Japan: health system review

ABSTRACT

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Japan’s health system provides universal coverage of the populationthrough 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 financingsystem 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 financed through insurance and administered by municipal governments.