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Japan's health care system: containing costs and attempting reform
Naoki Ikegami1, John Creighton Campbell
1Department of Health Policy and Administration, Keio University School of Medicine, Tokyo. ikegami@sc.itc.keio.ac.jp
Insights
Japan
Area of Science:
- Health Economics
- Healthcare Policy
- Public Health
Background:
- Japan's economy experienced a decline, prompting significant changes in healthcare financing.
- Previous cost containment measures were in place before the observed reduction in medical spending.
Purpose of the Study:
- To analyze the factors contributing to the reduction in Japanese medical spending in 2002.
- To evaluate the impact of implemented cost containment strategies and future healthcare reforms.
Main Methods:
- Analysis of healthcare financing mechanisms, including fee schedules and copayment rates.
- Examination of the introduction of case-mix-based inclusive fees in university hospitals.
Main Results:
- For the first time, Japan's medical spending decreased in 2002 due to price and volume controls.
- Case-mix-based fees were implemented in university hospitals, with plans for expansion to other care types.
- Patient accountability in the healthcare system has seen slow but meaningful progress.
Conclusions:
- Intensive price and volume controls successfully reduced medical spending in Japan.
- While some reforms like case-mix-based fees are progressing, broader market-based reforms are unlikely.
- Improvements in healthcare system accountability to patients are gradual.
Abstract:
As Japan's economy declined, more intensive control of prices and even volume through the fee schedule, plus increases in various copayment rates, led to an actual reduction of medical spending in 2002 for the first time in history. To augment established mechanisms of cost containment, case-mix-based inclusive fees for inpatient care were introduced in university hospitals in 2003 and are planned for subacute and long-term care. However, substantial reform, including the introduction of market-based medicine, is not likely to occur in other areas. Progress in making the delivery system more accountable to patients has been meaningful but slow.
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