be longer in the US due to the more aggressive use of chemotherapy in late stage cancers A comparison of the data from United States Renal Data System USRDS 2009 and Japan Renology Society 2009 shows that the annual mortality of patients undergoing dialysis in Japan is 13% compared to 224% in the US Five-year survival of patients under dialysis is 599% in Japan and 38% in the US

In an article titled "Does Japanese Coronary Artery Bypass Grafting Qualify as a Global Leader"20 Masami Ochi of Nippon Medical School points out that Japanese coronary bypass surgeries surpass those of other countries in multiple criteria According to the International Association of Heart and Lung Transplantation, the five-year survival of heart transplant recipients around the world who had their heart transplants between 1992 and 2009 was 719% ISHLT 20116 while the five-year survival of Japanese heart transplant recipients is 962% according to a report by Osaka University21 However, only 120 heart transplants have been performed domestically by 2011 due to a lack of donors

The 47 local government prefectures have some responsibility for overseeing the quality of health care, but there is no systematic collection of treatment or outcome data They oversee annual hospital inspections The Japan Council for Quality Health Care accredits about 25% of hospitals22


Japanese Super Ambulance, Tokyo Fire Department

In Japan, services are provided either through regional/national public hospitals or through private hospitals/clinics, and patients have universal access to any facility, though hospitals tend to charge more to those patients without a referral As above, costs in Japan tends to be quite low compared to those in other developed countries, but utilization rates are much higher Most one doctor clinics do not require reservations and same day appointments are the rule rather than the exception Japanese patients favor medical technology such as CT scans and MRIs, and they receive MRIs at a per capita rate 8 times higher than the British and twice as high as Americans8 In most cases, CT scans, MRIs and many other tests do not require waiting periods Japan has about three times as many hospitals per capita as the US23 and, on average, Japanese people visit the hospital more than four times as often as the average American23 Due to large numbers of people visiting hospitals for relatively minor problems, shortage of medical resources can be an issue in some regions The problem has become a wide concern in Japan, particularly in Tokyo A report has shown that more than 14,000 emergency patients were rejected at least three times by hospitals in Japan before getting treatment A government survey for 2007, which got a lot of attention when it was released in 2009, cited several such incidents in the Tokyo area, including the case of an elderly man who was turned away by 14 hospitals before dying 90 minutes after being finally admitted,24 and that of a pregnant woman complaining of a severe headache being refused admission to seven Tokyo hospitals and later dying of an undiagnosed brain hemorrhage after giving birth25 The so-called "tarai mawashi" ambulances being rejected by multiple hospitals before an emergency patient is admitted has been attributed to several factors such as medical imbursements set so low that hospitals need to maintain very high occupancy rates in order to stay solvent, hospital stays being cheaper for the patient than low cost hotels, the shortage of specialist doctors and low risk patients with minimal need for treatment flooding the system

Interior of standard ambulance


Health insurance is, in principle, mandatory for residents of Japan, but there is no penalty for the 10% of individuals who choose not to comply, making it optional in practice2627 There are a total of eight health insurance systems in Japan,28 with around 3,500 health insurers According to Mark Britnell, it is widely recognised that there are too many small insurers29 They can be divided into two categories, Employees' Health Insurance 健康保険, Kenkō-Hoken and National Health Insurance 国民健康保険, Kokumin-Kenkō-Hoken Employees’ Health Insurance is broken down into the following systems:28

  • Union Managed Health Insurance
  • Government Managed Health Insurance
  • Seaman’s Insurance
  • National Public Workers Mutual Aid Association Insurance
  • Local Public Workers Mutual Aid Association Insurance
  • Private School Teachers’ and Employees’ Mutual Aid Association Insurance

National Health Insurance is generally reserved for self-employed people and students, and social insurance is normally for corporate employees National Health Insurance has two categories:28

  • National Health Insurance for each city, town or village
  • National Health Insurance Union

Public health insurance covers most citizens/residents and the system pays 70% or more of medical and prescription drug costs with the remainder being covered by the patient upper limits apply30 The monthly insurance premium is paid per household and scaled to annual income Supplementary private health insurance is available only to cover the co-payments or non-covered costs and has a fixed payment per days in hospital or per surgery performed, rather than per actual expenditure3132

There is a separate system of insurance Kaigo Hoken for long term care, run by the municipal governments People over 40 have contributions of around 2% of their income29


National Cancer Center Hospital in the Tsukiji district of Tokyo

The beginning of the Japanese Health care system happened in 1927 when the first Employee Health Insurance plan was created33

In 1961, Japan achieved universal health insurance coverage, and almost everyone became insured However, the copayment rates differed greatly While those who enrolled in Employees' Health Insurance needed to pay only a nominal amount at the first physician visit, their dependents and those who enrolled in National Health Insurance had to pay 50% of the fee schedule price for all services and medications From 1961 to 1982, the copayment rate was gradually lowered to 30%34

Since 1983, all elderly persons have been covered by government-sponsored insurance35

In the late 1980s, government and professional circles were considering changing the system so that primary, secondary, and tertiary levels of care would be clearly distinguished within each geographical region Further, facilities would be designated by level of care and referrals would be required to obtain more complex care Policy makers and administrators also recognised the need to unify the various insurance systems and to control costs

By the early 1990s, there were more than 1,000 mental hospitals, 8,700 general hospitals, and 1,000 comprehensive hospitals with a total capacity of 15 million beds Hospitals provided both out-patient and in-patient care In addition, 79,000 clinics offered primarily out-patient services, and there were 48,000 dental clinics Most physicians and hospitals sold medication directly to patients, but there were 36,000 pharmacies where patients could purchase synthetic or herbal medication

National health expenditures rose from about 1 trillion yen in 1965 to nearly 20 trillion yen in 1989, or from slightly more than 5% to more than 6% of Japan's national income The system has been troubled with excessive paperwork, assembly-line care for out-patients few facilities made appointments, over medication, and abuse of the system because of apparent low out-of-pocket expenses to patientscitation needed

Another problem has been an uneven distribution of health personnel, with rural areas favored over cities36

In the early 1990s, there were nearly 191,400 physicians, 66,800 dentists, and 333,000 nurses, plus more than 200,000 people licensed to practice massage, acupuncture, moxibustion, and other East Asian therapeutic methods

See alsoedit

  • Aging of Japan
  • Erwin Bälz—a foreign government advisor and cofounder of modern medicine in Japan
  • Birth in Japan
  • Health care compared—tabular comparisons with the US, Canada, and other countries not shown above
  • Public health centres in Japan
  • Social welfare in Japan
  • Timeline of healthcare in Japan


  1. ^ del Rosario, King 15 August 2013 "Abenomics and the Generic Threat" Retrieved 15 August 2013 
  2. ^ 1
  3. ^ National health expenditures summary Report Ministry of Health, Labour, and Welfare 2010-09-27 
  4. ^ a b c d e OECD "OECD Health Data" OECD Retrieved 2 February 2012 
  5. ^ Britnell, Mark 2015 In Search of the Perfect Health System London: Palgrave p 15 ISBN 978-1-137-49661-4 
  6. ^ a b c Hashimoto, Hideki 24 September 2011 "Cost containment and quality of care in Japan: is there a trade-off" The Lancet 378 9797: 1175 PMID 21885098 doi:101016/S0140-67361160987-2 
  7. ^ Arnquist, Sarah August 25, 2009 "Health Care Abroad: Japan" The New York Times Retrieved January 28, 2010 
  8. ^ a b c "Sick around the world" Frontline April 15, 2008 17 minutes in PBS 
  9. ^ Reid, TR August 23, 2009 "5 Myths About Health Care Around the World" The Washington Post Retrieved January 28, 2010 
  10. ^ Ito, Masanori December 2004 "Health insurance systems in Japan: a neurosurgeon's view" Neurologia medico-chirurgica 44 12: 624 PMID 15684593 doi:102176/nmc44617 
  11. ^ "Catastrophic coverage" Ministry of Health, Labour and Welfare Retrieved 3 February 2012 
  12. ^ Ikeda, Nayu 17 September 2011 "What has made the population of Japan healthy" The Lancet 378 9796: 1094–105 PMID 21885105 doi:101016/S0140-67361161055-6 
  13. ^ "Patient survey 2008" Ministry of Health, Labour and Welfare Retrieved 3 February 2012 
  14. ^ Britnell, Mark 2015 In Search of the Perfect Health System London: Palgrave p 17 ISBN 978-1-137-49661-4 
  15. ^ Hirose, Masahiro October 2003 "How can we improve the quality of health care in Japan Learning from JCQHC hospital accreditation" Health Policy 66 1: 32 PMID 14499164 
  16. ^ Matsumoto, Masatoshi August 2005 "Factors associated with rural doctors' intention to continue a rural career: a survey of 3072 doctors in Japan" The Australian journal of rural health 13 4: 219–220 PMID 16048463 doi:101111/j1440-1584200500705x 
  17. ^ MacDonald 6 September 2001 "Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction" NEJM 345: 725–30 PMID 11547741 doi:101056/nejmoa010187 
  18. ^ Sakuramoto 1 November 2007 "Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine" NEJM 357: 1810–20 PMID 17978289 doi:101056/nejmoa072252 
  19. ^ http://wwwradiologyjp/content/files/680pdf
  20. ^ Ochi, Masami 2012 "日本の冠動脈外科は世界標準を超えているか?" 日外会誌 Journal of Japan Surgical Society 113 3: 273–277 
  21. ^ http://wwwasasorjp/jst/pdf/factbook/factbook2011pdf
  22. ^ Britnell, Mark 2015 In Search of the Perfect Health System London: Palgrave p 18 ISBN 978-1-137-49661-4 
  23. ^ a b Harden, Blaine September 7, 2009 "Health Care in Japan: Low-Cost, for Now Aging Population Could Strain System" The Washington Post Retrieved January 28, 2010 
  24. ^ Yamaguchi, Mari February 4, 2009 "Injured man dies after rejection by 14 hospitals" Associated Press NBC News 
  25. ^ Kyodo News Nov 6, 2008 "Another case emerges of pregnant woman rejected by Tokyo hospitals" The Japan Times Retrieved January 28, 2010 
  26. ^ http://wwweurowhoint/__data/assets/pdf_file/0011/85466/E92927pdf
  27. ^ Reid, TR April 14, 2008 "Japanese Pay Less for More Health Care" NPR Retrieved January 28, 2010 
  28. ^ a b c "Health Insurance" City of Kagoshima 2010 Retrieved January 28, 2010 
  29. ^ a b Britnell, Mark 2015 In Search of the Perfect Health System London: Palgrave p 16 ISBN 978-1-137-49661-4 
  30. ^ Yosomono November 28, 2009 "How to navigate the Japanese Health System" gaijinass Retrieved January 28, 2010 
  31. ^ Rapoport-Jacobs-Jonsson 1973, p 157
  32. ^ Fukue, Natsuko, "National health insurance a basic universal safety net", Japan Times, May 25, 2010, p3
  33. ^ Kōdansha 1993, p 338
  34. ^ Ikegami, Naoki 17 September 2011 "Japanese universal health coverage: evolution, achievements, and challenges" The Lancet 378 9796: 1108 PMID 21885107 doi:101016/S0140-67361160828-3 
  35. ^ 講談社インターナショナル 2003, p 183
  36. ^ Masatoshi Matsumoto, Masanobu Okayama, Kazuo Inoue, Eiji Kajii High-tech rural clinics and hospitals in Japan: a comparison to the Japanese average 2004
  • 講談社インターナショナル 2003 Bairingaru Nihon jiten in Japanese 2003 ed 講談社インターナショナル ISBN 4-7700-2720-6  - Total pages: 798
  • "employees' health insurance" Japan: An Illustrated Encyclopedia Tokyo: Kodansha Ltd 1993 OCLC 27812414 ISBN 4069310983 set, ISBN 4-06-206489-8 volume 1  - Total pages: 1924
  • Rapoport, John; Jacobs, Philip ;Jonsson, Egon Cost Containment and Efficiency in National Health Systems: A Global Comparison Health Care and Disease Management 2009 ed Wiley-VCH ISBN 3-527-32110-1 CS1 maint: Multiple names: authors list link - Total pages: 247

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