Japans Health System

This book provides an examination of the American health care system, a benchmark for cost-containment efforts, exploring two worlds: that of cost containment and that of the patient experience. It emphasises on the quality of care as perceived by the individual patient.

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.

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.

During the past three decades, health care systems in the East Asian regions of China, Japan, South Korea, and Taiwan have undergone major changes. Each system has its unique achievements and challenges. Global health care policymakers are increasingly interested in understanding the changes that have taken place in these four systems. This four-volume reference set is designed to help health care professionals, academics, policymakers, and general readers gain a good grasp of the background and latest developments in the health care systems of China, Japan, South Korea, and Taiwan. This reference set provides an in-depth comparative health policy analysis and discussion of health care reform strategies in each of these systems. One unique feature of this set is that each volume has been edited by a leading scholar who has been deeply involved in the development of the health care system in that particular region. Each of these editors also has invited both scholars and practitioners to provide a first-hand description and analysis of key health care reform issues in that system. The many examples provided in each volume demonstrate how findings of evidence-based policy research can be implemented into policy practice.Volume 1 describes and discusses China's ambitious and complex journey of health care reform since 2009. The Chinese government has achieved universal health insurance coverage and has embarked on reforms of the service delivery system and provider payment methods that are aimed at controlling health expenditure growth and improving efficiency. This volume includes pilot and social experiments initiated by the government and researchers and their evaluations that have guided the formulation of health reform policies. It provides information on how to make reforms work at the local and provincial levels. The findings detailed in this volume will contribute to a global knowledge base in health care reforms.Volume 2 provides a comprehensive review and evaluation of the Japanese health care system. Japan has a long history of health care system development and provision of universal health coverage, with a mature and well-developed health care system among East Asian countries. However, due to increases in health care costs, economic stagnation and the country's rapidly aging population, Japan has undergone significant health care reform during the last two decades, both in the delivery as well as financing of health services in its hospital sector, medical technology sector and long-term care insurance. Despite these challenges and reforms, health outcomes among the Japanese population have been progressively among the best in the world. This volume shows how policy research can lead to policy analysis, implementation and assessment. It also provides valuable lessons learnt for mutual learning among other health care systems.Volume 3 offers a comprehensive review of the developments in South Korea's national health insurance system since 1989 in terms of financing, delivery systems, and outcomes. The volume analyzes the efficiency of cost and service delivery by public sectors versus private sectors. It points out areas of challenge to future Korean health care reform. Chapter authors in this volume are leading experts involved in Korean health care policy implementation.Volume 4 reviews the development and achievements of Taiwan Health Insurance since 1995. Because of its continuous reform in payment, services delivery, and pharmaceutical technology, Taiwan has been considered a model example of universal health insurance among global health systems. This volume shows the processes used to translate policy research findings into policy changes. While the health care reform in Taiwan is ongoing, the Taiwan example provides a real-world and practical understanding of health care system changes.In summary, this four-volume set makes an outstanding contribution to health care system reform and policy research, based on solid scholarly work. It also introduces policy researchers and academic communities to current debates about health systems, health financing, and universal health coverage. This reference volume is a must for anyone keen on East Asia's health care system reform dynamics and changing scene.

In the 1970s and 80s Japan experienced some deep-rooted social changes which affected attitudes to health care services among both professionals and consumers alike. Health Care in Japan provides an introduction to and overview of health and medical services in Japan at that time. It describes the historical development of modern medical care; the social, political, and cultural factors which have influenced the development of the system for the provision of health and medical services. It also discusses and analyses those aspects of the health care system which are of concern to the government and assesses how the existing system of health care will meet the needs of Japanese society in the future.

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.

A New York Times Bestseller, with an updated explanation of the 2010 Health Reform Bill "Important and powerful . . . a rich tour of health care around the world." —Nicholas Kristof, The New York Times Bringing to bear his talent for explaining complex issues in a clear, engaging way, New York Times bestselling author T. R. Reid visits industrialized democracies around the world--France, Britain, Germany, Japan, and beyond--to provide a revelatory tour of successful, affordable universal health care systems. Now updated with new statistics and a plain-English explanation of the 2010 health care reform bill, The Healing of America is required reading for all those hoping to understand the state of health care in our country, and around the world. T. R. Reid's latest book, A Fine Mess: A Global Quest for a Simpler, Fairer, and More Efficient Tax System, is also available from Penguin Press.

During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages-cancer and cardiovascular disease-available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which-unlike randomized controlled trials-are subject to many biases.