Japan has a universal healthcare system that aims to provide affordable care to all. The government regulates medical fees to keep costs low for patients, who pay between 10-30% of fees out-of-pocket depending on income. Japan has seen tremendous growth in life expectancy over the last 50 years due to economic growth and public health programs like mass cancer screenings. The healthcare system is financed through a mix of public health insurance programs and is characterized by universal coverage and equal access to care.

1. Health care system of JAPAN
Public health
department of global health
By,
Dr. Amina T Khan
Lsmu, Kaunas, Lithuania

2. Introduction
• Japan has one of the top healthcare systems, which aims to provide
healthcare to all without rising costs, as Japan believes it a right
everyone is entitled to.
• Medical fees are strictly regulated by the government to keep them
affordable. Depending on the family income and the age of the
insured, patients are responsible for paying 10%, 20%, or 30% of
medical fees, with the government paying the remaining fee.

3. • There has been tremendous improvement in life expectancy in Japan
over the last 50 years and Japan now leads to international life
expectancy.
• Reasons: the rapid growth in wealth and narrowing of the differences
in its distribution, together with the typical diet with its continuing
relatively low fat intake and recent decreases in salt intake have all
contributed to this favourable situation.

4. Japan health ranking
• WHO Ranking for Health Attainment: 1
• WHO Overall Ranking: 10
• % GDP spent on health care: 7.9% (OECD median 8.6%)
Source; http://www.who.int/countries/jpn/en/

5. Gross indicators
• Population (proj., 000)2016 is 127 million.
• GDP: Gross domestic product (million current US$)2013 is 4.92
trillion dollar , ranked 4th in the world.
• GDP per capita (current US$)2014 is 36298.2
• Health: Total expenditure (% of GDP)2014 is 10.2
Source; http://www.who.int/countries/jpn/en/

6. Life expectancy by country
http://worldhistoryblogpaloma.blogspot.lt/2015/10/longer-life-expectancy.html

7. History
• The beginning of the Japanese Health care system happened in 1927 when the first
Employee Health Insurance plan was created.
• In 1961, Japan achieved universal health insurance coverage, and almost everyone
became insured.
• By the early 1990s, there were more than 8,700 general hospitals, and 1,000
comprehensive hospitals with a total capacity of 1.5 million beds.
• In addition, 79,000 clinics offered primarily out-patient services, and there were
48,000 dental clinics. Most physicians and hospitals sold medication directly to
patients, but there were 36,000 pharmacies where patients could purchase synthetic
or herbal medication.
• Despite its long history of development, Japanese health care system especially of
public health system has been strongly influenced by Europe.
Source: Wikipedia/ healthcare of Japan;/history of healthcare

8. Structure
• Structurally the ministry of health and welfare is responsible for
health administration. Ministry of education for school health, the
ministry of labour for industrial health, and environmental agency
for environmental hazards.
• In addition the public health council, with its experts subgroups
advices the ministry of health and welfare.
• Most new public policies and strategies are formulated by central
government and implementation is delegated to local government.
( source from pubmed central figure, ; prev med public health
/www.ncbi.nlm.nih.gov/pmc/articles/PMC4050210/figure/F2/

9. Mass screening especially
for cancer (one of the
leading causes of death)
has been a major form of
preventive activity in
Japan.
Also supported by 1982 act for
health of elderly , is mass screening of
gastric cancer, cervical cancer, breast
cancer, and lung cancer. ( major
causes of mortality ) this act
integrated health promotion
,financial aid and medical care for 40
years and above
Source: effectiveness of mass screening for
cancer in Japan, ;
https://www.researchgate.net/publication

10. Health expenditure or financing of health
care
1. Low health care costs: 8.0% of GDP (2005,
OECD)
• Low compared with other major OECD
countries (20th)
• Macro and micro management by
government have led to decreases in
expenditures in 2002, and nearly zero since
2. Basically egalitarian system with universal
coverage
3. Excellent health indices
• Infant mortality rate: 4 per thousand children.
Source: OECD Health Data 2008, OECD
(2008)
Healthcare expenditures, per
capita PPP US$, ratio to GDP
(2005)
0
2
4
6
8
10
12
14
16
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000

11. Source of financing
source: OECD health data 2010

12. Provision of health in Japan
• In 2008 per 1000 population, the
number of practicing physicians
was 2.2, which was almost the
same as that in U.S. (2.4), and the
number of practicing nurses was
9.5, which was a little lower than
that in U.S. (10.8), and almost the
same as that in UK (9.5) or in
Canada (9.2).[4]
• Source - (4) OECD. "OECD Health Data".
OECD. Retrieved 2 February 2012.

13. Access to health care in Japan
• In Japan, services are provided either
through regional/national public
hospitals or through private
hospitals/clinics, and patients have
universal access to any facility.
• Japanese patients favour medical
technology such as CT scans and
MRIs, and they receive MRIs at a per
capita rate 8 times higher than the
British and twice as high as
Americans.[8]
• Source-
health_services/service_delivery_profile_japan

14. The health insurance system in Japan
There are a total of eight health insurance systems in Japan,[28] . They can be
divided into two categories, Employees' Health Insurance (健康保険 Kenkō-
Hoken?) and National Health Insurance (国民健康保険 Kokumin-Kenkō-Hoken?).
Employees’ Health Insurance is broken
down to the following systems:[28]
 Union Managed Health Insurance
 Government Managed Health
Insurance
 Seaman’s Insurance
 National Public Workers Mutual Aid
Association Insurance
 Local Public Workers Mutual Aid
Association Insurance
 Private School Teachers’ and
Employees’ Mutual Aid Association
Insurance
National Health Insurance is generally
reserved for self-employed people
and students, and social insurance is
normally for corporate employees.
National Health Insurance has two
categories:[28]:
 National Health Insurance for
each city, town or village
 National Health Insurance Union
Source; (28) "Health Insurance". City of Kagoshima
2010. Retrieved January 28, 2010.

15. Japan - strengths and weaknesses
Strengths
• The health insurance coverage is
universal.
• All costs are controlled by national fee
schedule imposed by the government
with limits on expenditure increases.
• Freedom to choose from physicians to
hospitals as less wait time when in need
of treatment.
• Each medical provider is paid same
across the board
weaknesses
• The coverage does not include
preventive health screening.
• The financial incentives uses excess
use of labs, high tech equipments,
and prescription drugs.
• The medical services given are
fragmented making clinics and
hospitals suffer excess capacity and
duplication of services.

16. Interesting facts of Japanese healthcare
•People per doctor: 610 (compared to 32,650
in Ethiopia, 611 in the United States and 210
in Italy).
•U.S. Health Care Spending Highest,
Japan Lowest: Study
• In May 2011, a study of 13 industrialized
countries released showed Japan spends the
least on health care, while the United States
spends the most without providing superior
care for the money.

17. Conclusion
The major gains in health status in Japan over last few decades
have not been primarily due to public health programmes. Rather the
driving force seems to have been economic growth and relative equality
in income distribution; specifically supportive social networks.
Japan still has 3 major challenges to face:
1. The ageing population
2. The rise in epidemic of tobacco caused disease
3. Westernisation of diet.
The Japanese, however, do have more capacity to address
problems more purposefully and with appropriate action than is
apparent in most other countries.

18. References
(4) OECD. "OECD Health Data". OECD. Retrieved 2 February 2012.
(8) "Sick around the world". Frontline. April 15, 2008. 17 minutes in. PBS.
http://web-japan.org/factsheet/en/pdf/e44_healthcare.pdf
(28) "Health Insurance". City of Kagoshima. 2010. Retrieved January
28, 2010.
https://en.wikipedia.org/wiki/Health_care_system_in_Japan#cite_note-
kagoshima-28
Bibliographic references: The global health management – public health in
wealthy countries – public health in japan.

19. Thank you
ありがとうございました
Arigatōgozaimashita