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.