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Japanese universal health coverage: evolution, achievements, and challenges
Naoki Ikegami1, Byung-Kwang Yoo, Hideki Hashimoto
1Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan. nikegami@a5.keio.jp
Lancet (London, England)
|September 3, 2011
Summary
Japan
Area of Science:
- Health Policy
- Social Insurance
- Healthcare Systems
Background:
- Japan established employee-based and community-based social health insurance systems.
- Universal health coverage was pursued through these diverse insurance plans.
Purpose of the Study:
- To analyze the advantages and limitations of Japan's social health insurance model.
- To provide insights for countries aiming for universal health coverage.
Main Methods:
- Analysis of Japan's universal health coverage system.
- Examination of equity, cost containment, and coverage issues.
- Review of policy implications for future universal health coverage initiatives.
Main Results:
- Achieved near-universal insurance by 1961 with equitable fee schedules and co-payments.
- Fragmentation into 3500 plans created premium disparities and an emerging uninsured population.
- Subsidies and cross-subsidization maintained equity for low-income individuals and the elderly.
Conclusions:
- Consolidating insurance plans within prefectures is recommended to ensure universal and equitable coverage.
- Japan's experience highlights the challenges of fragmented social health insurance systems.
- Lessons learned are crucial for nations developing employment and residential-based universal health coverage.
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