Michael r reich global health population hsph 26 april 2012
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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

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Michael R. Reich Global Health & Population, HSPH 26 April 2012

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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, kokuminkaihokenseido (国民皆保険制度) = 50 years

  • Japan has had Michael coverage since 1971 = 40 years


Field Research in Japan, 1971-74

Me


Presentation Based onLancet 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


Life Expectancy of WomenFor G7 Countries

source: MHLW.


Japan’s Under-5 Morality(1950-2008)

92 (1950)

Boys

Girls

MDG 4: Reduce by 2/3’s

(1950-1965)

24 (1965)

Source: ランセット日本特集号 Population Health


In 50 Years Since AchievingUniversal 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


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


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


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


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


Serious problems in Japan’s Political Economy

  • Twenty years of economic stagnation


Japan’s Challenges Ahead

  • Three major issues for Japan’s health system:

  • National fiscal situation and healthcare financing

  • Political governance

  • Changing expectations about health and quality


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


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


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


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