How Japan prioritises preventative care

We discuss healthcare in Japan, from its early adoption of universal healthcare to its vision for a health system that is fit for the future

Japan’s high life expectancy has long been a subject of curiosity and inspiration for other countries around the world. According to Japan’s Ministry of Health, Labour and Welfare, the average life expectancy in Japan in 2021 was 87.57 years for women and 81.47 years for men, one of the highest in the world. This is predominantly due to the country’s early adoption of universal healthcare and emphasis on preventative care. In contrast to many other developed nations, Japan boasts remarkably low mortality rates from ischemic heart disease and cancer, which is thought to be attributable to the country’s low levels of obesity (4.8% for men and 3.7% for women) and higher consumption of plant-based foods, fish – specifically n-3 polyunsaturated fatty acids – and non-sweetened beverages like green tea. ⁽¹⁾

Universal healthcare in Japan

‘focuses on providing treatment and care based on “patient-centeredness”, prioritizing the provision of rational medicine to patients as a team under the initiative of medical doctors. ⁽²⁾

In 1961, Japan implemented the National Health Insurance (NHI) system to enable universal health coverage for medical care funded by taxes and individual contributions. While copayment rates were initially variable and meant some had to pay up to 50% of the scheduled fee for all services and medications, over the years, rates have gradually declined, and patients generally accept responsibility for up to 30% of medical and pharmaceutical costs while the government pays the remaining 70%. Some Japanese residents have additional private health insurance to supplement their universal health insurance, such as for extensive medical or long-term care. Children and low-income older adults have lower coinsurance rates.

Japan’s universal healthcare insurance system has been applauded for helping to reduce healthcare inequities and enable people to access the most appropriate care at costs they can afford. A government committee sets fees, and all residents in the country for more than three months are required by law to register for health insurance. Individuals who do not have insurance provided by their employer may enrol in a health insurance programme that is run by local governments.

In Japan, the National Health Insurance and Employee Insurance plans cover medical appointments and procedures related to illness, injury, and dental care. What’s more, patients have the freedom to choose their preferred physicians or facilities and hospitals must also operate as non-profit organisations and are overseen by medical professionals.

The Japanese government has taken steps to improve healthcare services throughout the country by increasing the number of medical schools, particularly in rural areas. This initiative aims to address the shortage of physicians and improve the quality of healthcare services. The universal healthcare reimbursement system evaluates the services provided by each facility to further promote equal access to high-quality care across the country. (2) Small regional differences in the mortality rate for ischemic cerebral infarction and the high five-year survival rate of all carcinomas reflect government efforts to balance standards of care. ⁽²⁾

Supporting global health

Promoting universal health coverage globally has been an important objective for Japan’s government. In 2015, it announced the ‘Basic Design for Peace and Health’, which functions as a guideline for Global Health policy under the Development Cooperation Charter. It comprises three basic policies that reflect Japan’s commitment to strengthening global health, including establishing resilient health systems and governance that can respond to public health emergencies and disasters, promoting seamless utilisation of essential health services and universal healthcare and leveraging Japanese expertise, experience, and medical products and technology. The Basic Design for Peace and Health further supports the 2030 Agenda for Sustainable Development of ensuring that good health and wellbeing are achievable for all. Japan released a revised Development Cooperation Charter earlier this year.

Prioritising the promotion of universal health coverage has been a significant theme at summit-level meetings. The government has endeavoured to push this agenda forward, supporting the establishment of universal healthcare in Africa, Asia, and other regions alongside the international community and organisations. Following a high-level forum on universal healthcare co-hosted by Japan in 2017, government leaders from over 30 countries and representatives and experts from international organisations adopted the Tokyo Declaration on UHC, outlining their commitment to accelerate efforts to achieve universal health coverage by 2030.

Japan’s focus on achieving more resilient, equitable, and sustainable health systems was reiterated last May when the Kishida administration announced its new Global Health Strategy based on the experience of responding to the spread of COVID-19. The guidelines aim to assist in developing global health infrastructure and strengthening healthcare systems so they are better prepared for public health emergencies.

At this year’s G7 summit hosted by Japan, ministers announced an eight-point action plan to realise universal health coverage for all people by 2030. Strengthening global cooperation and learning from the COVID-19 pandemic was central to this year’s summit; health ministers from the group of seven major countries said they would work collaboratively to ensure rapid and equitable access to vital medical supplies, including vaccines. There was a call for an international framework and more sustainable funding to support the response to future public health crises, including narrowing gaps between LMICs and high-income countries.

Japanese Health Minister Katsunobu Kato, who chaired the Nagasaki meeting, told a news conference, “We agreed that each country will work promptly to build a system to improve access to pharmaceutical products.” ⁽³⁾

Adapting health systems for today’s society

The government has adopted several reforms in the past two decades to help manage increasing healthcare expenditures and changing demands, including the Long-term Care Insurance System (2000), the Integrated Community Care System (2006), The Comprehensive Reform of Society Security and Tax (2010); and the Regional Healthcare Vision (2014).

Recently, the Ministry of Health, Labour and Welfare launched Japan Vision: Health Care 2035 – Japan’s vision for a ‘sustainable health care system that delivers unmatched health outcomes through care that is responsive and equitable to each member of society and that contributes to prosperity in Japan and around the world.’ ⁽⁴⁾

This paradigm shift in Japan’s healthcare provision is centred on three main pillars of reform: lean healthcare (implement value-based healthcare), life design (empower society and support personal choice) and global health leader (lead and contribute to global health). It also emphasises principles of fairness, solidarity built on autonomy and shared prosperity of Japan and the world. ⁽⁵⁾

Japan’s commitment to preventative, high-quality care has afforded Japanese citizens a better quality of life and has been recognised as a positive approach internationally. However, as in many countries, demographic changes and slow economic growth mean Japan’s health system must adapt to changing demands and healthcare needs. Reforms across healthcare and other sectors are necessary for the government to realise its vision of low-cost, equitable health systems that can suitably support society today and in the future.

References

1. https://observatoireprevention.org/en/2021/03/09/why-do-the-japanese-
   have-the-highest-life-expectancy-in-the-world/
2. Kondo T; MEJ Four Dimensional Health Innovation Group. Report on the nature, characteristics, and outcomes of the Japanese healthcare system. Glob Health Med. 2022 Feb 28;4(1):37-44. doi: 10.35772/ghm.2021.01097. PMID: 35291196; PMCID: PMC8884037.
3. https://www.japantimes.co.jp/news/2023/05/14/national/g7-health-ministers-vaccines/
4. https://www.mhlw.go.jp/seisakunitsuite/bunya/hokabunya/shakaihoshou/hokeniryou2035/future/en/
5. https://apps.who.int/iris/bitstream/handle/10665/259941/9789290226260-eng.pdf