Characteristics and Reforms of Public Health Insurance System in Japan

In Japan, the public health insurance system consists of several health insurance plans, and equal benefit levels as well as fair burden-sharing of costs among plans are considered important under the universal system. This paper deals with health insurance reforms, which are divided into two periods after the achievement of universal coverage in 1961: the 1960s to the early 1980s, and the early 1980s to today. Future reforms will be classified as another period. After the achievement of universal coverage, the Ministry of Health and Welfare further reformed health insurance plans to expand health benefits with a view to equal benefit levels by raising contributions from the central government through to the early 1980s. However, because of the increase in national health expenditures, especially health expenditures for the elderly, the Ministry reformed health care to emphasize cost containment in the early 1980s, the goal being that the rate of growth in national health expenditures should be equal to or below the rate of growth in national income. There have been three major cost containment efforts made toward achieving this goal: (1) Introducing deductible and copayment, (2) Revising the medical fee schedule, and (3) Establishing new programs for elderly persons which are largely financed by contributions from all health insurers. Japan is a rapidly aging society. Future health insurance plan reforms will be focused on controlling health care costs for elderly persons, thereby easing the financial burdens of health insurance plans for non-elderly persons. Furthermore, the Ministry plans to establish public long-term care insurance in the near future, which will have a large impact on plan reforms.