HEALTH SYSTEM IN FOCUS
description
Transcript of HEALTH SYSTEM IN FOCUS
![Page 1: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/1.jpg)
HEALTH SYSTEMIN FOCUS JAPAN
Reporters: Lustre,Ceferino Salisi, James
Members: Sabularce, Joey Motos, Jeffrey
de Guzman,Angelo Dubrico, Gretchen
![Page 2: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/2.jpg)
Profile of JAPAN
• 3rd largest economy in the world (recently surpassed by China)
• constitutional monarchy with a parliamentary government
• 47 perfectures
![Page 3: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/3.jpg)
• Japan has a healthcare system characterized by universal health insurance coverage, as all Japanese citizens belong to one of the country’s health insurance systems.
![Page 4: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/4.jpg)
• hybrid system funded by job-based insurance premiums and taxes -- is universal and mandatory, and consumes about 8 percent of the nation's gross domestic product
![Page 5: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/5.jpg)
BISMARCKIAN Model• State-mandated social
insurance, started by Bismarck in 1883, 1st Chancellor in Germany• Covers all or most citizens
through employer and employee payments to insurance , while providing care through public &
private providersfound in Germany, Japan, Belgium,
France, Netherlands
![Page 6: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/6.jpg)
DEMOGRAPHIC Characteristics and Health Status of the
Japanese People
![Page 7: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/7.jpg)
Demographic Characteristics
• As of May 2010: population 127, 360, 000
Male: 62, 010, 000Females : 65, 340, 000
![Page 8: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/8.jpg)
Distribution by Age group
![Page 9: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/9.jpg)
• The average life expectancy remains among the highest in the world.
• In 2009: 86.44 years - women79.59 years – men
In 2008, the crude birth rate was 8.7 per 1000 persons and the crude death rate was 9.1 per 1000 persons
![Page 10: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/10.jpg)
NATALITY
![Page 11: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/11.jpg)
8.6 per 1,000
19.6 per
1,000
![Page 12: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/12.jpg)
Yearly comparison of live birth rates by age group of mother
![Page 13: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/13.jpg)
GENERAL MORTALITY
![Page 14: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/14.jpg)
General Mortality
• death rates had gradually declined since 1957, recording the lowest rate of 6.0 in 1979 and 1982.
• deaths have demonstrated an upward trend, and death rates have been growing, reflecting the aging of the population
![Page 15: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/15.jpg)
Trends in deaths and death rates, 1955-20068.5 per 1,000
![Page 16: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/16.jpg)
General Mortality
• Due to a highly-technological, competition-oriented society, the stress levels felt by all age groups are rising.
• The number of suicides in Japan surpassed the 30,000 mark for the first time in 1998 and has since remained in the range of 30,000 per year, registering at 30,649 in 2009.
• The number of suicides was particularly high for men in their 20s, 30s and 40s.
![Page 17: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/17.jpg)
273
143
![Page 18: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/18.jpg)
INFANT MORTALITY
![Page 19: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/19.jpg)
Trends in infant deaths and infant death rates, 1955-2006
![Page 20: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/20.jpg)
Causes of infant deaths
![Page 21: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/21.jpg)
Causes of Infant Deaths
• 30% congenital malformations
• 13.8% respiratory and cardiovascular diseases
![Page 22: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/22.jpg)
FETAL MORTALITY
![Page 23: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/23.jpg)
Trends in foetal deaths and fetal death rates, 1955-2006
![Page 24: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/24.jpg)
Health Service Delivery
(Organization and Administration)
![Page 25: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/25.jpg)
Four Primary Mechanisms:• Public health centers – prevention and
maintenance, • Physician offices – solo-practice
physician in smaller communities• Clinics – in large communities,
in-/outpatient care offered • Hospitals – more than 20 beds
and contain higher level of technology
![Page 26: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/26.jpg)
Public Health System
• 411 Public health centers by perfectures– doctor, dentist, pharmacist, veterinarian, X-ray specialist,
nurse, dietician– Regulatory (licensing, sanitation)
• 2,692 Municipal health centers– Community health promotion– General services
![Page 27: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/27.jpg)
• The four subsystems are not always closely coordinated and continually
compete for resources. • Traditional medicine is extensively
practiced and herbal medicines are widely sold.
![Page 28: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/28.jpg)
Organizational Structure
![Page 29: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/29.jpg)
Health Insurance System
• There is universal coverage of the population by statutory health insurance
• Three insurance schemes:– SMHI , for employees of large companies and
their dependents– GMHI, for employees of small to medium-sized
corporations and their dependents– NHI, for the self-employed
![Page 30: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/30.jpg)
• Public-administered financing through numerous schemes,
• Delivery is highly fragmented/decentralized,
• Private hospitals dominate the hospital system,• Hospitals operate as a closed system,• There is freedom to choose providers,• There is no gate-keeper system,
![Page 31: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/31.jpg)
• Payment system is fee-for- service under a national uniform price schedule,
• There is long waiting time but short consultation time,
• Expenditure on drugs comprises a high share of total health expenditure,
• There is no complete separation of drug prescribing and dispensing,
![Page 32: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/32.jpg)
Utilization of Health Facilities
• Overutilization– 14 consults per person per yr (vs 4 consults in US, 2003)– 13.8 days ave. stay in acute beds in hospital (vs. 5.6 US,2006)– Overprescribing of diagnostic tests (doctors own equipment)
Source: The Challenge of Reforming Japan’s Health System. McKinsey &Company Nov 2008
![Page 33: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/33.jpg)
Responsiveness and Client Satisfaction
• Long waiting time– 50% of the time > 30 mins
• Short care time spent with physician
-13.5 % < 3 mins, 54% 3-9 mins
Source: 2010 Japan Ministry of Health data
![Page 34: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/34.jpg)
Financial Risk Protection
• Overall Health spending– 14% in out of pocket expenditures
![Page 35: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/35.jpg)
HUMAN HEALTH RESOURCE
James Salisi
![Page 36: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/36.jpg)
Pharmacists
• Only secondary role versus physicians in dispensing medications
![Page 37: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/37.jpg)
Nurses• 980 nurses per 100,000 (2008 data), improved from 821 in
2000 • Nurses in Japan have similar situations as in other
OECD nations—lack of autonomy, low salaries, lack of professional recognition, MDs in teaching positions
• Public health nurses have most advanced training• Clinical nurses• Nurse midwives• Assistant nurses
![Page 38: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/38.jpg)
• Four levels of nursing:– Public health nurse: graduate program, provide home
health, pediatric check-ups, industrial health– Clinical nurse: 3 yrs beyond high school, 80% in hospital,
15% in clinics– Nurse Midwives: Critical role in prenatal care and delivery,
clinical training & practicum, 50% hospital based, 33% own practice
• Assistant nurse: 2 year vocational program, like LPN in US (Tracey Lynn Koehlmoos, PhD, MHA,Lecture 13, HSCI 609 Comparative International)
![Page 39: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/39.jpg)
Physicians• Decline in number especially in pediatrics and obstetrics
– 222 per 100,000 in 2008 (very low for OECD, since average is 300 per 100,000)
• No academic differentiation between specialist and generalists
• Most clinics and small hospitals are owned and operated by private physicians
• However, the trend is now away from private FFS practice toward more prestigious, salaried hospital-based practice (Tracey Lynn Koehlmoos, PhD, MHA, Lecture 13, HSCI 609 Comparative Internation)
![Page 40: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/40.jpg)
• Physicians as businessmen• Physicians as pharmacists• Physicians as policy makers• No emphasis on informed consent or full
disclosure
![Page 41: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/41.jpg)
Midlevel and other Health Professionals
• Allied medical professions have been slow to develop
• Midwives, health admin, mental health counselling, psychotherapy,
• Medical technology• Emergency medical services• Long term care
![Page 42: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/42.jpg)
HEALTH FINANCING
![Page 43: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/43.jpg)
• Universal insurance (all employers offer coverage for employees and dependents, 1995) –started 1961
• National insurance program supplements for those not fully employed
• Health Insurance Law of 1922• New Medical Service Law 1948
![Page 44: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/44.jpg)
• Health costs are lowered by:– limiting prices for pharmaceuticals and
discouraging high-cost services
![Page 45: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/45.jpg)
• Promoting an appropriate combination of the fee-for-service reimbursement system (medical fees are paid for each medical act)and fixed payment system (a fixed amount of fee is paid regardless of individual medical act), and encouraging appropriate divisionof roles and collaboration between hospitals and clinics.
![Page 46: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/46.jpg)
• Health and welfare services for disabled and senior citizens
• The proportion of Japan's social security expenditure to national income registered 24.4 percent. (70% elderly cost) – SHJ 2010
![Page 47: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/47.jpg)
Distribution of health spending
• 49.2% insurance• 36.4% taxes• 14.4% out of pocket
• 1/3 of spending for elderly
Source: Japan:Health Systems Review,vol. 11, No.5, World Health Organization, 2009
![Page 48: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/48.jpg)
Health Spending
• 6.6% of GDP (Gross Domestic Product), among the lowest in OECD countries, from a low of 2.6% of GDP in 1956, yet GDP growth is stagnating
• $ 2,600 per capita in 2005
![Page 49: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/49.jpg)
Health Facilities
• 80% of hospitals and 94% of clinics(20 beds) are privately owned
![Page 50: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/50.jpg)
Health Regulation and Governance
![Page 51: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/51.jpg)
Health Regulation and Governance
The New Medical Service Law (1948)basis for development and regulation of healthcare
facilitiesMedical Care Council recommends and coordinates
hospital services and clinics
• Health Promotion Law (2002) – importance of an environment conducive to healthier lifestyles as
strategy for the ageing society
![Page 52: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/52.jpg)
• Universal Insurance coverageCoverage for all citizens including nonemployed in
1961
![Page 53: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/53.jpg)
1. Medical Care Acthuman and capital resources are regulated
2. Health Insurance Actfinancing is regulated
![Page 54: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/54.jpg)
Regulation at central government level
• Supervision and regulation of health care providers (hospitals and clinics)regarding health insurance
• Pharmaceutical manufacturing and imports• supervises the pharmaceutical industry over
manufacturing, clinical trials and post-marketing surveillance
![Page 55: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/55.jpg)
Regulation at prefecture level
• The Medical Care Act delegates regulation of health care providers (hospitals, clinics, pharmacies and health care homes) to the prefecture governments.
• stand in the forefront of activities and responsibilities
• health insurance reimbursement and health service management
![Page 56: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/56.jpg)
Regulation and governance of the purchasing process
• Contracts for the insurance system with providers are made between the government and individual providers, and there is little room for the discretion of the insurers
• the government possesses sole purchasing power over health insurance practices
![Page 57: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/57.jpg)
Regulating quality of care
• Medical Care Act sets the minimal standards of health care based on structural indicators such as health personnel and hospital facilities, the violation of which may result in criminal charges
![Page 58: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/58.jpg)
Key Challenges to Japan’s Health System
![Page 59: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/59.jpg)
Challenges to Japan’s Health Sector
• Aging Population• Differential Insurance Benefits• Inadequate Coordination between Public and
Private Health Care• Obsolete physicians• Health worker shortage• Duplication and Overlap of Providers• Inadequate Incentive Structure• Insufficient Attention to Modern Management
![Page 60: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/60.jpg)
Aging Population
• Japan has the world's oldest population¹– by 2050, 40 percent will be 65 or older– Treatment will be more expensive for anticipated case
mix– Demand for medical care will triple in the next 25
years
¹Harden B. Health Care in Japan: Low-Cost, for Now: Aging Population could Strain System. The Washington Post. September 9, 2009.
![Page 61: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/61.jpg)
Differential Insurance Benefits
• Basic benefits are universal• Special benefits vary widely
– Extras services are covered by private insurers– Costs are not effectively controlled²– Access to health care becomes a problem
²McKinsey. The Challenge of Reforming Japan’s Health System
![Page 62: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/62.jpg)
Inadequate Coordination between Public and Private Health Care
• Little formal cooperation and coordination between the private health care system and locally based public health care system – Physicians as entrepreneurs
• Unmitigated development of private health care providers
![Page 63: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/63.jpg)
Obsolete Physicians
• No continuing medical education for physicians – Head Surgeon of Tokyo Medical University lost 3 out
of 20 patients he performed a heart valve operation on; he was not trained to do heart valve surgeries
• No academic differentiation between general practitioners and specialists
![Page 64: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/64.jpg)
Health Worker Shortage
• Physicians aggregate in lucrative fields like dermatology and ophthalmology and avoid surgery because of its stressful nature
• Not enough surgeons, obstetricians, and nurses, anesthesiologists, emergency room physicians– Low pay, long hours, stressful job
![Page 65: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/65.jpg)
Duplication and Overlap of Providers
• Hospitals experience a “crowding-out” effect– Space for emergency care and serious medical conditions
are taken by routine treatment³• No gatekeeper for medical care or hospital stay
• Japan has three times as many hospitals as the US per capita
3Harden B. Health Care in Japan: Low-Cost, for Now: Aging Population could Strain System. The Washington Post. September 9, 2009.
![Page 66: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/66.jpg)
Inadequate Incentive Structure
• Does not encourage careful practice because services are rewarded regardless of quality or the skills of provider– Physicians are revered, their decisions are rarely
questioned
![Page 67: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/67.jpg)
Insufficient Attention to Modern Management
• Relative lack of hospital administration– Lack formal systems to evaluate quality and
appropriateness of care• Overutilization of unnecessary medical procedures
– Physicians with no administration training continue to dominate decision making
![Page 68: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/68.jpg)
HEALTH CARE REFORMS
![Page 69: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/69.jpg)
Outline of ReformsYear REFORMS
1922 Health insurance law(private sector)
1938 Ministry of Health & Welfare established
National Health Insurance Law
1948 Medical Service Law, Public Health Center Act, Act on Nurses & Midwives
1961 Universal Health Insurance completed
1982 Health Services for the Elderly Act
1985 Revision of Medical Care Act
1989 10 year Plan for Elderly (Gold Plan)
2002 Health Promotion Act or Healthy Japan 21
2006 Structural Health Care Reform Act,
2008 Elderly Health Care Security Act
![Page 70: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/70.jpg)
Medical Service Law
• 1948– Post war period– Medical facilities destroyed, shortage of
Personnel– Formalized the system, allowing physicians to
open own practice or clinics– Together w/ Act on Medical Practitioners, Nurses
and Midwives
![Page 71: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/71.jpg)
National Health Insurance
• National Health Insurance Act in 1938– Included the farmers, self-employed– Low coverage since voluntary participation– Approximately 30 million still uninsured
Source: Growth of Economy and Accomplishment of Universal Medical Insurance and Pension Programs: 1955-1964, Japan Ministry of Health website
![Page 72: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/72.jpg)
Universal Health Insurance
• Completed in 1961– Required all citizens to be insured– Increased subsidies to 30% from the national to
municipal government
![Page 73: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/73.jpg)
Separation of prescribing & dispensing
• Stipulated in 1874 Medical Actbut not implemented
• 1980s• Advocacy for implementation
• 1990s– 54% drugs dispensed by pharmacists
![Page 74: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/74.jpg)
Health Services for the Elderly Act
• 1982– Financial redistribution mechanism for elderly
insured– insurers with higher than national average
enrolment will contribute less and vice versa
![Page 75: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/75.jpg)
Gold Plan• 1989
– 10 year Strategic Plan for Health & Welfare Services for the Elderly
– Each municipality then had own Health & Welfare Plan
– However, heavily relied on taxes for financing the plan
![Page 76: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/76.jpg)
Healthy Japan 21• 2000
– Addressed the increasing # of lifestyle-related diseases
– Influenced by the Healthy People 2000 of US, where smoking is declining
– National Health Promotion in the 21st century– Community level involvement
![Page 77: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/77.jpg)
Healthy Japan 21• 2000
– 9 areas (smoking, alcohol , nutrition, exercise, leisure, circulatory, diabetes, cancer)
![Page 78: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/78.jpg)
Health Care Reform Package
• 2002– For 1st time in Japan history,
Health expenditures decreasedue to price reduction in
medical fee (2.7%), thus*decrease in overall health
spending by 0.7%
Source: “Japan and Massachussetts: a Comparison of Universal Health Care Systems”
![Page 79: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/79.jpg)
Structural Health Care Reform Act
• 2006– Addressed problems in inequality in elderly
enrolment– Effectively separated the insurance of 75 yrs old
from other insurances
![Page 80: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/80.jpg)
Elderly Health Care Security Act• 10% co-insurance for
old-old above 75 yrs• 30%co-insurance for young- old,65-75 yrs
![Page 81: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/81.jpg)
TELEMEDICINE and COMMUNITY Health Centers
• addressed lack of physicians in rural areas– Manned by nurses– Use of Information technology
![Page 82: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/82.jpg)
2 year Mandatory Internship in General Medicine
• 2006– Addressed the “stagnation” of Japanese doctors– Mandatory before practice of medicine– General residency (focus medical and surgical
areas)
![Page 83: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/83.jpg)
Japanese Residency Matching Program
• 2003– Addressed the “stagnation” of Japanese doctors– Similar to US, where a doctor is matched to the
appropriate training hospital
![Page 84: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/84.jpg)
Recent Innovations
• Toyono town in Osaka Perfecture– Telephone consultations– Primary care services in emergency rooms– 80% drop in # children treated in emergency
rooms
![Page 85: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/85.jpg)
Remaining Issues
• Lack of monitoring in reimbursements of insurance
• Lack of assessment mechanism of cost effectiveness of medical interventions
• Lack of incentives for personnel for results (more incentives if more patients)
• Lack of accreditation of physicians
![Page 86: HEALTH SYSTEM IN FOCUS](https://reader036.fdocuments.in/reader036/viewer/2022062411/5681668e550346895dda6031/html5/thumbnails/86.jpg)
THANK YOU and Have a Good Day!