Considering the Direction of Health Care Reform
In Japan, since the universal health insurance system was introduced in 1961, equal opportunity to see a doctor has been basically guaranteed for each person. Consequently, the country has achieved a society with long, healthy life expectancy, and low infant mortality rates. On the other hand, the financial balance of health care insurance is deteriorating mainly due to the increase in medical expenses with the aging of the population and the advancement of medical technology. The reform of the health care system (especially its financial system) has become one of the important issues in modern times.
With the basic purpose of maintaining and stabilizing this system, medical fee, drug pricing and health care delivery systems have been reviewed respectively. Furthermore, social insurance premiums, taxes and patient’s co-payment have also been revised. The main contents of these revisions are as follows: (1) Gradual shift from fee-for-service system to flat-rate medical fee system (e.g., per diem, capitation), (2) Reduction of drug price standard as official price of medicine, (3) Regulation for the number of hospital beds and promotion of home care. For financial resources, social insurance premiums and patient’s co-payment have been gradually raised, and a portion of the revenues by increasing consumption tax (raising the tax rate) is supposed to be allocated to social security benefits according to the “Comprehensive Reform of Social Security and Tax.”
While these have been the basic directions for reforming the health care system, in recent years, promotion of preventive health care, introduction of telemedicine (online medical care) and strengthening of family doctor function are being advocated mainly by the Ministry of Health, Labor and Welfare as well as public health care insurers (e.g., National Federation of Health Insurance Societies and Japan Health Insurance Association). Although these proposals may lead to a change in the conventional method of consultation and treatment (which is based on free-access and face-to-face treatment), they are considered useful in reducing the incidence of disease, serious illness and long-term hospitalization respectively.
With respect to this, in Japan, as in other developed countries, some diseases related to lifestyle and mental health are increasing, and primary prevention and secondary prevention are becoming a crucial measure. In general, primary prevention refers to encouraging periodic health checkups and improving lifestyle, and secondary prevention refers to early detection and early treatment. Furthermore, for improvement in outcome, it is thought that an appropriate combination of face-to-face treatment and telemedicine is important, and that long-term and continuous efforts between patients and their doctors are also important for prevention.
These are issues related to the review and reform of the basic structure rather than the maintenance and stabilization of the existing health care system, and require basically the voluntary participation and action of each person/patient. Although there are still some issues to be solved, such as how to coordinate prevention and treatment and how to deal with the system of medical fee, the reforms in this direction are considered necessary for the future health care system.
This essay is the English version of No. 42, July 30, 2019 on the Japanese website.
(Author: Masahito Abe)