Towards a Sustainable Health Insurance System in Japan

The health insurance system in developed countries may be classified into three typesof system, namely ( 1 ) a national health service, as in the United Kingdom and Sweden,( 2 ) a social insurance and public health service, as in Germany and Japan, ( 3 ) privatemedical services supplemented by public medical services, as in the U.S.Because of population ageing and the progress of medical technology, the financial situationof social security for health is assumed to be especially severe in Japan where populationaging is proceeding rapidly.Fundamentally three policies are required. First, a higher rate of economic growth andlower rate of unemployment will be required to mitigate the financial difficulties involvedin implementing social security policies. Secondly, in the long run, if the ageing of thepopulation slows down, the financial situation of social security and health insurance inthe future will be brighter than current forecasting suggests. Thirdly, if the proportion ofthe direct costs charged to patients becomes higher, medical costs will be restrained to acertain extent.Regression ( 1 ), which is based on time series data of more than fifty years suggeststhat the above four points are probable.As characteristic features of, and problems faced by, health services as the social securityin Japan the following factors can be identified.( 1 ) The so-called free access system. However, recently, with a view to mitigatingcongestion in large hospitals, large hospitals have begun to require patients to have an introductionfrom family doctors. Family doctors sometimes carry out the role of so-called"gate keepers".( 3 ) Excessively long stays in hospitals and a severe shortage of nursing homes are notoriousfeatures of health services in Japan. However, thanks to the development of nursing home and personal social services since 2000, long stays in hospital are decreasingsomewhat. Still, there is a serious shortage of personal social services for the elderly.( 4 ) Too many expensive medical machines per member of the population such as machinesto carry out CT scans, MRI scans, etc.( 5 ) The high proportion of the cost of medicaments within the total medical costs.( 6 ) The distinguished position of the doctor in the medical team.The above features and problems in Japan are gradually improving.The proportion of social security costs for health services to national income is 9.82%in 2012, which is around the middle of OECD countries. Considering the very high rateof population ageing and the long average lifespan of Japanese people, the Japanese medicalservices function fairly well.The proportion of social security costs for health services to national income is highlyinfluenced by ( 1 ) the proportion of aged people to the total population or to employees,( 2 ) economic factors such as the rate of economic growth and the unemployment rate,( 3 ) the proportion of payments made by patients as a contribution to the total medicalcosts as regression suggests. The proportion of annual medical costs to national incomesince 1960 is explained by regression equation ( 1 ). Regression ( 1 ) suggests that besidesthe ageing population and the patient fee, economic factors such as economic growth andthe unemployment rate influence the financial situation of medical services.In order to maintain sustainable medical services, the above problems have to be improved.M/Y = 3.811 + 0.102n + 0.254u – 1.024g + 0.110r -----( 1) (19.174) ( 14.752) ( 4.934) ( –3.044) ( –9954)R = 0.993R -2 (adjusted co-determined co-efficient) = 0.985, Figures in parentheses are t-valuesM: Social security costs for health services, Y: National income, n: Proportion of agedpeople more than 65 years old to the employed persons, g: Rate of economics growth, u:Unemployment rate. r: Proportion paid directly by patients as a contribution towards thetotal medical costs.

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