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Health insurance system in Japan
Features
1
Universal healthcare
Mandatory coverage for all residents in Japan. It includes both Japanese citizens and Non-Japanese citizens. Enrollees have no choice of health insurance programs.
Plans are designated according to the enrollee's employment status, age, and residence.
2
Free Access
Japanese patients are free to receive care from the medical facility of their choosing. There is no primary doctors or gate keepers. For example, a man who works at a firm in Tokyo can visit a specialist at the hospital near his office without a referral, then in the same week be seen by a physician at a clinic near his home.
3
Same co-payments across all plans
Medical service fee is determined by the Minister of Health, Labour and Welfare.
It is revised every year. Co-payment is basically the same for all services(Burden ratio varies according to age of patients.)
Types of medical facilities
In Japan, medical institutions are divided into the following types.
Source : Modified from “Survey of Medical Institutions 2019”, Ministry of Health, Labour and Welfare
About DPC system
DPC or Diagnosis Procedure Combination, is a comprehensive per- diem payment system similar to the DRG in the United States. The Japanese government first implemented the DPC system in 2003, starting with 82 hospitals. Since then, the number of DPC hospitals has gradually increased to 1,700+, with financial incentives. It is mandatory for DPC hospitals to submit DPC survey data(Discharge summary, nursing/monitoring care level of patients, etc.) to Ministry of Health, Labour and Welfare.
Types of healthcare operators
Enrollment in either an employment-based or a residence-based health insurance plan is required for all Japanese.
The types of insurance operators are as follows.
Source : 23rd Medical economics survey by Central Social Insurance Medical Council(November 2021), Ministry of Health, Labour and Welfare