
Japanese Health System Overview
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Health System Outcomes
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Japan’s COVID-19 Strategy
Health System Expenditures
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Long-Term Care
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Political System
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People With Disabilities
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Social Determinants & Health Equity
Health System History and Challenges
“Until recently, Japan and South Korea were among the few countries that used centralized systems of grading disability based on medical criteria to determine eligibility for state assistance and benefits. These systems help explain the relatively lower numbers of officially recognized disabled people in both countries, which at 6 to 7 percent of each population is far below other OECD countries. It took a 1,842-day sit-in in a Seoul subway station for Korean disability rights advocates to persuade their government to replace this system in 2019 with one that assesses individual needs and situations, such as rural versus urban. Japan still uses the grading system.”
Source: Celeste L. Arrington; Disabled People’s Fight for Rights in South Korea and Japan. Current History 1 September 2021; 120 (827): 233–239. doi: doi.org/10.1525/curh.2021.120.827.233
“As noted above Japan’s system takes into consideration the cultural Confusian values, family responsibilities and productivism in social issues. Disability is seen as an individual problem to be dealt with individually and/or by families and mothers. If the impairment could be eliminated by means of cure or rehabilitation, so to can disability. There are strict limitation of types of disabilities recognized by the law. The strict dependence on the medical model implies that Japan has “a conspicuously small number of people with disabilities as a percentage of the total population” (Yoda, ¯ 2002, p. 4).”
Source: Lindqvist, R., & Lamichhane, K. (2019). Disability policies in Japan and Sweden: A comparative perspective. Alter, 13(1), 1-14.
“Understanding disability, in medical terms, has led to exclusionary government practices, segregated schools and workplaces, and sophisticated welfare and rehabilitation institutions separate from the rest of the society. Such developments of Japanese welfare legislation seem to emphasize special needs at the expense of equal rights and integration (Heyer, 1999, pp. 105–6; Heyer, 2015). However, government interventions are necessary requirements to enforce employers accommodate disabilities, hence, Japan has sought to combine its welfare with American style rights approach (inspired by the Americans with Disability Act, ADA), though, adapted to its own unique socio-political context and priorities (Heyer, 2015).
“Interestingly, the idea of normalization inspired by the writings of Scandinavian activists, like Niels Bank-Mikkelsen and Bengt Nirje in the 1960s, became included as a major policy directive in Japanese disability policy discourse. This was a result of pressure from disability activists promoting independent living in the community, and a more self-sufficient identity (Stevens, 2013, p. 64). However, normalization was given a specific connotation with its main objective of “encouraging integration into mainstream society” (Stevens, 2013, p. 89), without mentioning eligibility to Scandinavian-style welfare measures like child allowances, personal pensions, old-age allowances and home help services. Being without public social services support, people with disabilities had to conform and adapt to a non-disabled life-style through employment, and, in case that was impossible, receive support from family and kinship, and income-tested social protection programs.
“Because people with disabilities in Japan, like elsewhere are at an economic disadvantage the goal of social welfare is to provide services (or extra funding) necessary because of the effects of a person’s impairments. For example, Japan’s Special Child Rearing Allowance (tokubetsu shogaisha ¯ teate) provides payment (depending on the severity of the disability) to eligible parents and caregivers of children with disabilities. Like in Sweden, disability welfare laws frequently were expressed as providing financial support for living expenses and facilities for medical treatment (for disabling medical conditions), specialist equipment and the prominence of the idea of rehabilitation (Lindqvist, 2000; Stevens, 2013, pp. 60–65).
“Income test is in general in tune with Japan’s welfare mindset. Financial support must not have an impact on work incentives, and granted only after all other personal and public resources is exhausted, including assistance from persons who are required to support the person by law. Furthermore, public assistance is provided a household rather than to an individual (Yoda, ¯ 2002, p. 10). Stevens (2013, pp. 76–77) contends, “government views the individual with a disability as an extension of the family, rather than as an individual”.
Source: Lindqvist, R., & Lamichhane, K. (2019). Disability policies in Japan and Sweden: A comparative perspective. Alter, 13(1), 1-14.
“Japan has long displayed a strong orientation towards rehabilitation. Yoda ¯ (2002, pp. 1–15) writes about this in terms of a rehabilitation paradigm, that sees disability as an individual problem, assuming that if the impairment can be eliminated so too can the problem, and persons with disabilities can adopt (or approximate) to normative able-bodied life-styles. It follows that the rehabilitation paradigm tends to extend social protection only to those people with disabilities “who have been deemed potentially able to contribute to labour and the economy” (ibid. p. 2). Vocational rehabilitation services and comprehensive employment support for persons with mental disabilities are available under the Employment Promotion Act for Persons with Disabilities (EPAPD). In this context, the Quota System and the Levy and Grant System play a central role in promoting employment for disabled persons, implying that public and private employers are obliged to employ, and report to the employment authorities a certain ratio of disabled persons. Those enterprises that fail to achieve the quota must pay a levy used to encourage employers who employ disabled workers above the quota and to improve their working conditions.”
Source: Lindqvist, R., & Lamichhane, K. (2019). Disability policies in Japan and Sweden: A comparative perspective. Alter, 13(1), 1-14.
Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.
Page last updated Sept. 11, 2022 by Doug McVay, Editor.