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 through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through 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.
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Enrollment in one of Japan's health insurance programmes is compulsory for residents of Japan.[1] There are a total of eight health insurance systems in Japan.[2] They can then 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 to the following systems:[2]
National Health Insurance is generally reserved for self-employed people and students, whereas social insurance is normally for corporate employees. National Health Insurance can be broken down into[2]:
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 higher for those without a referral. Cost in Japan tends to be quite low compared to other developed countries, but utilization is much higher. This is achieved principally through tight regulation of the price of every medical service. Japan has about three times as many hospitals per capita as the United States[3] and, on average, people visit the hospital more than four times as often as the average American.[3] Due to large numbers of people visiting hospitals and doctors for relativity minor problems, space can be an issue in some regions. The problem has become a wide concern in Japan, particularly in Tokyo. A report that more than 14,000 emergency patients were rejected at least three times by Japanese hospitals before getting treatment in 2007, according to the government survey for that year, got a lot of attention when it was released in 2009, and around this time there were several highly publicised incidents in the Tokyo area, such as an elderly man who was turned away by 14 hospitals before dying 90 minutes after being finally admitted,[4] and a case 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 birth.[5]
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 apply).[6] 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 usually makes a fixed payment per days in hospital or per surgery performed, rather than per actual expenditure. In 2005, Japan spent 8.2% of GDP on health care, or US$2,908 per capita. Of that, approximately 83% was government expenditure.[7][8]
The beginning of the Japanese Health care system happened in 1927 when the first Employee Health Insurance plan was created.[9]
In the 1980s, health care spending was rapidly increasing as was the case with many industrialized nations. While some countries like the United States allowed costs to rise Japan instead tightly regulated the health industry to rein in costs.[10] As of 2009, an MRI scan of the neck region costs $US 1,500, but in Japan, $US 98.[11] Japanese patients favor medical technology such as scans, and they receive MRIs at a per captia rate 8 times higher than the British and twice the amount of Americans.[12] Prices all for health care services are set every two years by negotiations between the health ministry and physicians.[12] The negotiations determine the price for every medical procedure and drug, and prices are identical across the country.[12] If doctors attempt to game the system by ordering more procedures to generate income, the government lowers at the next round of price setting.[12] For example, the price of MRI's were lowered 35% in 2002 by the government.[12]
Since 1983 all elderly persons have been covered by government-sponsored insurance.[13]
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 1.5 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 (because few facilities made appointments), over medication, and abuse of the system because of apparent low out-of-pocket expenses to patients. Another problem is an uneven distribution of health personnel, with rural areas favored over cities.[14]
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.
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.