Population Insurance Coverage For A Core Set Of Healthcare Services* (%) (2019):
Public Coverage: 100%; Primary Private Health Coverage: 0%; Total: 100%

*”Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is countryspecific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. In both, financing is linked to ability to pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population). Additional private health insurance is always voluntary. Voluntary private insurance premiums are generally not income‑related, although the purchase of private coverage may be subsidised by the government.”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

Annual household out-of-pocket payment, current USD per capita (2019): $563

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed June 8, 2022.

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2019): 2.6%

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“Japan’s health system is distinctly characterized by universal health insurance, which provides excellent health outcomes at a relatively low cost with equity (Ikegami N et al., 2011; Murray CJL, 2011). By law, all residents of Japan (including foreign nationals with a residence card) must be enrolled in a health insurance programme.

“There are two main types of health insurance in Japan – the Employees’ Health Insurance System and National Health Insurance (NHI) (previously called Community Health Insurance). The Employees’ Health Insurance System is provided to employed workers (company employees) and their dependents, while NHI is designed for self and unemployed people (hence those not eligible to be members of Employees’ Health Insurance) and is run by municipal governments (i.e., cities, towns and villages).

“Patients’ co-payments for medical expenses must be paid at every visit to clinics and hospitals. The nationally uniform fee schedule (i.e., amount of reimbursement, including the patients’ co-payment) covers most health-care procedures and products, including drugs. The health insurance pays 70–90% of the cost while the remainder is paid by the insured as co-payment. The co-payment rate as of March 2017 is as follows: pre-elementary school3 = 20%; elementary school up to age 69 years = 30%; age 70–75 years = 20%; and age 75 years or above = 10% (see more details in Chapter 3) (Ishii M, 2012).”

Source: Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H et al. Japan Health System Review. Vol. 8 No. 1. New Delhi: World Health Organization, Regional Office for South-East Asia, 2018.

“Japan’s journey towards the universal insurance system has been marked by eras of foundation, expansion and managed growth in a post-War nation. But seemingly, the path to universal insurance was illuminated by strong egalitarian principles. Comparatively, with reference to other countries at the same level of industrialization and wealth, it is not surprising that the universal insurance system could be achieved in Japan; however, what remains unusual is the breadth and depth of the health system that has been achieved.

“Unique to the Japanese health system is the existence of both: Employees’ Health Insurance plans and Community Health Insurance (CHI) plans, which are now classified as National Health Insurance. Employee’s Health Insurance system has its origin in the Bismarckian system of social health insurance in Germany. Although Employees’ Health Insurance and CHI have different origins, together they extended coverage to the entire population over time. CHI – which later became National Health Insurance (NHI), mainly covered self-employed and temporary workers.

“The history of national insurance systems after the Second World War was marked by a movement towards attaining a higher level of care, in terms of health-care and welfare similar to that of Western nations. Even now, tensions among contending political parties, interest groups and public opinion on health care and health insurance have continued to influence political debate, especially during national elections.”

Source: Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H et al. Japan Health System Review. Vol. 8 No. 1. New Delhi: World Health Organization, Regional Office for South-East Asia, 2018.

“The government regulates and controls nearly all aspects of the health system, including the health insurance system. Across the 47 prefectures, there are a total of 1718 municipalities. There are three types of municipalities in Japan: cities, towns and villages. The Central and local (prefectural/municipal) governments are responsible by law for ensuring a system that efficiently provides quality health-care services. The Central Government sets the nationally uniform fee schedule for insurance reimbursement and subsidizes and supervises local governments, insurers and health-care providers. It also establishes and enforces detailed regulations for insurers and health-care providers at the prefecture levels.

“Based on regional context, each prefecture is required by the Health Care Structural Reform Act passed in June 2006 to create detailed descriptions called “Medical Care Plans (MCP)”. By promoting collaboration and differentiation of medical institutions, these MCP aims to secure medical services for local residents, where necessary healthcare will be provided seamlessly from the acute phase to the long-term phase, including in-home care. Initially, the MCP was introduced in 1986 to control the escalating number of hospital beds. However, the 2006 Act strengthened the MCP by adding “disease-specific integrated clinical pathways” and stipulating effective liaisons among providers (clinics and hospitals) on a disease-specific basis. One should be cautioned that “integrated clinical pathway” is different from “in-hospital clinical pathway,” which aims to streamline the hospitalization. MCP may include evaluations of quality of care on a regional basis, and some prefectures also included clinical indicators. However, most indicators are limited to structural and process measures, and outcome indicators are not included.

“Each prefectural government is responsible for developing this “MCP” for effective and high-quality health-care delivery. Prefectural governments are also in charge of annual reviews and inspections of hospitals to ensure maintenance of compliance with regulatory standards. If a hospital admits too many patients per nurse – an indication of a poor quality of hospital care – the reimbursement rate for the hospital is reduced.”

Source: Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H et al. Japan Health System Review. Vol. 8 No. 1. New Delhi: World Health Organization, Regional Office for South-East Asia, 2018.

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. 28, 2022 by Doug McVay, Editor.