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Public/Private Health Care Delivery in Japan: and Some Gaps in “Universal” Coverage

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Abstract

Legal universal health coverage is not enough for ensuring equal access to health care. If coverage is not effective for those requiring health services, additional measures shall be considered along with the existing mix of public and private health care providers. This paper aims to describe and discuss how health care services are delivered to low-income people in a mixed delivery system in Japan, where a combination of a statutory health insurance system and a public assistance program legally covers all residents. In the late twentieth century, the national government rather suppressed expansion of public providers but stimulated private provision. It also designates private providers as public-interest medical institutions to provide services that would not be paid sufficiently by the insurance system, e.g., rural health services and emergency medicine. Consequently, different public/private mixes in different specialties exist in different regions, although private providers are dominant overall and public providers are supposed to take various complementary roles that would not be achieved with the market. With the collectively exhaustive combination of mandatory insurance and public assistance, issues around access to health care for low-income people are often marginalized, despite increasing poverty. In reality, however, some of them are not able to pay insurance premiums and face high amounts of charges by losing their coverage at the point of services. Meanwhile, restrictive conditions of public assistance make it difficult for people on the border line to use health care with the program. After describing policy measures, including the Free/Low Cost Medical Care Program, to address these issues, the paper argues that one of the most critical issues is mainstreaming the issue of access to health care for those in need.

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Notes

  1. The FLCMS started in 1951 before the universal coverage was established in the 1960s. Sugiyama (2015) discusses it was rooted in charity health care before the WWII, as provided by Saiseikai. The number of medical institution participating in the program has been gradually increasing: 232 in 2003, 249 in 2008, 325 in 2025, and 509 in 2014 (Ministry of Health, Labour and Welfare 2009, 2015c)

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Acknowledgments

I would like to express my gratitude towards members of the staff of IRDES for their warm hospitality while I developed this paper. Takashi Sugiyama’s supports on my work are greatly appreciated. This work is supported by the Grants-in-Aid for Scientific Research (KAKENHI) of the Japan Society for the Promotion of Science (No. 26285140).

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  1. College of Social Sciences, Ritsumeiken University, Kyoto, Japan

    Ryozo Matsuda

  2. Institut de Recherche et de Documentation en Economie de la Santé (IRDES), Paris, France

    Ryozo Matsuda

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Correspondence to Ryozo Matsuda.

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Matsuda, R. Public/Private Health Care Delivery in Japan: and Some Gaps in “Universal” Coverage. Glob Soc Welf 3, 201–212 (2016). https://doi.org/10.1007/s40609-016-0073-1

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