Lessons from Japan on Universal Health Coverage

Susan Hubbard, JCIE/USA
December 12, 2015

On December 16, JCIE and the government of Japan held a conference on universal health coverage (UHC) and the new development agenda. The JCIE Global Health Special Series comprised four blogs that ran from December 12—also known as “UHC Day”—up until the start of the conference. This is the first of those blogs.

Today is UHC Day, created to commemorate the unanimous endorsement of a UN resolution on December 12, 2012, that urged governments to ensure universal access to health services for all people without causing them financial hardship. The goal of UHC has been gaining political momentum around the world in recent years, but it is far from being a new concept. In fact, Japan can be commended for achieving UHC in 1961—more than 50 years ago. While Japan is among the world’s wealthiest countries today, it is important to remember that in 1961 Japan was still a developing country. In other words, UHC is not just a luxury of wealthy countries but rather a basic human need in every country, regardless of GDP.

Japan is widely recognized as one of the world’s healthiest societies, and its people enjoy the longest life expectancy of any country. Remarkably, it has achieved these levels while still spending a much lower portion of its GDP on health than most other advanced industrialized countries.

Of course, Japan’s health system is certainly not without its own problems, especially given the growing healthcare burden it faces with a rapidly aging population. Still, it is useful to reflect on what has been achieved so far, especially since some of those lessons can be applied in other countries that are working toward achieving UHC.


A waiting room at Maizuru Red Cross Hospital in Kyoto (Photo: 硲彪)

So what are some of the secrets to Japan’s success? The Japan Center for International Exchange (JCIE) has worked closely with partners in Japan and around the world to better understand how Japan has been able to maintain UHC for more than 50 years and keep its population relatively healthy. The following are three key lessons for consideration while celebrating UHC Day 2015:

  1. Use of a global fee schedule: One unique aspect of Japan’s health system is the global fee schedule that is revised and agreed upon at the national government level every two years. Once the government sets the allowable fees for every health service and product—through careful calculations that take into account unit price and volume—every single provider across the country is required to charge the exact same amount and is banned from negotiating different prices with different payers, reducing unpredictability and overall healthcare costs. Japan’s system of setting the global fee schedule may not be feasible in every country, but aspects of it may be applied elsewhere to control healthcare costs.
  2. Equity: Cross-subsidization across the different types of health insurance plans, as well as government subsidies from general tax revenues allow all plans to provide the same benefits with similar premium and copayment rates despite the large disparities in the age and health profile of enrollees across plans. The global fee schedule has also helped Japan avoid the disparities between public and private health services that have plagued some other health systems.
  3. Putting prevention and health promotion in patients’ hands: One health promotion tool in Japan that has received a great deal of global attention is the Maternal and Child Health Handbook, which compiles prenatal and childbirth records and tracks the child’s development from birth through the sixth year, as well as the child’s immunization and illness history. Every family receives one when they become pregnant, and many parents hold onto them even after their children are well into adulthood. Another tool, the ningen dock—essentially, “human dry dock”—is a comprehensive medical examination that is followed up by a consultation with the physician tailored to each patient after their test results come back, allowing patients to make healthy lifestyle changes to control their risk factors at an early stage.

Japan’s rapidly aging population and the 2011 earthquake and ensuing tsunami and nuclear disaster have exposed numerous vulnerabilities in its health system, while the country’s economic stagnation over the past several decades has added to the challenges that it faces in sustaining UHC. Nonetheless, Japan’s experience still offers many lessons for countries around the world striving to build more resilient health systems.

JCIE Global Health Special Series

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