The Future of Japan's Health System — Sustaining Good Health with Equity at Low Cost  

Oleh:

Reich, Michael R. ; Shibuya, Kenji

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 373 no. 19 (Nov. 2015), page 1793-1797.

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Perpustakaan FK Nomor Panggil: N08.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Four years ago, Japan celebrated 50 years of achievement of good health at low cost and increasing equity for its population.1 In 1961, at the beginning of a period of rapid economic development, while the country was still relatively poor (with a gross domestic product [GDP] half the size of Britain's), Japan reached full health insurance coverage of its population. In the next half-century, it continued to develop its health system and improve equity, even applying this principle of universal health coverage in its global health diplomacy.1 Now, however, Japan faces serious fiscal pressure due to a sluggish economy and the rapid aging and low birth rate of its population — but it is striving to sustain its health system in the face of these challenges. Japan followed a nonlinear path to universal coverage. Previous Japanese policymakers were sometimes motivated to develop the health system for reasons of political economy that were unrelated to health. For example, Japan's first national policy for health insurance was introduced in 1923, motivated in part by imperial visions and the desire for a strong and healthy workforce for war. During World War II, Japan achieved nearly 70% health insurance coverage. Then, in the post-war period, political competition among the major parties promoted government efforts to expand coverage, as the conservative Liberal Democratic Party sought to provide benefits to its rural constituents and to weaken the agendas of the Socialist and Communist parties by redistributing social resources to industrial workers. Japan was not unique in this regard: in countries such as Britain and Germany, the process of attaining universal health coverage also stretched over long periods and was advanced by various political motivations.2 Though such mixed origins don't diminish the value of Japan's health policy accomplishments, they do highlight the importance of viewing the process from historical and political perspectives.

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