Japan is the fastest aging country, with the largest super-aged society in the world and growing larger by the day, yet its universal health care costs are relatively low. In Health Insurance Politics in Japan, Takakazu Yamagishi draws back the curtain for an international audience and investigates how Japan has been able to control health care costs through health insurance politics. Covering the period from the Meiji Restoration to the Abe Administration, Yamagishi uses a historical institutionalist approach to examine the driving force behind the development of health insurance policies in Japan. Yamagishi pays special attention to the roles of government and medical professionals, the main actors of the policymaking and medical worlds, in this development. Health Insurance Politics in Japan pushes Japan into the spotlight of the international conversation about health care reform.

This book explains the origins and early developments of Japanese medical insurance systems from the 1920s to the 1950s. It closely examines the changes in the systems and the symbiotic relationship between Japan’s status in international relations and the development of domestic medical insurance systems. While previous studies have regarded the origins and development of Japanese medical insurance systems as merely a domestic issue and pay little attention to the role or effects of international affairs, this book closely examines the changes in these systems by looking at the enactment of the Health Insurance Law in 1922, the establishment of the National Health Insurance in 1938, the epoch-making reforms of 1942, numerous plans in the early Allied occupation period, and Japan’s social security plan in 1950. In doing so, it shows that there was indeed a symbiotic relationship between Japan’s status in international relations and the changing nature of domestic medical insurance systems. It also reveals that Japan’s status in international relations set the framework within which interested groups, primarily the government, made rational choices. This book is a valuable resource for academics, researchers and students who have an interest in the Japanese medical insurance systems.

Compared to the rest of the world, Japan has a healthy population but pays relatively little for medical care. This book analyses how the health care works, and how it came into being. Taking a comparative perspective, the authors describe the politics of health care, the variety of providers, the universal health insurance system, and how the fee-schedule constrains costs at both the macro and micro levels. Special attention is paid to issues of quality and to the difficult problems of assuring adequate high-tech medicine and long-term care. Although the authors discuss the drawbacks to Japan's stringent cost-containment policy, they also keep in mind the possible implications for reform in the United States. Egalitarian values and a concern for 'balance' among constituents, the authors argue, are essential for cost containment as well as for access to health care.

World War II forced extensive and comprehensive social and political changes on nations across the globe. This comparative examination of health insurance in the United States and Japan during and after the war explores how World War II shaped the health care systems of both countries. To compare the development of health insurance in the two countries, Takakazu Yamagishi discusses the impact of total war on four factors: political structure, interest group politics, political culture, and policy feedback. During World War II, the U.S. and Japanese governments realized that healthy soldiers, workers, mothers, and children were vital to national survival. While both countries adopted new, expansive national insurance policies as part of their mobilization efforts, they approached doing so in different ways and achieved near-opposite results. In the United States, private insurance became the predominant means of insuring people, save for a few government-run programs. Japan, meanwhile, created a near-universal, public insurance system. After the war, their different policy paths were consolidated. Yamagishi argues that these disparate outcomes were the result of each nation's respective war experience. He looks closely at postwar Japan and investigates how political struggles between the American occupation authority and U.S. domestic forces, such as the American Medical Association, helped solidify the existing Japanese health insurance system. Original and tightly argued, this volume makes a strong case for treating total war as a central factor in understanding how the health insurance systems of the two nations grew, while bearing in mind the dual nature of government intervention -- however slight -- in health care. Those interested in debates about health care in Japan, the United States, and other countries, and especially scholars of comparative political development, will appreciate and learn from Yamagishi's study.

The Japanese health care system provides universal coverage to a healthy but aging population. Its costs are among the lowest in the world and have remained nearly constant as a share of the economy for more than a decade. Americans concerned about runaway medical spending need to know about the successes that Japan has experienced and the problems the country has encountered in its effort to control costs while maintaining quality of care. Offered here is an analysis of the key issues of cost-containment by specialists followed by reactions from some of America's best-known experts on health care delivery and finance. Topics include the macro-and microeconomics of health care, technology and costs, institutions and costs, attitudinal and behavioral aspects, and the politics of health care. This collection provides an authoritative study of successful cost-containment in the Japanese health care system---a chronicle of success that is neither a statistical illusion nor a result of sociocultural factors. Detailed here is information on the key mechanism of cost constraint: a fee schedule that covers virtually all medical services and rewards inexpensive services while making expensive services unprofitable. This system has resulted in the provision of quality health care to the entire population at roughly half the cost of American health care. Is it a single-payer system? Would the United States have to introduce a dramatically altered health care structure to benefit from the Japanese experience? No. Japan relies mainly on fee-for-service medicine financed by multiple insurers---a system familiar to Americans and one from which many lessons may be learned. Based on conferences held in Washington, D.C., and Izu, Japan, this volume collects original chapters on the overall cost structure, how the negotiated mandatory fee schedule works, specific mechanisms for cost control, the politics of health care financing, and the impact of cost cutting on quality, among other topics. These pathbreaking studies will be a significant resource for policymakers and scholars interested in comparative health care systems as well as those interested in health care reform in the United States.

Japan is suffering from a "device gap." Compared to its American and European counterparts, Japan lags in adopting innovative medical devices and making new treatments and procedures available to its patients. Many blame its government and bureaucracy for Japan's delayed access to modern medicine and new medical devices. Christa Altenstetter examines the contextual social, historical, and political conditions of Japan's medical field to make sense of the state of the country's medical profession and its regulatory framework. She explores the development of regulatory frameworks and considers possibilities for eventual reform and modernization. More specifically, Altenstetter looks into how physicians and device companies connect to the government and bureaucracy, the relationships connecting Japanese patients to their medical system and governmental bureaucracy, and how the relationships between policymakers and the medical profession are changing. The issues addressed here are becoming increasingly relevant as numerous countries in Asia, Latin America, and Central and Eastern Europe are only now beginning to regulate medical technology, following the lead of the US and the European Union. Those interested in global medicine and Asian studies will find this book both informative and compelling.

The goals of universal health coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey have shown how UHC can serve as a vital mechanism for improving the health and welfare of their citizens and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low-income and middle-income countries, where most of the world’s poor live. Universal Health Coverage for Inclusive and Sustainable Development synthesizes the experiences from 11 countries—Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam—in implementing policies and strategies to achieve and sustain UHC. These countries represent diverse geographic and economic conditions, but all have committed to UHC as a key national aspiration and are approaching it in different ways. The book examines the UHC policies for each country around three common themes: (1) the political economy and policy process for adopting, achieving, and sustaining UHC; (2) health financing policies to enhance health coverage; and (3) human resources for health policies for achieving UHC. The findings from these country studies are intended to provide lessons that can be used by countries aspiring to adopt, achieve, and sustain UHC. Although the path to UHC is specific to each country, countries can benefit from the experiences of others in learning about different approaches and avoiding potential risks.

Ageing population poses a set of complex policy and dilemmas for social security systems, intensifying the concerns about rising expenditures in health care and long-term care for elderly. In this context, ageing societies has many valuable lessons to learn by studying Japan's experience dealing with its hyper-aged society and particularly from its strategies to ensure the financial sustainability of the Long-Term Care Insurance (LTCI) system. Based on an exhaustive literature review, and the results from six original researches on long-term care expenditures in Japan (LTCE) conducted during a doctoral program, the book provides a comprehensive view in analyzing trends and factors associated with increasing expenditures in the Long-Term Care Insurance system in Japan. The book address relevant topics such as; the main socio-demographic changes experienced by the Japanese society during the last three decades, predictors of the LTCE, measuring efficiency in nursing homes, the impact of the LTCI 2005-reform to contain expenditures, cost-effectiveness of the in-home and community based services and institutional LTCE in the last year of life. The book end with a discussion on futures challenges and strategies oriented to contribute with the sustainability of LTCI system in Japan.