Japan's Health System
A health system - according to Skolnik (2021) - is a collaboration between "institutions, organizations, and resources" to improve the health of the targeted population. The goal of a health system is to ensure that everyone has access to a basic level of healthcare that is free or at a low cost (Skolnik, 2021). Japan's health system is characterized as Universal Health Coverage by providing a high quality of care at a low price (Sakamoto, Rahman, Nomura, Okamoto, Koike, Yasunaga, Kawakami, Hashimoto, Kondo, Abe, Palmer & Ghaznavi, 2018).
Universal Health Coverage (UHC)
Japan's Universal Health Coverage promotes fairness and value by using "social insurance premiums and tax subsidies, with virtually free access to health-care facilities" under the supervision of the Ministry of Health, Labour and Welfare (MHLW) (Sakamoto et al, 2018). Japan's residence and foreign nationals - with a residence card - are required by law to enroll in health insurance programs (Sakamoto et al, 2018).
Two Main Types of Health Coverage
Employee's Health Insurance System
&
National Health Insurance (NHI)
Employees Health Insurance is available to all employees through their employers. This insurance option also allows the employee's dependents to be covered under their policy, affecting approximately 58.7 of the population (Sakamoto et al, 2018).
NHI is designed for those who are self-employed or unemployed with an enrollment rate of approximately 28.3% of Japan's population. The NHI health coverage is governed by cities, towns, and villages - the different municipal governments (Sakamoto et al, 2018).​
There are additional and smaller health insurance plans available throughout Japan that that target the rapidly increasing aging population. The goal of these insurance companies is to help minimize the rising cost of healthcare in the late-stage medical care system and covers 12.4% of the population (Sakamoto et al, 2018).
Patient Co-Payments
Health insurance pays approximately 70 - 90% of cost, while the balance is paid by the insured as "co-payment" (Sakamoto et al, 2017).
Co-Pay Rates (as of March 2017):
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Pre-elementary school: 20%
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elementary school up to 69 years: 30%
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Age 70 - 75 years: 20%
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75 years and up: 10%
Access to Care
Healthcare is available and "open to all domestic participants equally" with everyone charged the same prices for medicine, devices, and services (Zhang & Oyama, 2016). Japan has four types of facilities that fall under the "free access" within the healthcare system and includes: hospitals, clinics, health centers, and pharmacies (Zhang & Oyama, 2016).
Japan's healthcare system allows a patient to access and receive treatment from any of Japan's healthcare facilities, regardless of the type of insurance or severity of illness (Sakamoto et al, 2018). For the people living below the poverty line in Japan, the social welfare system provides access to health at that same level as those covered by the Universal Health Coverage (Sakamoto et al, 2018).
​ Free access to healthcare services often coincides with long wait times for specialty services because it is harder to gain access to specialists in rural areas of Japan because of the opportunities available in the larger urban areas (Sakamoto et al, 2018). This distribution of physicians across Japan has not changed since the 1980s, and it continues to make it hard for those in rural areas to gain access to free health services and facilities (Sakamoto et al, 2018).
Barriers to Care
A barrier to gaining access to healthcare in Japan is that medical resources are concentrated in "profitable areas" and these places have the largest population size (Zhang & Oyama, 2016). The smaller, remote, and rural regions of Japan find it challenging to gain access to any type of health-related care because the government prioritizes medical services and resources to the populated areas (Zhang & Oyama, 2016).
Japan's approach to healthcare is with a "tight control of healthcare cost" and a laissez-faire mentality (OECD, 2019). This approach further provides a mismatch in the supply and demand of medical resources (Sakamoto et al, 2018). This Japan is also facing the issue of not having enough "primary care" or general practitioners because of a lack of dedicated training programs (OECD, 2019).
Other barriers the citizens of Japan are facing include a shrinking economy with a rise in unemployment rates along with the rise in the cost of medical technology that further increases health costs (Sakamoto et al, 2018).
References
OECD (2019), OECD Reviews of Public Health: Japan: A Healthier Tomorrow, OECD Publishing, Paris. https://doi.org/10.1787/9789264311602-en
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Sakamoto, H., Rahman, M., Nomura, S., Okamoto, E., Koike, S., Yasunaga, H., Kawakami, N., Hashimoto, H., Kondo, N., Abe, S. K., Palmer, M., Ghaznavi, C. (2018). Japan Health System Review (Vol. 8). New Delhi, India: WHO Regional Office for South-East Asia. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/259941/9789290226260-eng.pdf?sequence=1&isAllowed=y
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Skolnik, R. (2021). Global Health 101 (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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Zhang, X., & Oyama, T. (2016). Investigating the health care delivery system in Japan and reviewing the local public hospital reform. Risk management and healthcare policy, 9, 21–32. https://doi.org/10.2147/RMHP.S93285
