Transcript 日本の国民皆保険制度 - Harvard University

Reflections on
Japan’s 50 Years of
Universal Health Coverage
Michael R. Reich
Global Health & Population, HSPH
26 April 2012
“Reflections”
• Not a focused research presentation
• More of a personal perspective
• Japan has had universal coverage since
1961, kokumin kaihoken seido (国民皆
保険制度) = 50 years
• Japan has had Michael coverage since
1971 = 40 years
2
Field Research in Japan, 1971-74
Me
Presentation Based on
Lancet Japan Series
Leaders of the Japan Research Group
Prof. K. Takemi
Prof. N. Ikegami
Prof. K. Shibuya
50 Years Since Achieving
Universal Health Coverage
• Major improvements in health status in
the postwar period
• Japanese women have ranked as number
one in life expectancy for 25 years
7
Life Expectancy of Women
For G7 Countries
source: MHLW.
Japan’s Under-5 Morality（1950-2008）
Under-5 Morality （per 1000 live births）
100
80
92 (1950)
Boys
Girls
60
MDG 4: Reduce
by 2/3’s
(1950-1965)
40
20
24 (1965)
0
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
Year
Source: ランセット日本特集号 Population Health
9
In 50 Years Since Achieving
Universal Health Coverage
• Also excellent control of national medical
expenditures in Japan
• Today Japan’s NME represent only 8.1%
of GDP, placing them at number 20
among OECD countries
• Cost control has continued, even with
rapid aging of the population
10
Medical Expenditure among
OECD Countries (2005）
source: MHLW.
Reasons for Japan’s Successes
•
•
•
•
•
•
Not easy to explain
Public health policies,
High literacy rates and educational levels,
Diet and exercise,
Economic growth, and
A stable political environment
12
Perry and his Black Ships
“Open” Japan in 1853
Recent Historical Context - 1
• About 3.2 million deaths during WW2
Hiroshima after the Bomb
Recent Historical Context - 2
• Under the Occupation, social change and
democratization
• New public health policies introduced
• Effective control of infectious diseases
and tuberculosis
• From 1947 to 1955, average life
expectancy increased by 14 years
• Serious pollution problems in 1960s
15
Expanding Coverage
Japan’s Achievements
“Good Health at Low Cost with Equity”
Four main points:
• Universal coverage with increasing equity
• Cost containment and service quality
• Policies for ageing
• Impressive gains in population health
17
Growing Social Challenges
• the rise of part-time and temporary
employment for young workers
• growing number of young women who
postpone marriage and child-bearing
• ever-expanding number of elderly
• increasing sense of widening income
inequality and diversity in values
18
Serious problems in
Japan’s Political Economy
• Twenty years of economic stagnation
19
Japan’s Challenges Ahead
• Three major issues for Japan’s health
system:
1. National fiscal situation and healthcare
financing
2. Political governance
3. Changing expectations about health
and quality
20
Political Merry-Go-Round
According to the Economist (17 March 2011)：
Japan is “a despondent country with a dysfunctional political system”
27 August 2011: PM candidates
For Japan Democratic Party
21
Three Reform Proposals
• Clarify national values of “human
security” for structural reform
• Redefine the roles of central and local
governments
• Improve the quality of healthcare
22
Conclusions
• Possible to achieve progress in public
health without a school of public health
• Fee for service reimbursement does not
always lead to cost escalation;
institutions and political economy matter
• The pursuit of universal coverage is not a
one-time effort, but a long historical and
political process
23