Japan’s health care system - muddling through and incremental changes

Universal coverage was achieved in 1961 by gradually expanding the population covered by social insurance plans. There are over 3,000 plans but no choice of plans. To mitigate disparities in the enrolees’ income levels, the national government subsidizes plans that enrol those with low income. The health expenditures of elders 65 and over are cross-subsidized across plans. To contain costs, the price at which pharmaceuticals and devices are reimbursed have been decreased. The delivery system has developed incrementally and is dominated by the private sector. To nudge providers towards meeting policy goals, fees and the conditions of billing have been revised. Long-term Care Insurance was introduced in 2000 to meet the challenges of the aging society. All those 65 and over and all those 40 to 64 with disability from an age-related disease are entitled to service benefits ranging from 400 to 2,500 Euros monthly. Expenditures have subsequently tripled.