U.S. State Department Geographic Bureaus: East Asia and Pacific Bureau

Health Care in Japan

Fact sheet released by the Bureau of East Asian and Pacific Affairs,
U.S. Department of State, July 31, 1997.

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Japan has the longest life expectancy--76 years for men and 82 for women--and among the lowest infant mortality rates in the world. A prime factor in Japan's success has been the nation's health care system, which offers universal coverage and stresses preventive care. Eighty percent of Japan's hospitals and 94 percent of its physician-run clinics are privately owned. Patients are free to select care providers, and competition ensures an adequate number of facilities, except in rural areas. Investor-owned, for-profit hospitals are prohibited.

While recently on the rise, health care costs remain relatively low in Japan. Prices are regulated through a "fee schedule" determined by the Ministry of Health and Welfare in consultation with insurers, health care providers and consumers. All doctors receive the same salary regardless of experience.

Most Japanese employees and their dependents obtain health insurance through their employers, financed largely through mandatory payroll contributions from both employers and employees. The self-employed, people working for small businesses, and others not covered can apply to the government for low-cost National Health Insurance, which provides coverage similar to workplace-based insurance.

The Japanese focus on preventive care has played an important role in containing costs. Using tax revenues, for example, the government promotes preventive programs for the middle-aged. However, the rapid aging of Japan's population--by 2025, a quarter of the population will be 65 or older--has raised concerns about rising health care costs. To address concerns about an aging Japan, the Ministry of Health and Welfare has begun to shift the emphasis of care for the elderly from institutionalization to prevention, rehabilitation and community-based care.

While quite successful, the Japanese health care system is not without its share of problems. Some in Japan have asserted that private practitioners, limited in the fees they can charge, have a tendency to over-prescribe drugs from their attached pharmacies. In addition, some writers have also stated that health care procedures (like heart transplants) and technology are not as advanced as those in the United States.

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