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

Reflections on

Japan’s 50 Years of

Universal Health Coverage

Michael R. Reich

Global Health & Population, HSPH

26 April 2012


Reflections

“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


Michael r reich global health population hsph 26 april 2012

Field Research in Japan, 1971-74

Me


Presentation based on lancet japan series

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

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 women for g7 countries

Life Expectancy of WomenFor G7 Countries

source: MHLW.


Japan s under 5 morality 1950 2008

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 achieving universal health coverage

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

Medical Expenditure among OECD Countries (2005)

source: MHLW.


Reasons for japan s successes

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


Michael r reich global health population hsph 26 april 2012

Perry and his Black Ships

“Open” Japan in 1853


Recent historical context 1

Recent Historical Context - 1

  • About 3.2 million deaths during WW2

Hiroshima after the Bomb


Recent historical context 2

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


Michael r reich global health population hsph 26 april 2012

Expanding Coverage


Japan s achievements

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

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

Serious problems in Japan’s Political Economy

  • Twenty years of economic stagnation


Japan s challenges ahead

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

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

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

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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