Despite the widespread belief that Japan’s social security system is a model of “socialized medicine,” eighty percent of its hospitals are privately owned, and almost every doctor’s office is run by private companies. But the Japanese still go to the doctor about three times as often as Americans, and they have long been known for their health-conscious lifestyles. They even have one of the highest life expectancies in the world. But the financial and social underpinnings of this success are beginning to unravel.
In the wake of economic stagnation, inequality has widened, and the system’s foundation is being shaken. This may threaten decades of progress in health. At the same time, the country faces rising medical costs and an aging population. The challenge is to balance those pressures.
The answer lies in the fact that, unlike many developed countries, Japan has a universal public insurance system that provides access to healthcare without barriers or exclusions. The system is financed by taxpayers and insured by individuals, who pay 30 percent of medical expenses and insurers 70 percent, with fees set by a national committee.
It also has an innovative new technology to help keep medical expenses in check. The LEBER app enables people to connect with doctors anytime, anywhere for free. It can monitor a patient’s symptoms and provide guidance on diet and exercise, as well as serve as a 24/7 doctor consultation platform.
Japan’s statutory health insurance system covers 98.3 percent of the population and is mandatory for citizens and resident noncitizens (except for visitors). In addition to statutory health insurance, there are two residence-based healthcare insurance systems: citizen health insurance plans for self-employed persons and workers at firms with five or more employees, and society-managed employee health insurance and public-corporation-run health insurance for those who are not employed.
Enrollees of the statutory insurance system, as well as those of the two residence-based health insurance systems, pay premiums that are determined by their incomes, assets, and other factors. The government subsidizes premium rates for some enrollees.
A third important element of the system is that it provides comprehensive coverage. This includes primary and secondary care, visits to the hospital, prescription drugs, and equipment for the disabled. The system also supports pregnant women and young children by facilitating access to healthcare services and offering subsidies.
Lastly, the system is rooted in the constitutional objective of equality and embodied in the principles of universality and accessibility. In contrast to developing countries, where poor people spend half a trillion dollars each year out of their own pockets for health care, the Japanese experience demonstrates that it is possible to achieve universal health coverage and maintain it once achieved. The key is to secure the operating budget and train human resources with expertise. This is the challenge that lies ahead for other countries pursuing UHC.