Health Insurance
1. C o u n t r y I n t r o d u c t i o n
- Culturally, Japanese culture is rich in values and
heritage handed down for generations. It focuses on
respect and dignity with a deep sense of honor.
- Economically, Japan is a world leader in
the manufacture of electrical appliances.
- In terms of health, Japanese citizens have a
longer life expectancy than anyone else, possibly
because of their lifestyles and healthcare services
excellence, and how the system puts a high priority on
preventative care instead of reactive care.
All these aspects influence the healthcare system in Japan today.
2. Healthcare System
Structure/Facilities
• The Japanese healthcare system is known for its brilliance. The
Legatum Institute’s Prosperity Index ranked the Japanese health
care system as the tenth best in the world, but this quality has a
price, and with a super-ageing population and declining
demography, Japanese policymakers have to be creative to
maintain its long-term sustainability. Therefore, it has Japan’s
statutory health insurance system that provides universal
coverage.
• The primary healthcare services are provided under government
supervision, mostly through private non-profit organizations.
• The limited private (for-profit) system is predominantly focused
on elective and cosmetic procedures.
The picture provides a summary
of the Government agencies
involved in health care in Japan.
The
national
and
local
governments are required by law
to ensure a system that efficiently
provides good-quality medical
care. The national government
regulates nearly all aspects of
the
SHIS.
The
national
government sets the SHIS fee
schedule and gives subsidies to
local governments (municipalities
and prefectures), insurers, and
providers.
Providers
 Private Providers
there are comparatively very few
general practitioners since most
physicians have a sub speciality. You
go directly to the specialist you need for
your illness, with no gatekeeping, so
they provide primary care. Paid mostly
FFS (fee-for-service) with some percase and monthly payments.
 Hospitals
Mainly private nonprofits and 15% of
them are public. Most acute care
hospitals receive case-based
(diagnosis-procedure combination)
payments; FFS for the remainder.
National Health Insurance
(NHI) certificate.
3. H e a l t h I n s u r e r s
• The Government
 Responsible for insuring 100% of the population, including expatriates
and foreigners. 70% of the cost associated with medical expenses is billed
to the government.
 The only provider/insurer of primary health services under the SHIS
insurance programs.
 The cost of medical appointments and hospital visits is determined by a
government committee.
• Private Sector Insurers (Secondary Insurance)
 In general, private insurance plays a supplementary role, and offsets
the cost of other procedures such as orthodontics.
 The 30% cost which the patients have to shoulder during medical visits
can also be covered by private carriers.
4. H e a l t h I n s u r a n c e P l a n s
Japan’s statutory health insurance system (SHIS) covers 98.3
percent of the population, while the separate Public Social
Assistance Program, for impoverished people, covers the
remaining 1.7 percent. Citizens and resident non-citizens are
required to enroll in a SHIS plan; undocumented immigrants and
visitors are not covered.
The SHIS consists of two types of mandatory insurance plans:
 The employees’ health insurance scheme (EHI) for full-time
employees and their families.
 The national health insurance scheme (NHI) for students,
freelancers, self-employed, farmers, and the retired which
includes The long-term care insurance (LTCI) for the elderly
over 65.
• It is funded primarily by taxes and individual contributions.
Role Of Private
Insurance Plans:
Health
• Although the majority (more
than 70%) of the population
holds
some
form
of
secondary, voluntary private
health
insurance,
private
plans
play
only
a
supplementary
or
complementary
role.
It
provides additional income in
case of sickness, usually as a
lump sum or in daily
payments over a defined
period, to sick or hospitalized
insured persons.
5. H e a l t h I n s u r a n c e
Challenges/Issues
 The most evident problem that Japanese health insurance has (or will
have) is that Japanese citizens have the longest life expectancy
globally, therefore, long-term care expensive expenses will be piling up
soon. The number of users and spending has increased far beyond
expectations, that’s why the country’s healthcare system is constantly
looking at ways to serve its large and ageing population better.
 By 2050, 40% of the Japanese people will be over 65 years old. Thus,
the government must establish a better healthcare system and a
stronger Long-term care insurance (LTCI) base.
 A consequent problem is known as “Social Hospitalization” had been
identified as a critical reason for the long lengths of hospital stay, the
lack of nursing facilities has caused patients to spend their last days
and die in hospitals, even though they prefer to die at home, this
because they are afraid of being a burden on their families.
Thank you for listening
Amal Alnabelsi
140670
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