Japan's Healthcare: Insurance And Access

Japan's healthcare system is one of the best in the world, with a strong emphasis on preventative care and strong medicines. The country's constitution expressly declares that citizens have a right to health, and the government is responsible for ensuring this right is realised.

Japan's healthcare system is a hybrid system, combining government-funded programmes and private insurance. The government pays 70% of the cost of all health procedures, with the remaining 30% covered by private health insurance. This can be employer-sponsored or bought privately.

There are two public schemes: one for salaried workers and one covering the remaining population. It is mandatory for expats with any visa exceeding three months to be registered on one of these public insurance schemes. There is also a private system of health insurance.

All residents of Japan are required by law to have health insurance coverage. People without insurance from employers can participate in a national health insurance programme, administered by local governments.

Japan's healthcare system is one of the most cost-efficient in the world

One key factor contributing to the cost-efficiency of Japan's healthcare system is the strict regulation of medical fees by the government. The government sets the fees for medical services, ensuring they remain affordable for citizens. Fees for all healthcare services are negotiated between the health ministry and physicians every two years, and these fees are identical across the country. This regulation helps control costs and prevents excessive charges.

Another factor is the emphasis on preventive care and health promotion. Japan has a separate system for pricing and regulating pharmaceuticals, with the government playing a significant role in negotiating drug prices to ensure their affordability. The maximum profit allowed for drug companies is set at 17% under the NHI. Additionally, Japan places a strong emphasis on health promotion and disease prevention through regular health check-ups and public health campaigns.

The structure of the healthcare system also contributes to its cost-efficiency. Japan has a mix of public and private healthcare providers, with private sector-dominated delivery systems. This competition among healthcare providers promotes efficiency and ensures accessibility for patients. Patients have freedom of choice and can visit any registered healthcare facility or doctor without needing a referral, promoting competition and accessibility.

Furthermore, Japan has a system of cross-subsidization among its health insurance schemes to financially stabilize the plans due to variations in enrollee income levels. There are over 3000 health insurance funds divided into three insurance schemes: employer-based health insurance, residence-based NHI, and health insurance for those over 75. Each scheme contributes to a common fund used to support the others.

Overall, Japan's ability to maintain relatively low healthcare costs while providing universal coverage and promoting accessibility makes its healthcare system one of the most cost-efficient in the world.

Japan has a hybrid healthcare system, combining government-funded programmes and private insurance

Japan's healthcare system is one of the best in the world, with a strong emphasis on preventative care. The country's healthcare system is also one of the most cost-efficient globally, spending only 9.5% of its GDP on healthcare despite its ageing population.

The SHIS consists of two types of mandatory insurance: employment-based plans, covering about 59% of the population, and residence-based insurance plans, which include Citizen Health Insurance plans for non-employed individuals aged 74 and under (27% of the population), and Health Insurance for the Elderly, which covers all adults aged 75 and older (12.7% of the population).

Each of Japan's 47 prefectures has its own residence-based insurance plan, and there are more than 1,400 employment-based plans. Enrollment in either an employment-based or residence-based health insurance plan is required by law.

The SHIS provides universal coverage, funded primarily by taxes and individual contributions. Benefits include hospital care, primary care, specialty care, mental healthcare, and prescription drugs. Citizens pay 30% coinsurance for most services, and some copayments. Young children and low-income older adults have lower coinsurance rates, and there are monthly and annual out-of-pocket maximums for healthcare costs, varying by age and income.

While private insurance is available in Japan, it is not as commonly used as public healthcare. Private health insurance is often used as a supplement to the SHIS, providing additional income in the event of illness. It is also used by those with serious medical problems, as the public system can result in high bills over time, and by foreigners on a temporary stay.

Japan's healthcare system provides universal coverage

Japan's statutory health insurance system (SHIS) covers 98.3% of the population, while the remaining 1.7% are covered by the Public Social Assistance Program, which is intended for impoverished people. All residents of Japan are required by law to have health insurance coverage. Enrollment in either an employment-based or residence-based health insurance plan is mandatory.

The SHIS is funded primarily by taxes and individual contributions. Benefits covered by SHIS include hospital care, primary and specialty care, mental health care, prescription drugs, and more. In addition to premiums, citizens typically pay 30% coinsurance for most services, with some exceptions and copayments. There are also safety nets in place, such as reduced cost-sharing for young children, low-income older adults, and individuals with specific chronic conditions, mental illnesses, or disabilities.

The residence-based National Health Insurance (NHI) gives healthcare governance to each of Japan's 47 prefectures, and residents are covered by their respective prefecture's insurance plan. The NHI was established by the National Health Insurance Law in 1938 but did not achieve full coverage until 1961 due to challenges posed by World War II.

Japan's healthcare system allows patients to seek treatment at any public or private medical facility of their choice, with no difference in cost. This free-access system enables private facilities to establish hospitals or clinics if they meet the requirements of the Medical Care Act. There is no strict gatekeeper system, so patients are not always required to have a regular primary care doctor.

While Japan's healthcare system provides universal coverage and high-quality care, it also faces challenges such as rising healthcare costs and the need to improve mental healthcare services, which are currently lacking compared to other developed countries.

Japan's healthcare system places a strong emphasis on preventative care

Japan's low mortality rates from ischemic heart disease and cancer are thought to be a result of the country's low obesity levels (4.8% for men and 3.7% for women) and higher consumption of plant-based foods, fish, and non-sweetened beverages like green tea. The country's universal healthcare system, implemented in 1961, enables coverage for medical care funded by taxes and individual contributions. Over the years, copayment rates have gradually declined, and patients are generally responsible for about 30% of medical and pharmaceutical costs, while the government pays the remaining 70%.

The Japanese government has taken several steps to improve healthcare services, including increasing the number of medical schools, particularly in rural areas, to address the shortage of physicians and improve healthcare quality. The universal healthcare reimbursement system evaluates each facility's services to promote equal access to high-quality care across the country. Small regional differences in the mortality rate for ischemic cerebral infarction and the high five-year survival rate of all carcinomas reflect the government's efforts to balance standards of care.

Japan has also been proactive in promoting universal health coverage globally. In 2015, it announced the 'Basic Design for Peace and Health', which serves as a guideline for Global Health policy under the Development Cooperation Charter. This demonstrates Japan's commitment to establishing resilient health systems and promoting seamless utilisation of essential health services and universal healthcare worldwide.

Japan's healthcare system does not place great importance on mental health

One of the main reasons for the underutilisation of mental health services in Japan is the high hurdle that needs to be jumped to seek medical care when feeling mentally unwell. In Japan, only 6% of people have used psychological counselling for mental health problems, compared to 52% in Europe and the US. Many people in Japan are under the impression that counselling is not readily available. This is despite the fact that psychiatric services are covered by Japanese Health Insurance.

Another reason for the low penetration of counselling in Japan is the ingrained belief that enduring what is unacceptable is a virtue. Japanese people are often reluctant to confide in those closest to them and try to survive and overcome their mental illnesses alone. This is partly due to the strong peer pressure and societal cooperation that tends to take precedence over the individual in Japan. As a result, people are compelled to suppress their thoughts and feelings.

Furthermore, mental health literacy education has not been a part of the school curriculum in Japan for a long time, and most people have not had the opportunity to learn how to deal specifically with mental health issues. However, in recent years, a course on the prevention and recovery from mental illness has been added to high school health and physical education classes.

The COVID-19 pandemic has also had a major impact on the mental health of women and young people in Japan, with the prevalence of depression doubling between 2013 and 2020, and the number of suicides increasing for the first time in 11 years. In response, the Japanese government has adopted new suicide prevention guidelines with enhanced support for women and young people.

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