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Health Care in Japan Fact sheet released by the Bureau of East Asian and Pacific Affairs U.S. Department of State, June 26, 2000

Japan has the longest life expectancy--77 years for men and 84 for women--and among the lowest infant mortality rates in the world. Japan's national health care system offers universal coverage and stresses preventive care, in part to lower costs. Eighty percent of Japan's hospitals and 94 percent of its physician-run clinics are privately owned. Patients are free to select care providers, and competition seeks to ensure an adequate number of facilities. Investor-owned, for-profit hospitals are prohibited.

While recently on the rise, health care costs remain relatively low in Japan. Prices are regulated through a "fee schedule" determined by the Ministry of Health and Welfare in consultation with insurers, health care providers and consumers. Most Japanese employees and their dependents obtain health insurance through their employers, financed largely through mandatory payroll contributions from both employers and employees. The self-employed, employees of small businesses, and others not covered by employer plans can apply to the government for low-cost National Health Insurance, which provides coverage similar to workplace-based insurance.

The Japanese focus on preventive care has helped in containing costs. However, the rapid aging of Japan's population--by 2020, over thirty percent of the population will be 65 or older--has raised concerns about rising health care costs. To address concerns about an aging Japan, a public nursing-care insurance system went into effect in April 2000. Under this system, designed to lighten the load of those providing care at home, the elderly may select services from private sector care providers.

The Japanese health care system is not without its critics. Some in Japan have asserted that private practitioners, limited by the fee schedule as to prices they may charge, have a tendency to over-prescribe drugs from their attached pharmacies. In addition, some argue that certain health care procedures and technology are not as advanced as in the United States. Japan's first organ transplant from a brain-dead donor was performed in February 1999 under the October 1997 organ transplant law. By April 2000, seven such procedures had been performed.

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