Study of Global Health Strategy Based on International Trends: -Promoting Universal Health Coverage Globally and Ensuring the Sustainability of Japan's Universal Coverage of Health Insurance System: Problems and Proposals

Abstract

The Japanese government at present is implementing international health and medical growth strategies mainly from the viewpoint of business. However, the United Nations is set to resolve the Post-2015 Development Agenda in the fall of 2015; the agenda will likely include the achievement of universal health coverage (UHC) as a specific development goal. Japan's healthcare system, the foundation of which is its public, nationwide universal health insurance program, has been evaluated highly by the Lancet. The World Bank also praised it as a global model. This paper presents suggestions and problems for Japan regarding global health strategies, including in regard to several prerequisite domestic preparations that must be made. They are summarized as follows. (1) The UHC development should be promoted in coordination with the United Nations, World Bank, and Asian Development Bank. (2) The universal health insurance system of Japan can be a global model for UHC and ensuring its sustainability should be considered a national policy. (3) Trade agreements such as the Trans-Pacific Partnership (TPP) should not disrupt or interfere with UHC, the form of which is unique to each nation, including Japan. (4) Japan should disseminate information overseas, including to national governments, people, and physicians, regarding the course of events that led to the establishment of the Japan's universal health insurance system and should make efforts to develop international human resources to participate in UHC policymaking. (5) The development of separate healthcare programs and UHC preparation should be promoted by streamlining and centralizing maternity care, school health, infectious disease management such as for tuberculosis, and emergency medicine such as for traffic accidents. (6) Japan should disseminate information overseas about its primary care physicians (kakaritsuke physicians) and develop international human resources. (7) Global health should be developed in integration with global environment problem management. (8) Support systems, such as for managing large-scale disasters of international scale or preventing the spread of infectious diseases, should be developed and maintained. (9) International healthcare policy, which the Japanese government is trying to promote in accordance with international trends, and international development of Japanese healthcare industry should be reconsidered.

Keywords: Global health; Kokumin-Kaihoken; Post-2015 Development Agenda; TPP; UHC; Universal health coverage; Universal health insurance of Japan.

Fig. 1

The 3 dimensions of universal coverage as proposed by the WHO

Fig. 2

Changes in the proportion of health insurance policyholders out of the national population (by insurance program) Please note that the data on the health insurance program for day laborers are pursuant to the provision of Article 3, Paragraph 2 of the Health Insurance Act. Please also note that the health insurance program for the late-elderly was initiated in 2008. The data on total population size are based on the national census for Japanese citizens.

Fig. 3

Changes in average life expectancy for males in Japan and standards in ASEAN countries

Fig. 4

Maternal mortality rate (per 100,000 people)

Fig. 5

Tuberculosis morbidity (per 100,000 people)

Fig. 6

Conceptual diagram of efforts in the health sector undertaken by the Japan International Cooperation Agency (JICA)