Healthcare in Japan

The 2000 WHO special report ranked the health systems of all its member countries according to the following system of indicators. Japan's health system was ranked 1st in terms of health, 8th-11th in terms of equity of financial burden, 13th in terms of per capita health expenditures as measured by international purchasing power parity (PPP) converted using the US dollar ratio, and 10th in terms of the overall performance of the health system as a whole (as shown in the chart) for several major indicators. This great achievement of the Japanese health system is largely determined by the health system that Japan has adopted. Since the 1960s, Japan has had a health insurance system that covers the entire population. There are national health insurance and employee health insurance in Japan. The former is an insurance policy for ordinary citizens (including farmers, self-employed persons, and retired persons), while the latter is an employees' health insurance policy, i.e., an insurance policy that must be enrolled in by all workers and their families employed in enterprises with more than five employees, and consists of four types of health insurance programs for specific employees: seafarer's insurance, the national civil servant's and other ****support group, the local civil servant's and other ****support group, and the private school staff's and teachers' and staff's ****support group. The following health insurance programs are available for specific employees. These can be divided into two main categories depending on the organizer: those run by the government and those run by health insurance mutual aid societies. The government-sponsored portion mainly absorbs small and medium-sized enterprises that do not have a health insurance mutual association to participate in the insurance, while the health insurance mutual association is a mutual insurance organization established and run separately by large enterprises and institutions themselves. Goal Attainment Performance Health Satisfaction Equity of Financial Burden Overall Goal Attainment Per Capita Level Expenditures in International Dollars Health Performance Overall Performance Level of the Entire Health System Health Distribution Level of Satisfaction Distribution 1363-388-11113910 1. Composition of Japan's Social Security System Japan's current social security This includes social security in the narrow sense, social security in the broad sense, and social security-related systems. Social security in the narrow sense includes five areas: public **** assistance, social welfare, social insurance, public health and medical care, and health care for the elderly. Social security in the broad sense of the term is the addition of ex gratia payments and assistance to the war dead to the narrow sense of social security. Social security-related systems include the housing system and employment countermeasures. Japan's entire social security system*** consists of 63 systems, of which Japan's social insurance dominates the entire social security system. Japan's social insurance is divided into four areas: health insurance, pension insurance, unemployment insurance, and worker's compensation insurance.2. Japan's Health Administration System At the national level, the Ministry of Health, Labour and Welfare (MHLW) is responsible for formulating national policies on health, social security, and employment, and for leading the implementation of the health care program in 47 prefectures across the country. Under the MHLW are the Department of Statistics and Information, the Department of Injury Health and Welfare, the Bureau of Health Policy, the Bureau of Life Health, the Bureau of Medical Safety, the Bureau of Health and Welfare for the Elderly, the Bureau of Children and Families, the Bureau of Insurance, the Department of Social Insurance, and the Local Medical Bureaus, etc. The 47 prefectures have their own independent health authorities, which are named independently. Most of them combine the functions of "health care" and "welfare" and are called "Ministry of Health and Welfare" or "Ministry of Health and Welfare". Health and Welfare Department" or "Health and Welfare Department". At the grass-roots level in cities, towns and villages, there are generally health and welfare divisions with departments of livelihood, insurance and hygiene in charge of local medical and health care.3. Japan's Medical and Health Care System and Resource Allocation Japan's medical and health care system can be simply divided into a medical system and a health care system. Japanese hospitals are divided into two categories: state-owned and private. Large and medium-sized hospitals with more than 300 beds are basically organized by the state or local governments; hospitals and clinics of less than medium size are mainly privately run. The social characterization of public hospitals is that they are non-profit public welfare institutions, so they aim to "improve efficiency, provide transparent services, and operate in a stable manner". The national average hospital income/expenditure ratio in 2003 was 93.9%, an increase of 5 percentage points over the previous year, which indicates that public hospitals are generally in the red, with losses subsidized by the state and local finances. This indicates that public hospitals are generally losing money, with losses subsidized by national and local governments. In Japan, almost all issues related to human health other than medical treatment fall under the category of health care and are basically supported by legislation. For example, the Nutrition Improvement Law, the Mother and Child Health Care Law, the Elderly Health Care Law, the Vaccination Law, the Health Promotion Countermeasures Law, the Medical Care Law, the Pharmaceutical Law, the Water Law, the Food Sanitation Law, and laws related to cemeteries and burials. Health care services are generally provided by health clinics and municipal health centers. (1) Distribution of medical institutions in Japan As of October 1, 2003, there were 9,178 hospitals in Japan*** (of which 8,116 were general hospitals, 1,069 were psychiatric hospitals, and 2 were tuberculosis hospitals), which is 1.3 times as many as there were in the Showa 40 years, and there were 94,819 general clinics and 65,073 dental clinics, which are 1.5 times and 2.3 times as many as in 1966, as of October 1, 2003, respectively. This is 1.5 times and 2.3 times more than in 1966, respectively. Medical institutions can be run by medical corporations or by individuals. Hospitals run by medical corporations account for 60.2% of the total number of hospitals, while those run by individuals account for 10.4% of the total number of hospitals. Of these, 55.2% of general clinics and 87.5% of dental clinics are run by individuals, which is the most important feature of medical institutions in Japan. As of October 1, 2003, there were 164,259,593 beds in Japanese hospitals***, with an average of 1,289.0 beds per 100,000 people, which is one and a quarter times the number of beds per 100,000 people in 1966, and the number of beds per 100,000 people in different prefectures is also higher than the number of beds per 100,000 people. There are also great differences in different prefectures, such as Kochi (KOUTI) Prefecture, which has 2,456.9 beds per 100,000 people, Kagoshima (KAGOSIMA), which has 2,025.0 beds per 100,000 people, and Saitama (SAYITAMA) Prefecture, which has only 878.1 beds per 100,000 people, and Chiba (TIBA) Prefecture, which also has only 941.2 beds per 100,000 people. In Chiba Prefecture, there are only 941.2 beds per 100,000 people. As of October 2003, there were 196,596 beds in general clinics, with an average of 154.3 beds per 100,000 people. The utilization rate of different types of hospital beds as well as other hospital beds is more than 80% per year; the utilization rate of beds for mental diseases exceeded 100% in 1986 and was 93.2% in 2002; the utilization rate of beds for tuberculosis was lower, at only 43.7% in 2002. (2) Medical staff in Japan After the war, due to the shortage of doctors, the Japanese government increased its efforts to train doctors in order to be able to reach the goal of 150 doctors per 10,000 people by 1986. By 1966, there were 111.3 doctors per 100,000 people in Japan, and at the end of 2003, the number of registered doctors was 262,678, an average of 206.1 doctors per 100,000 people. If the training rate in 1976 continues, there will be a serious oversupply of doctors. The Ministry of Health and Welfare established the "Discussion Committee on the Future Supply of and Demand for Doctors" to discuss the above situation. In June 1987, the committee recommended that the number of new doctors should be reduced by at least 10 percent by 1996. On the basis of several subsequent discussions on the situation of supply and demand of doctors, the MHLW asked MEXT to reduce the number of students enrolled in medical universities (medical faculties), which was reduced by 8% in 2001 compared to 1985, while the number of students enrolled in dental universities (dental faculties) was reduced accordingly, with the number of enrollees in dental universities (dental faculties) in 1998 reduced by 19.7% compared to 1985.4 ．Medical Insurance Programs and Contents Since the 1960s, Japan has established a medical insurance system that covers the entire population. There are two types of medical insurance in Japan: national health insurance and employee health insurance. The former is an insurance policy for ordinary citizens (including farmers, self-employed persons, and retired persons); the latter is an employees' health insurance policy, which is mandatory for workers employed in enterprises with more than five employees and their family members, and consists of four types of health insurance programs for specific employees: seafarer's insurance, the National Public Employees' and Other ****Japanese Financial Institutions Group, the Local Public Employees' and Other ****Japanese Financial Institutions Group, and the Private School Employee's and Staff's ****Japanese Financial Institutions Group. The following health insurance programs are available for specific employees. These can be divided into two main categories depending on the organizer: those run by the government and those run by health insurance mutual aid societies. The government-sponsored section mainly attracts small and medium-sized enterprises that do not have health insurance mutual associations, while the health insurance mutual associations are mutual insurance organizations set up and run by large corporations and institutions themselves. Since health insurance is mandatory in Japan, general employees and civil servants have insurance premiums automatically deducted from their paychecks from the day they start working. Farmers and self-employed people who are covered by the National Health Insurance can only pay the premiums at the municipal office because they are not wage earners. Under the system, those who fail to pay their premiums are required to pay for their own medical expenses. The ratio of medical insurance premiums varies somewhat between insurance policies, but in the case of the National Health Insurance, the premiums are charged at a fixed rate per household, with an average of 150,893 yen per household per year. In the case of medical insurance for employed workers, the rate of insurance premiums for general employees is 8.5%, with labor and management each paying 4.25%; the rate of insurance levied for seafarers is 8.8%, with labor and management each paying 4.4%; civil servants, in principle, pay between 2.46-5.00% of the individual's contribution; and the rate of contribution for private school staff is 8.45%, with labor and management each paying half of the contribution for both categories as well. In addition, medical insurance provides that those who are incapable of working, have no source of income and are unable to pay for insurance can be classified as living protection, exempted from paying insurance premiums and enjoy free medical treatment upon verification, and that low-income farmers and self-employed persons are entitled to exemption from half of the insurance premiums.5. Japan's Health Care System: Cost Controls and Attempts at Reforms As Japan's economy declined, stricter price controls, stabilized fund reserves, and the With tighter price controls, stabilized fund reserves, and increased deductibles for various types of insurance, Japan reduced its health care expenditures in 2002 for the first time in its history. This reduction was not due to fundamental structural reforms, but rather to traditional statistical calibers. In the regular biennial review conducted in 2002, the prices of medical services and medicines were reduced by an average of 2.7 percentage points. This also resulted in a 0.7 percentage point reduction in all healthcare spending. As a result of the economic stagnation, there are many reform opinions that focus on an efficient payment system, the structure of health insurance, and the distribution of medical services. Of course, there are other opinions that Japan's health care system is not assuming its due responsibilities.6. Structural Reform of Japan's Health Care System Reform Proposal 1: Implementation of a New Payment System Both the government and the experts have recognized that the fee-for-service system is the main reason for the high expenditures. Therefore, this was the biggest motivation for the government to introduce a comprehensive payment system in May 2003 for patients with acute conditions. This system is limited to 80 university hospitals and two state medical centers (on cancer and cardiovascular disease). Patients are organized into Diagnosis and Procedure Combinations (DPCs). This is different from the DRG/PPS system in the United States. Japan in May 2004 is considering expanding the DPCs-based payment system to other hospitals. While there are still many limitations to its application, one of the many constraints is that only nearly 10 percent of hospitals are using the International Classification of Diseases (ICD) principles that underlie the current system. Reform Proposal 2: Restructuring the Health Insurance System In order to implement the structural reform, in December 2002 the Labor Security and Welfare Department proposed two alternative options. The most basic option is called the cross-subsidy program: adjustments would be made to the various insurance plans to eliminate differences between participants of different ages and incomes, and eventually all the plans would be integrated into a single regional financial plan. This would address all of the problems caused by increased aging, including the increased burden on the fund, the CHI financial crisis, and the collapse of the insurance program. But the EHI plans are against this proposal because the program will increase the burden of their cross-subsidies, and they believe that the method of determining insurance premiums is unfair because self-employed people always tend to under-declare their income. Another problem is that local governments, which play an active role in the health care system, oppose this program. This is because of their inexperience and the financial crisis they might face. Another option argues that the burden of the EHI program can be reduced by having a separate health care plan for those aged 75 or older. On the face of it, this option is very attractive, but considering the amount of money it would require, you can see that unless it is supported by EHI premiums and financial support from the government, the high premiums for seniors would cause serious political problems. Reform Proposal #3: A New "Free Market" Philosophy Under Japan's current health care system, it is not permissible to balance the bill or to charge patients more than the amount of the health insurance rebate. both the MHLW and the Japan Medical Association are opposed to balancing the bill and believe that all patients should have equal access to health care services. To date, the debate over balanced billing has been largely ideological, with very little presented on the practical level regarding operations. First, private insurers have neither the incentive nor the expertise to make such a claim, and they do not have the proper mechanisms to prevent internists from engaging in side-induced demand. Second, more hospitals will offer higher-tech, high-quality care to the public. This is very different from them treating patients based on their ability to pay. The debate over whether to allow investors to own hospitals is more ideological than practical. Reform requires market competition and hospitals should not own shares, while the MHLW and JMA argue that hospitals should not put the interests of shareholders ahead of the interests of patients and communities. The door to market-based care is open, but it is open very little. both MHLW and JMA hold opposing views: opinion polls show that the majority of the population is reluctant to change the current system because the quality and quantity of services one receives can reflect one's ability to pay. Reform Proposal 4: Patient-Oriented Healthcare Delivery System The reforms needed in the Japanese healthcare system are not only focused on policy making or spending. Patients have been complaining about hospitals for many years: waiting times are too long; doctors disclose too little information; and there is indifference and arrogance throughout the health care system, with some reports of medical malpractice getting a lot of attention in the media. the MHLW has tried to address such issues but many of their approaches have been unsuccessful, and they are more than willing to join forces with the JMA. Although there are many problems at the political and managerial level to reform the current service delivery system, there are also many structural barriers. Firstly, with patients having free access to all hospitals and private clinics, there is the inevitable problem of longer waiting times. Long waiting times are a common problem at medical service centers as many patients prefer to go to reputable medical service centers compared to local medical clinics. Dissatisfied with the long waiting times, MHLW has tried to reduce the demand for large hospital outpatient clinics by utilizing private doctors. Second, too little disclosure in Japan is due to shorter consultation times. This is mainly due to the short consultation time, while the fee system and the traditional professional ethics of doctors contribute to this tendency (this will change due to the addition of new doctors). Recently, there has been an increase in reports of medical malpractice, mainly due to a greater willingness to disclose and learn about such information. In response to this change, in 2002 the MHLW proposed reforms to the health care delivery system that emphasized patient expectations and the need for transparent disclosure.