Health Care

Today the medical system in Japan is at the world’s highest level in many respects, such as average life expectancies and the death rates of infants and small children. At the same time, the system is faced with a number of challenges, including the small number of medical professionals (doctors, nurses, etc.) per bed and the long length of the average hospital stay. In the 21st century, the medical system will have to cope with changes in the disease structure, changes that include the growing prevalence of psychiatric disorders such as depression, the appearance of new infectious diseases like SARS, and, most of all, the greater number of cases of geriatric disease that will result from the rising average age of the population.

The health insurance system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance programme administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals. Clinics must be owned and operated by physicians.

As of October 2009, Japan had 29.01 million elderly people. Today one in every five people is 65 years or older, and in 2050 the ratio will likely be one in three. In 2007, medical expenditures of this group totaled 17.7 trillion yen, or 52.0% of the total, and per capita spending amounted to ¥646,100, as compared to ¥163,400 for those under 65.

Through advances in medical treatment technology, the best medical care available can be given, yet at the same time this can lengthen the period of care. In addition, withthe progressing trend toward nuclear families and women entering the work force, caring for the elderly at home has become difficult for some households. Concomitantly, there is a shortage of facilities such as nursing homes to care for the aged. This has led to the aged, who primarily require more nursing care than medical treatment, being cared for at hospitals for long periods of time rather than at nursing care facilities, thus accelerating the increase in medical expenditures for the elderly.

In an attempt to improve the quality of elderly care, provide additional funding, and eliminate efficiencies that have resulted from the intermixing of medical treatment and longterm care functions, the government implemented a long-term care insurance system in 2000. This system collects obligatory insurance contributions from a broad sector of the population (all persons aged 40 or older) and provides such services as home visits by home helpers, visits to care centers, and long-term stays in nursing homes for older persons suffering from senile dementia or confined to bed for health reasons.

A 2005 revision to the Long-Term Care Insurance Law added an emphasis on prevention aimed at helping those with relatively mild problems to maintain and improve their conditions, and thereby avoid deteriorating to the point where extensive care is necessary. This preventive care management is handled by community-based comprehensive support centers.

As of 2009, the medical expenses of the elderly account for about one third of the total at a time when overall health care expenditures are skyrocketing. The costs for people 75 years of age or older on average are about five times higher than those of adults under 65. Japan’s medical care system is at a major turning point. In order to create a health and medical care system that is sustainable over the long term, the government continues to study and implement wide-ranging reform measures.

Japanese hospitals are increasingly trying to tap the growing medical tourism trend, touting their attractive, modern treatments and facilities to draw more foreign patients.In 2010, the government designated the medical and healthcare sectors as a key growth industry, with a special focus on medical tourism - tours combining sightseeing and hospital examinations. The vision is aimed at offering wealthy foreigners medical services, which are often perceived as a burden on the public healthcare insurance system. Their stays in Japan are also expected to help stimulate the economy.

The Development Bank of Japan estimates that the market for medical treatment will grow to 92.3 billion yen by 2020, a view based on the expectation of more visits from countries with high medical expenses, such as the U.S. But it is worth noting that an increasing number of people are coming to Japan from Russia and Asia to seek advanced medical treatment.