Japan: Health system review. Health Systems in Transition, 2009;

Posted on November 10, 2009. Filed under: Health Status | Tags: |

Tatara K, Okamoto E. Japan: Health system review. Health Systems in Transition, 2009; 11(5): 1–164.

European Observatory on Health Systems and Policies – a partnership between the World Health Organization Regional Offi ce for Europe, the Governments of Belgium, Finland, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine


“The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, fi nancing and delivery of health services and the role 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 population through health insurance system for employees and their families (60% of the population) and National Health Insurance (NHI) system for the selfemployed, 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 financed through insurance and administered by municipal governments.”


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