International Handbook of Medical Education

By Abdul W. Sajid; Christine H. McGuire et al. | Go to book overview
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18
Japan

DAIZO USHIBA


OVERVIEW OF THE HEALTH CARE DELIVERY SYSTEM

Japan enjoys one of the highest standards of health in the world. Life expectancy was 75.9 years for males and 81.8 years for females in 1989. To sustain this level of health, approximately seven percent of the general national product and three percent of the labor force are devoted to health. Health care and medical services are supplied both by public and private sectors. While curative services are financed on a fee-for-service basis by national health insurance that covers the entire population, public health services are provided by the public sector and financed by general taxation. The health insurance system covers the unemployed and is financed either by the government or by the health insurance unions of the organizations in which the individual is employed.

The public sector facilities and services include hospitals and clinics established by the national or local government, and public groups designated by the Ministry of Health and Welfare, such as the Japanese Red Cross Society. Public facilities are eligible for a subsidy from the government when necessary. The government may exercise control over the establishment of public medical facilities, the utilization of buildings and equipment, and some other matters engaged in by doctors outside hospitals. It is also responsible for furnishing the necessary conditions and facilities for the clinical training of doctors. Public hospitals were expected to deal with those medical services that are difficult, from the technical and economic points of view, for private hospitals to handle. With the recent improvement of private sector health care, however, almost the same quality of service is now being supplied both groups.

While the present trend in health and medical care in Japan is still oriented toward specialties, particularly in large hospitals, there is increasing national interest in primary health care. Large hospitals can be overcrowded, and there is a growing general preference for the old tradition of having a family physician to whom access is easier and more available. At the same time, changes in national

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