Ministry of Health, Labour and Welfare


Health Insurance Bureau

Providing Health Care for All People without Worries

Health Insurance Bureau develops ideas and plans on medical insurance systems including health insurance, national health insurance, seamen's insurance and medical care for the elderly to stabilize the medical insurance system for long time so that all people can access medical care without worries in a full-fledged aging society with fewer children in the future.

Roles of Medical Insurance

When you go to hospitals and clinics for injuries and illness, you can receive necessary medical care for a small fee. This is because of the medical insurance system. Japan practices a universal medical care insurance system in which all citizens subscribe one of medical care insurance systems so that everybody has access to adequate medical care without worries. This is contributing greatly to the stabilization of the people's living and the maintenance of their health.

Types of Medical Insurance

The medical care insurance system in Japan consists of a number of systems. In rough classification, there are 2 types: The National Health Insurance (45.45 million subscribers) which self-employed people, farmers and jobless people subscribe, and employees' health insurance. Employees' health insurance includes the Health Insurance Society (32.58 subscribers) which is mostly subscribed by the employees of large companies, and Government-Managed Health Insurance (37.58 subscribers) which is mainly subscribed by the employees of small to medium size companies.
In addition, we have medical care insurance systems designed for seamen, national public service employees, local public service employees, and teachers and staff employees of private schools. Thus the universal health care insurance system consists of various systems.

Thinking about Medical Care in the Future

Japan's medical care insurance system is at a major turning point now. Forty years have passed since the establishment of the universal health insurance system, and while we are becoming a true aging society with fewer children, the imbalance between the increase of medical expenditure and the economic growth is growing further more. In addition, along with the social change and the change of people's awareness, the requirement to medical care is diversifying.
While in this condition, it is urgent to implement a radical reform of the medical care insurance system to minimize the growth of inflating medical expenditure while allowing all people to receive quality medical care services without worries.
Here are some examples of corrective actions:
To promote the optimal usage of drugs by eliminating the gap between the purchase cost of drugs by hospitals and the health insurance reimbursement on the drug as much as possible.

To realize proper combination of the reimbursement system with fee for service that reimburses each type of medical care, and fixed payment system that reimburses a fixed amount for a service regardless of individual medical practices, and to promote proper division of roles and collaboration between large hospitals and clinics.

To rebuild a mechanism where both the elderly and non-elderly can share the burden of increasing medical expenditure for the elderly with impartiality while efficiently offering necessary medical care for the elderly. We are now working on these issues indicated above.

About Health Expenditure

National health expenditure is increasing every year. In fiscal 1999 it exceeded yen30 trillion for the first time, and the ratio to the national income reached 8%. In particular, the medical care cost for the elderly is growing at the rate of about 9% annually as the aging population increases rapidly. In recent years this is the key driver for the increase of medical expenditure. When we compare the medical examination fee per person, the fee for the elderly is 5 times greater than that for the non-elderly. Considering these factors, it is necessary that we continue to promote the improvement and management of lifelong health as well as to offer adequate medical care for the elderly in an efficient manner.