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Japan: achieving UHC by regulating payment.

Naoki Ikegami1

  • 1School of Public Health, St. Luke's International University, Tokyo, Japan. nikegami@a5.keio.jp.

Globalization and Health
|November 29, 2019
PubMed
Summary
This summary is machine-generated.

Japan achieved Universal Health Coverage (UHC) by implementing a single, unified fee schedule for social health insurance (SHI). This system effectively covers the entire population, controls costs, and ensures equitable access to services.

Keywords:
Balance billingExtra billingFee scheduleJapanUniversal health coverage

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Area of Science:

  • Health Policy
  • Health Economics
  • Social Insurance

Background:

  • Universal Health Coverage (UHC) aims for population-wide access, reduced patient costs, and equitable service availability.
  • Japan's journey towards UHC involved strategic reforms, with its payment system playing a pivotal role.
  • The social health insurance (SHI) system in Japan has evolved significantly since its inception in 1922.

Purpose of the Study:

  • To analyze Japan's experience in achieving UHC goals.
  • To highlight the critical function of the payment system (fee schedule) in realizing UHC.
  • To examine how Japan's fee schedule facilitated population coverage, cost containment, and equitable access.

Main Methods:

  • Analysis of Japan's historical health insurance policies and payment system evolution.
  • Examination of the impact of the unified fee schedule on UHC goals.
  • Review of legislative changes related to co-insurance, catastrophic coverage, and billing restrictions.

Main Results:

  • A single, unified fee schedule was established by 1958, adopted by all social health insurance plans.
  • Mandatory enrollment in SHI in 1961 achieved universal population coverage.
  • Introduction of catastrophic coverage in 1973 capped co-insurance, and restrictions on extra/balance billing were implemented in 1984.

Conclusions:

  • Japan's success in achieving and sustaining UHC is attributed to its adaptable fee schedule.
  • The fee schedule enabled cost containment and resource reallocation, crucial for UHC.
  • Continuous revision of the fee schedule is key to maintaining UHC goals and ensuring equitable access to healthcare services.