8/14/2019 Japan Health Care
1/40
8/14/2019 Japan Health Care
2/40
DAIKANGEI
8/14/2019 Japan Health Care
3/40
Contents
PART I
Introduction to Japan
Vital Statistics
Organisation of Ministry of Health Japan
Regulations and Policies in vogue
Vision of the Ministry of Health Japan 21
Social Marketing
Health Financing
Health Insurance
Health Care Reforms
Conclusion
8/14/2019 Japan Health Care
4/40
PART I
The World Health Organization (WHO)announced in the report WHO 2000 that thestate of Japanese health is ranked the first inthe world, and the performance of theJapanese health care system is tenth in theworld
8/14/2019 Japan Health Care
5/40
Country Demography
Independence: 660 BC (founded by Emperor Jimmu)
Area: 377,864 sq. km.
Constitutional Monarchy
Japanese 99.4%, other 0.6% (mostly Korean)
Religions are both Shinto and Buddhist 84%, other 16%Literacy: 99% (age 15 who can read and write)
Capital: Tokyo
Administrative Divisions: 47 prefectures
Constitution: 3 May 1947
8/14/2019 Japan Health Care
6/40
Population and Health Data (2002 estimates)
Population [Total] 127 435 000 Life expectancyat birth (years)[0-14 years] 18 102 000
(14.20%)[Male] 78.32
[65+ years] 23 628 000(18.54%)
[Female] 85.23
Crude birth rate(per 1 000 population)
9.20 Total fertility rate 1.32
Crude death rate(per 1000 population)
7.80 Populationserved withsafe water
96.70 %
Infant mortality rate(per 1000 live births)
3.00 Population with adequatesanitary facilities
98.40 %
Maternal mortality rate(per 100 000 live births)
7.10
Vital Health Statistics
8/14/2019 Japan Health Care
7/40
Health Care Facilities (2002estimates)
Predominantly owned and operated by the private sector
Hospitals 9,731 (Provide out-patient and in-patient care)
72% of the hospitals (54.6% hospital beds) are classified as private sector
General Health Clinics: 85,588 (92% primarily offer out-patient services)
Dental clinics: 57,213
Beds ratio: 1 bed / 65 persons
Doctors: 230,000 (184 doctors for 100,000 people)
Most physicians and hospitals sell medicine directly to patients
36,000 Pharmacies provide synthetic or herbal medication
8/14/2019 Japan Health Care
8/40
Ministry of Health, Labour &Welfare
8/14/2019 Japan Health Care
9/40
Ministry of Health & Welfare
External Bureaus
Affiliated Institutions
Local Branches
Internal Bureaus
8/14/2019 Japan Health Care
10/40
Organisational Highlights MOH Japan
In Japan Healthcare is classified as:In-patient services
Out-patient services
There are NO categories named day-careDay-surgery is classified as out-patient services
8/14/2019 Japan Health Care
11/40
Organisational Highlights MOH Japan
Health care facilities range from
Small neighbourhood clinics to hospitals that provide moreintensive careSome companies run their own hospitals for employees
Public Health Centres provide:Health educationImmunizationPre- and post-natal carePreventive health care
Public Health services includeFree screening examinations for particular diseasesPrenatal care
Infectious disease control
8/14/2019 Japan Health Care
12/40
Health Care System Regulations
The Ministry of Justice Obihiro Comprehensive Office Building
8/14/2019 Japan Health Care
13/40
Health Care System Regulations
Highly centralized system
Government determines nearly all aspects of healthcareregulation including:
Pricing and financing
Covered proceduresStructure of healthcare delivery systems
Acts for Decentralization (July99) facilitates the shift towarda decentralized system of Government
Helps Local Governments to create their own policies
Gives local residents more participation
Japanese Medical Association (JMA) looks after the
providers interests
Hospital can bill the patient for extraroom & board charges only
8/14/2019 Japan Health Care
14/40
Health Care System Regulations
The Japanese Board of Medical Specialties, promotes knowledge
and skills under the standardized system
Medical Service Act of 1948 covers policies to include minimum
criteria of medical facilities
Ten Year Gold Plan initiated by the National Government (1989),
plans for elderly health and welfare by the year 2000
The Maternal Protection Law 1996
Ordinance-150 (2002) related to the calculation of contributions
by Insurers to the Long-term Care Insurance Scheme
Food Sanitation Law (amended 2002) prevents the occurrence of
health hazards arising from human consumption of food
8/14/2019 Japan Health Care
15/40
Vision of Ministry of Health, Labour &Welfare
8/14/2019 Japan Health Care
16/40
Healthy Japan 21
National health promotion movement in the 21st Century
Healthy Japan 21 initiated in 2000 by MHLW
This emphasizes primary prevention aiming at early
detection and treatment of diseases
The important areas targeted for improvement by 2010include:-
Improving healthy dietary habits
Promoting good exercise habits
Promoting appropriate relaxation
Promoting harmful effects of smoking & alcohol on health
The fee at healthy promotion facilities for exercise / hot
spring therapy etc. are tax deductible as medical expenses
8/14/2019 Japan Health Care
17/40
8/14/2019 Japan Health Care
18/40
Media and health Promotion
With deregulation of the Medical Advertising Law in Japan (Jul96)
advertising in the areas of new treatments and information of diseases, has become very popular
Hospitals, pharmaceutical companies and health care industries can
now present and position themselves
They are now able to build trust in their
patients & have customer satisfaction
8/14/2019 Japan Health Care
19/40
Media and Health Promotion
Health campaigns through media focused on:
Information of medical services
Promoting the concept of informed consent
Promoting disclosure of information about
medical institutionsPrevention of medical accidents
JPMA has conducted a national newspaper &
magazine campaign aimed to educatehealthcare consumers about topics related tothe work of the pharmaceutical industry
Social Anxiety Social Anxiety Difficulty (SAD)Difficulty (SAD)
Campaign in November 2001Campaign in November 2001
focused on the clinical trials processfocused on the clinical trials process
8/14/2019 Japan Health Care
20/40
Health Care Markets Challanges
Market Effects of Aging Society
Home and institutional nursing care services is at US$
65.88 billion (2000)
Market for products for the elderly and the disabled, e.g.
wheelchairs, medical kits etc, is already soaring
Govt introduced Information Barrier-free Environment:
Information Network for People with Disabilities
(Normanet)
A multimedia system can simultaneously provide letter,
voice, and image data in a set via the Normanet
8/14/2019 Japan Health Care
21/40
Health Financing
8/14/2019 Japan Health Care
22/40
8/14/2019 Japan Health Care
23/40
Japan's Health Care System
19221922
Manual WorkersManual Workers
Post World War IIPost World War II
Health Care a RightHealth Care a Right
19611961Universal Health CoverageUniversal Health Coverage
Preventive CarePreventive Care
Curative CareCurative Care
Medical services areavailable to all citizens
FinanceFinance
GovernmentGovernment
Tax DeductionsTax Deductions
FinanceFinance
Pay Roll DeductionsPay Roll Deductions
Tax DeductionsTax Deductions Patient co-payments
Employer-purchased Insurance
J H lth I
8/14/2019 Japan Health Care
24/40
Japan Health Insurance Background
Public Health Insurance Scheme 1927 (enterprises with 10employees or more)Regional Health Insurance Scheme 1938 (self-employed on avoluntary basis)1961- Public Health Insurance Scheme covered the whole
population1973 70 yrs or over persons were exempted from payment for health servicesHealth Service System for the Elderly 1983, includedmoderate co-payments by the elderly. In 1986 this wasextended to Intermediate Nursing FacilitiesLong-term Care Insurance System 2000, extended coveragefor:
Nursing homes and the supporting services for home care
Required contributions by the elderly themselves
8/14/2019 Japan Health Care
25/40
Types of Health Insurance s
Employee's Health Insurance
For regular workers
The employer handles all the paperwork and premium
payments will be deducted from salary
The National Health Insurance
For everyone who does not qualify for employee's
insurance - such as students and self-employed workers
The registration and payment procedures are done by
the individual
http://www.yokkaichi-u.ac.jp/~ushijima/my_mpeg/2002/image/020119_1_31_hokenshou.jpghttp://www.yokkaichi-u.ac.jp/~ushijima/my_mpeg/2002/image/020119_1_31_hokenshou.jpg8/14/2019 Japan Health Care
26/40
How Health Insurance Works
The Health Insurance Card (hoken-shou) is one per household, which is to be presented at the clinic or hospital
This is a valuable piece of personal identification
It is also used as identification in a variety of contexts:
Proof of address when you apply for a video rentalcard
Identification at financial institutions and personal
loan companies
8/14/2019 Japan Health Care
27/40
All What Is Insured
Insured:
Only diagnostic and treatment services
Basic dental treatment
Not Insured
Preventive care and cosmetic procedures
Neo- and postnatal care
Normal childbirth procedures
Some doctors whose clinics specialize in English
language services
Preventive dentistry
Cleaning and whitening of teeth
8/14/2019 Japan Health Care
28/40
Mode of Payment
Employee's Insurance20% of medical costs to the cashier of the hospital
National Insurance
30% of medical costs to the cashier of the hospital
Family members also pay 30%
8/14/2019 Japan Health Care
29/40
Charges For A Typical Case
Acute AppendicitisEmergency surgery and hospital stay 7 days
Initial Consultation Fee 2500
Hospital Charge (7days) 116270
Laboratory 31690
X Ray 18760Medication 1510
IV 14950
Bandage etc 3520
Surgery (Appendectomy) 64200
Anesthesia 10680
TOTAL 264080
(patient co-payment) 63600
yen, $1=125yen
8/14/2019 Japan Health Care
30/40
8/14/2019 Japan Health Care
31/40
The Need For Reforms
Problems Health Reforms 2002
Administrative
Japan's health insurance systemis "universal but fragmented"
systemUniversal guarantees that everysingle person is insured andmedical care is guaranteed toevery body
Fragmented in that there is aconsiderable inequality as to thepremium burden
The co-payment rate for employer'sinsurance raised from 20% to 30%Proposal to consolidate the presentMunicipal and the Governmentmanaged health insurance atprefectural level by 2007
8/14/2019 Japan Health Care
32/40
Medical Care Expenditures
8/14/2019 Japan Health Care
33/40
The Need For Reforms
Problems Health Reforms 2002
Financial
The total amount of nationalgovernment subsidies in the
FY2004 budget is 8.1 trillionIncrease in medical cost andslow increase in revenues
Growth of expenditure is not
controlled to a level that is in linewith economic growth
The co-payment rate for employer'sinsurance raised from 20% to 30%
The limit on monthly amount of co-payment raised from [63,600 yen to72,300 yen + 1% of the actual medicalcost]General outpatient drug co-payment is
abolishedThe premium rate for governmentmanaged health insurance raised from85% of monthly income to 82% of annual income
8/14/2019 Japan Health Care
34/40
The Need For Reforms
Problems Health Reforms 2002
Pharmacy
Over-prescription of drug bydoctors and hospital
There was a 15% profit margin(R-zone) in 1998 which wasreduced to 2% in 2000
Medical fees and drug pricing reducedby 1.0% in 2004
8/14/2019 Japan Health Care
35/40
The Need For Reforms
Problems Health Reforms 2002
Elderly
The annual growth rate of totalmedical expenditure for the
elderly in the past decade was8%
Expected to remain high over 5%
(The average medical cost for theelderly at and over 65 yrs old is 5 times as high as that for younger
persons)
The senior healthcare schemereformed as follows:
The eligible age would be raisedfrom 70 to 75 over a 5 year periodThe proportion of governmentsubsidies to total insuranceexpenditure would also be raisedfrom 30% to 50% over the same 5year periodThe co-payment rate unified at 10%
Transition in Source of Financing for
8/14/2019 Japan Health Care
36/40
Transition in Source of Financing forElderly
8/14/2019 Japan Health Care
37/40
The Accomplishment
The World Health Organization (WHO) announced in the report WHO 2000 thatthe state of Japanese health is ranked the first in the world, and the performance of the Japanese health care system is tenth in the world
8/14/2019 Japan Health Care
38/40
Heavy Investment in Preventive Care
Health Budget 2002Health Budget 2002
8/14/2019 Japan Health Care
39/40
The Best Solution..
Invest in Preventive Health
NOW..!!!!NOW..!!!!
8/14/2019 Japan Health Care
40/40