Japan health system review: Health systems in transition
Author(s)/Editor(s): Kozo Tatara, Etsuji Okamoto, Sara Allin, Ryozo Matsuda
Publisher/Organizer: European Observatory on Health Systems and Policies, WHO Regional Office for Europe
Publication date: 2009
Number of pages: 179
Language: English
Overview
“Japan’s health system provides universal coverage of the population through health insurance system for employees and their families (60% of the population) and National Health Insurance (NHI) system for the self-employed, retired and unemployed (40%). Annual expenditure is around 8% of gross domestic product (GDP) according to OECD estimates, and the main funding mechanisms are health insurance (50% of total spending), taxation (36%) and out-of-pocket payments (14%).
Population health in Japan is among the best in the world, with the longest life expectancy and lowest infant mortality. The population has aged considerably, with over 21% aged 65 years or older. Recent health system reforms are related in large part to this demographic challenge, such as the introduction of an independent financing system for the oldest-old population cross-subsidized by all health insurers, better integration of preventive services into the insurance system, reforming the methods of paying hospitals and the introduction of a new system of long-term care fi nanced through insurance and administered by municipal governments……”
“Japan’s annual health care spending is estimated to be 32.1 trillion yen in 2005, or 259 300 yen per capita (approximately US$2600), accounting for 6.6% of gross domestic product (GDP) according to national estimates and 8% from estimates of the Organisation for Economic Co-operation and Development (OECD), which include private payments. The three major methods of fi nancing are health insurance (49.2% of total health spending), provided by more than 3500 separate insurance funds, general taxation (36.4%) and out-of-pocket payments (14.4%).
Japan’s statutory health insurance system is administered by a multitude of insurers: the government (from October 2008, a quasi-governmental body, the Japan Health Insurance Association) for employees of small to medium-sized fi rms and their dependants, 1584 Society-managed Health Insurance funds for employees of large fi rms and their dependants, 76 Mutual Aid Society (MAS) funds for government employees and dependants, 1835 municipal National Health Insurance funds for the self-employed, retired and unemployed, and 166 National Health Insurance Society funds for some occupational groups such as doctors and lawyers, each with different premium contribution rates.
The contribution rate of Government-managed Health Insurance is 8.2% of monthly gross salary equally shared between employers and employees.”