Overview of Medical Service Regime in Japan•75 years or older
Patient (insured)
10% copayment(Those with income comparable tocurrent workforce have a
copayment of 30%)•70 to 74 years old
20% copayment*(Those with income comparable tocurrent workforce have a
copayment of 30%)
•Start of compulsory education to
69 years old
30% copayment•Yet to start compulsory education
20% copayment* Frozen at 10% for the 12-month period from
April 2008

[Medical Service Regime](2) Receive service& copayment

Hospital
Clinic(3)
Clinicalservice(5)
Reimburse
ment(1) Insurance
contribution(4) Claims

Insurer

Administrative[Medical insurance system]
bodiesNational
Prefectural
Municipal
governments

Publicfunding

Supportive
contribution

Respective insurer

MedicalCare Act（Number of insurers) (Number of enrollment)(Principle schemes)-National Health Insurance
1,888-Japan Health Insurance Association
administered health insurance
1-Association/union administeredhealth insurance
1,458

Approx. 39,000,000

Approx. 30,000,000-Mutual aid association

Approx. 9,000,000

Approx. 35,000,000

85* Numbers of insurer and the enrolled are as of the end of March 2011

-Advanced Elderly Medical Service System

47

Approx. 14,000,000* Number of those enrolled is as of the end of March 2011

PhysicianMedicalPractitioners Act

DentistDentalPractitioners Act

Pharmacist

Pharmacists Act

Public healthnurse
Midwife
Registered
nurse“Act on Public
Health Nurses,
Midwives andNurses”

Other healthcare professionals[Those with national
qualification are governedby respective acts]1Outline of the Healthcare Insurance System
Medical care system for the elderly aged 75 and over
Approx. 13 trillion yen

・Age 75 or over・About 14 mil people
・47 insurers (extended association)

Age 75
System to address the imbalance in the payment of medical expenses for the under 75(about 14 million people) approx. 6 trillion yen (aforementioned)Age 65・Retired salaried

Retired persons
Healthcare System(interim measures)

employee・ (About 2 mil
people)National Health Insurance(municipality controlled NHI+ NHI society)・Individual proprietor, Pensioner,
Irregular employer, etc
・About 39 mil people
・About 1,900 insurers
Approx.10 trillion yen

Public-corporation-run
Health InsuranceSociety-managed,
employment-based
Health Insurance

Mutual aid
association

・Salaried employee of SMEs
・About 35 mil people
・1 insurer

・Salaried employee of Large
Corporation
・About 30 mil people
・About 1,500 insurers

・Civil officer
・About 9 mil.
people・85 insurers

Approx. 4 trillion yen*1 Numbers of members and insurers are preliminary figures as of the end of March 2011
*2 Amounts are benefits based on the budget for FY2012.

Approx. 5 trillion yen (total)2

Meaning of the Universal Health Insurance Coverage System
 Our country has realized the world's highest level of life expectancy and healthcare standards through theuniversal health insurance coverage system.
 It is necessary to ensure a safe and secure living of the citizens continuously by firmly maintaining the universal
health insurance coverage with the current social insurance system.

[Characteristics of Japanese universal healthinsurance coverage system]
1. Covering all citizens by public medical insurance(In the U.S., about 18 million people are expected to be uninsured after
health insurance reform by the Obama administration.)

2. Freedom of choice of medical institution(free access)3. High-quality medical services with low costs(In the U.S., medical expenses per person are more than double thosein Japan. In case of the elderly in Japan, the amount paid at a medical
institution is about 40,000 yen if he or she receives 10 million yen of
medical services per month.)

4. Based on the social insurance system, spending the
public subsidy to maintain the universal healthinsurance coverage

Proportion of the burden of national medical expenses
in Japan (by resource) (FY2009)(Patient’s payment
13.9%)(Insured
28.3%)(Local government
12.1%)
Public subsidy
37.5%(State subsidy
25.3%)

Insurance
premium
48.6%(Employer
20.3%)• Other countries such as Germany, France, and South Korea have adopted the social insurance system.
• In countries adopting a tax-financed system, it is pointed out that citizens can not choose a medical institution
and waiting time to take medical care is long.
For example, general physicians (registered family physicians) perform primary medical care in the U.K. The problem is that it takes longtime to take medical care. Enabling patients to consult a general physician within 48 hours is set as a goal.
Average waiting time of patients from they are referred to a hospital until they are treated by a specialist: 8.6 weeks (2009)3

Comparison of Each Insurer
Municipality controlled
National Health
Insurance

National Health
Insurance society

Public-corporation-run
health insuranceSociety-managed,
employment-based healthinsurance

Mutual Aid Association

Medical system for theelderly aged 75 and overNumber of insurers(End of March 2011)

1,723

165

1

1,458

85

47

Number of members(End of March 2011)35.49 mil.
(20.37 mil. Households)

3.27mil.

34.85 mil.
The insured 19.58 mil.
Dependents 15.27 mil.

29.61 mil.
The insured 15.57 mil.
Dependents 14.03 mil.

9.20 mil.
The insured 4.53 mil.
Dependents 4.67 mil.

14.34 mil.

Average age ofmembers(FY2010)

49.7

39.0

36.3

34.0

33.4

81.9

¥910,000¥1,580,000
per household(FY2009)¥740,000 (*4)
¥1,290,000
per household(FY2009)¥3,470,000¥7,430,000
per household (*2)
(FY2008)¥1,370,000¥2,420,000
per household (*3)

¥1,960,000¥3,720,000
per household (*3)

¥2,290,000¥4,670,000
per household (*3)¥800,000(FY2010)- (*5)¥2,090,000 (*6)
¥3,700,000
per household (*3)

¥2,810,000 (*6)
¥5,330,000
per household (*3)

¥3,190,000 (*6)
¥6,510,000
per household (*3)¥670,000 (*4)
(FY2010)¥299,000¥176,000¥156,000¥138,000¥140,000¥905,000

97,000 yen <193,000 yen>
172,000 yen <344,000 yen>
per insured person

93,000 yen <207,000 yen>
177,000 yen <394,000 yen>
per insured person

112,000 yen <224,000 yen>
227,000 yen <455,000 yen>
per insured person

Health insurance premium
rate: 10.0% (FY2012)

Health insurance premium
rate: 7.67% (FY2010 audit
estimate)

16.4% of benefits(*10)

Fixed amount contribution to
those associations that are in
financial hardship

Average income(total compensation)(FY2010) (* 1)Amount used to work out thepremiums per member (FY2010)
Healthcare expenses per member(FY2010) (*7)
Average premium per member(FY2010) (*8)<amount including employers’
contribution>¥81,000¥142,000
per household¥126,000Government subsidies(Fixed rate portion only)

50% of benefits, etc.

42% of benefits, etc. (*9)

Amount of government subsidies(*11)(Average based on FY2012
budget )Health insurance premium
rate: 8.03% (FY2010 audit
estimate)¥63,000

Approx. 50% of benefits
Nil3,445.9 billion yen

284.2 billion yen

1,182.2 billion yen

1.6 billion yen

6,177.4 billion yen(*1) Means “total income, etc.” (an amount worked out by subtracting work-related expenses, salary earners deduction, and public pension deduction and so on from the total earning).
Under the municipality-managed national health insurance scheme and medical care system for the latter-stage elderly people, this is “total income and forestry income” plus “brought-forward deduction in relation to miscellaneous income” and “amount of separate transfer income”. The figure isworked out based on, in case of municipality-managed national health insurance scheme, “National Health Insurance Survey” and “Survey of Insured Persons under the Medical Care System for the Latter-stage Elderly People” in case of medical care system for the latter-stage elderly people.
The figures for national health insurance association are the data for your reference worked out by adding up the standard taxable income for municipal locality tax (total income after such deductions as basic deduction and income deduction including dependent family deduction and spouse deductionetc), basic deduction, and “income deduction other than basic deduction (such as dependent family deduction, spouse deduction etc)” (an estimated amount calculated using the figure obtained by dividing the amount of income deduction for each bracket (excluding basic deduction) applicable to“standard taxable income for those who have salary income and businesses income etc” worked out from “FY2009 survey of the current taxation status etc with respect to municipal locality tax” conducted by Ministry of Internal Affairs and Communications by number of tax payers).
As for Kyokai Kenpo, association-managed health insurance, and mutual aid association, the figure is a reference value worked out by subtracting an amount equivalent to salary income deduction from “an amount to be used to work out the insurance premium per subscriber” (the amount obtained by
dividing the total amount of standard remuneration with the number of subscribers).
(*2) The amount per household is worked out by multiplying the amount per subscriber with average number of person per household.
(*3) Means an amount per insured person.
(*4) This is the standard taxable amount (a base to calculate the insurance premiums) worked out by old provisory method. Being a method used to calculate the bases on which the insurance premiums of the medical care system for the latter-stage elderly people and most municipality-managed national
health insurance schemes are worked out, the old provisory method calculates the amount by subtracting basic deduction etc from the amount of total income (the amount worked out by subtracting work-related expenses, salary earners deduction, and public pension deduction etc from the total amountof earning).
(*5) Not included because, with regard to national health insurance association scheme, the calculation method to work out the income and insurance premiums is widely different from one insurer to another. According to the data from 2009 income study, the standard trade-by-trade taxable incomes formunicipal locality tax are 6.41 million yen for medical practitioners national health insurance association, 2.21 million yen for dentists national health insurance association, 2.18 million yen for pharmacists national health insurance association, 1.25 million yen for general trades national healthinsurance association, and 0.70 million yen for building industry related national health insurance association. The average amount of the whole sector, calculated based on the number of insured persons for each association, is worked out to be 2.15 million yen (no income study was conducted in2010).
(*6) This is the amount obtained by dividing the whole amount of standard remuneration with the number of subscribers.
(*7) Figures for healthcare expenditure per subscriber for Kyokai Kenpo and association-managed health insurance scheme are preliminary ones. In addition, figures for mutual aid association are healthcare expenditure assessed by the assessment/payment agent.
(*8) The insurance premiums per subscriber for municipality-managed national health insurance scheme/the medical care system for the latter-stage elderly people were estimated based on the insurance premiums arranged/set out for the year; and, premiums of employee insurance were estimated based on
the insurance premiums cited in the final accounts of expenditures and revenues. The amount of insurance premiums does not include the portion for aged care.
(*9) Average based on FY2012 budget(*10) The rate of government subsidies for Kyokai Kenpo to June 2010 in the FY2010 budget was 13.0% excluding the contribution to the latter-stage elderly people medical care system.
(*11) State subsidies and grants for the long-term care insurance levy, specified health examination/specified healthcare guidance, etc., are not included

4Current Medical Service System for the Elderly
Summary of systemIn anticipation of increasing medical expenditure with aging of society, from the viewpoint to clarify theburden between aged and young generations, the medical insurance system for the elderly aged 75 and over
was enacted in April 2008.
At the same time, in order to adjust the imbalance among the insurers due to the uneven distribution of theelderly aged between 65 and 74, a system to adjust the finance of insurers was introduced.
Structure of Medical Care System for the Elderly aged 75 and Over
[Extended association that all the municipalities participate]<Medical expenditure for the elderly aged 75
and over>13.4 trillion yen (FY2011 budget basis)
Benefit payment: 12.3 trillion yen
Copayment:
1.1 trillion yen

Copayment<Number of eligible people>
Elderly aged 75 and over:approximately 15 million people

Public expenditure (approximately 50%) 5.8 trillion yen[Nation : Prefecture : Municipality = 3.9 trillion yen : 1.0 trillion yen : 1.0 trillion yen = 4 : 1 : 1]
Premium of the elderly
0.9 trillion yen
Approximately 10%[Actually approximately 7% with
reduction measure]

Supportive contribution to medical insurance for elderly aged 75
and over (Insurance premium of young people)
5.3 trillion yen
Approximately 40%<payment>

Medical services
according to thephysical and mental
Account
characteristics of the transfer, bankelderly aged 75 and over transfer, etc.

Health Insurance Claims
Review &Reimbursement Services
Withdrawal
from pension<Lump-sumpayment>

Medical insurer
Health Insurance Societies,
National Health Insurance,
etc.

(Amount of insurance premiums (FY2011)>
Nationwide average:
approximately 63,300 yen /year<Breakdown of supportive
contribution>
Health insurance controlled by Japan Health
1.5 trillion yen
Insurance Association:
Health Insurance Society: 1.4 trillion yen
Mutual Aid Association: 0.5 trillion yen
Municipality controlled National Health
Insurance:
1.8 trillion yen

Insurance premium* For those who receive only the basic pension:

approximately 4,200 yen / year

Insured(Elderly aged 75 and over)Insured of each medical insurance (Medical insurance
controlled by Japan Health Insurance Association, National
Health Insurance, etc.) (people aged 0-74)5National Health Insurance & Health Insurance Benefits(As of April 2012)

National healthcare insurance
Healthcare insurance(local authority)
Until the entry into primary school: 80%
Healthcare
After junior high school to 69 years: 70%
Benefits
Visiting nursing 70-74 years: 80%* (those whose taxable income is more than average taxable income of the active workforce (1,450,000 yen per year): 70%)
healthcare
Low-income persons: ¥210 per meal
Meals during Standard amount borne for meals: ¥260 per meal
Persons of particularly low income (70 years old and over):hospitalization Low income persons after the 90th day of hospitalization:¥160 per meal¥100 per meal
expenses
Living care standard fee:
Low-income persons:
¥
460
per
meal
(meal
cost)*+¥320(residential
cost)¥210 per meal (meal cost) + ¥320 (residential cost)
Living care
Particularly low-income persons:
Persons receiving senior citizens welfare benefits:during¥130 per meal (meal cost) + ¥320 (residential cost)¥100 per meal (meal cost) + ¥0 (residential cost)
hospitalization(65 years old and (*) ¥420 at the insurance medical institutions that calculate living care
Note: The amount borne by patients with serious diseases
above)
during hospitalization (II)will be the living care standard fee
Aged under 70 years
Aged 70 to 74 years
Hospitalization
Outpatients(per person)(High income) ¥ 150,000＋(medical expenses – 500,000)×1%(¥ 83,400)(Working income level)¥ 80,100＋¥ 44,400
High-cost medical (General)(medical expenses – 267,000)×1%¥ 80,100＋(medical expenses – 267,000)×1% (¥ 44,400)
care expenses (Low income) ¥ 35,400(¥ 44,400)(¥ 24,600)(with individual(General*)¥ 44,400¥ 12,000
limit)(Figures in parenthesis are for the fourth month onwards)(Low income)¥ 24,600¥ 8,000(Particularly low income) ¥ 15,000¥ 8,000

Cash payments

Healthcare payments

Payment

Contents of benefits are decided byseparate regulations.
Lump-suminsurers pay ¥420,000 (¥390,000 if
allowance for (Mostthe additional payment set out in thechildbirthmaternity medical care compensation
scheme does not apply.)Contents of benefits are decided by
Lump-sumseparate regulations.
funeral allowance,(Most local authorities pay at a rateburial costs
between ¥10,000-50,000)
Practiced by most local authorities
Invalidity benefit
Maternity
allowance

Lump-sum allowance forchildbirthLump-sum allowance forchildbirth and nursing¥420,000 paid in the instance of the insured person or their dependent
giving birth(¥ 390,000 if the additional payment set out in the maternity medical carecompensation scheme does not apply)

Burial costs

Fixed amount of ¥50,000 paid in the instance of the insured person
dying

Family burial costs

Fixed amount of ¥50,000 paid in the instance of the insured person’s
dependent dying

In the case that the insured person becomes unable to work because of medical treatment being received
for a cause not related to work, an amount approximate to two thirds of that persons standards daily wage
will be paid daily for a maximum period of I year and 6 months.
Voluntary benefit(Not practiced by any local authorities) During the maternity leave taken by the insured person, an amount approximate to two thirds of that
persons standards daily wage will be paid daily for a maximum period of from 42 days prior to the birth
to 56 days after the birth.

* Since April 2008, patients’ on-the-spot copayment has not been changed from 10%; maximum monthly copayments of high-cost medical care has not also been changed as shown in this table.

6Patients Copayment for Medical Expenditure High Cost Medical Treatment System[Ratio of patients copayment
for medical expenditure]

A system that any amount that exceeds the fixed monthly limit will
be paid in order to ensure that the financial burden on the patientdoes not become too great.

10% copayment
20% copayment(currently remains at 10%)

Age 75
Age 70<Common Example: Case of a person with Employee
Insurance (30% copayment) on a general income>
Medical Expenses: 1 million yen
Paid to institution:¥300,000

30% copayment
Repaid for high cost medical treatment expenses:¥300,000 - ¥87,430 = ¥212,570

20% copayment

Age 6(Beforeschool age)

Individual limit: ¥80,100 + (¥1,000,000 - ¥267,000)×1%= ¥87,430
Note: There are three levels of maximum monthly copayment, i.e.
standard, high-income earner and low-income earner, dependingon the income of the insured person.

7

Medical Service Fees System(1) Structure of medical service fees Medical service fees are the fees received by medical institutions and pharmacies serving insured
persons, as the price of insured medical services.
 Determined by the Minister of Health, Labour and Welfare based on discussions in the Central
Social Insurance Medical Council (announced by the Minister of Health, Labour and Welfare)(2) Contents of medical service fees
Evaluation of technologies and services
Medical service fees
Evaluation of price of materials(for drugs, prices determined based on standard drug prices) The medical service fees grading table is used to evaluate costs by grading individual technologies
and services (10 yen/point; covered in announcements)* Types of grading tables: medical, dental, prescription drugs

8Outline of Insured Medical Treatment
Insured person (patient)(2) Medical services(benefits for medical services)(1) Payment of insurance
premiums(3) Payment of partial
costs
Insurance medical institution, etc.
(Hospitals, clinics, dispensing
pharmacies, etc.)

Health insurer

Insurance
doctor(7) Payment of medical
service fees

(4) Billing for medical
service fees(5) Sending examinedbills(6) Payment ofbilled amount

Examination and payment agency(Social Insurance Medical Fee Payment Fund,Federation of National Health Insurance
Associations)
Medical service fees first are categorized into medical, dental, and prescription drug fees.
Specific medical service fees are calculated at a cost of 10 yen/point, adding points corresponding to each item, in principle for each medical action
conducted. (This is referred to as a fee-for-service system.) For example, when hospitalized for appendicitis, costs are totaled for initial examination,
hospitalization fees for the number of days hospitalized, appendix surgery costs, testing costs, and prescription drug costs, and the insurance medical
institution receives from the examination and payment agency the amount derived by subtracting from the total the patient copayment amount.

9Trends in Medical Expenditure(trillion yen)

50

40

Reference: The ratio of total healthcare
expenditure to GDP
8.1%
7.3%
7.7%
30.1

6.7%

30

6.9%
27.0

6.0%
6.1%
4.8%

20

5.9%

6.0%

9.9%

8.6%

8.7%

8.8%

7.9%
31.1

8.0%
31.0

8.1%
31.5

6.3%

6.4%

6.3%

8.9

1990

33.1

8.1%

8.1%

34.1

33.1

9%

8.5%
36.0

34.8

37.4

8%

7.6%

7%

6.6%

6.6%

6.5%

6%

National medical expenditure (trillion yen)(through Sep. 2002)

5%
4%(beginning Oct. 2007)

3%

11.2

11.7

11.7

11.7

11.6

11.6

(37.2%)(37.5%)(37.9%)(36.9%)(36.1%)(35.1%)

11.3

11.3

(34.0%)(33.0%)

11.4

12.0

12.7

(32.8%)(33.3%)(33.9%)

Medical expenditure for the elderly (trillion yen)

(33.1%)

5.9

1985

8.2%

9.0%

Change of qualifying age (over 70 → over 75)

10(28.8%)

6.4%

5.4%

20.6

(25.4%)

32.1

8.8%

10%

10.6%

7.1%

The ratio of national medical
expenditure to GDP

4.1

8.8%

9.1%

8.0%

4.6%

16.0

0

11%

National medical expenditure as a percentage of national income

1%

Note: Figures in parentheses represent medical expenditure for theelderly (over 75) as a percentage of national medical expenditure

1995

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009
(Estimated)

Revisions to medical service fees
0.2％
• Introduction of long-term
Major system changes
care insurance system• Introduction of 10%
copayment for the elderly<Year-on year growth rates>

▲2.7%

▲1.0％

• Thorough applicationof 10% copayment
for the elderly▲3.16％• 30% personal
copayment for
employed persons etc.

▲0.82％• 30% copayment for
persons with income
equivalent to employment
income etc.

2010

0.19％

Expansion of measures to reduce theburden of infant patients (less than 3 yearsof age → children before school age)

1990

1995

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

（％）
2010

National medical
expenditure

6.1

4.5

4.5

▲1.8

3.2

▲0.5

1.9

1.8

3.2

0.0

3.0

2.0

3.5

3.9

Medical expenditure for theelderly (over 75)

12.7

6.6

9.3

▲5.1

4.1

0.6

▲0.7

▲0.7

0.6

▲3.3

0.1

1.2

5.2

5.5

National income
GDP

7.2
7.2

8.1
8.6

▲0.3
1.7

2.0
0.9

▲2.8
▲2.1

▲1.5
▲0.8

0.7
0.8

1.6
1.0

0.5
0.9

2.6
1.5

0.9
1.0

▲7.1
▲4.6

▲3.6
▲3.7

-

Note 2:0%（FY）(Estimated)

1985

Note 1:

2%

National income and GDP are from “National economic accounting” published by Cabinet Office (Dec. 2010). Being used to compare the medical expenditure among OECD countries, total healthcare
expenditure is a type of medical expenditure which covers wider areas such as preventative services and so on. The ratio of average medical expenditure of OECD countries to GDP was 9.5% in 2009.
The FY2010 figures for national medical expenditure and medical expenditure for the latter-stage elderly people are estimated figures worked out by multiplying previous year’s National medical
expenditure and Medical expenditure for the latter-stage elderly people respectively with the rate of increase of approximate medical expenditure for the year in question; figures in italic represent the rate ofincrease of approximate medical expenditure.

10Structure of National Medical Expenditure (FY2009)
National medical expenditure: 36.67 trillion yen
Medical expenditure per person: 282,400 yen

Breakdown of system-specificnational medical expenditure％

100

Associationcontrolled healthinsurance

11.3

90

Union-controlled
health insurance

For thebenefit ofhealthinsurance,
etc.

70

80

National
treasury
Publicexpenditure

National
HealthInsurance

90
Hospital

25.3

80

Hospitalization

70

12.1

Businessowner

80
Generalclinic 1.2

70

70

60

Hospital

20.3

50

50
40

For the benefit of healthinsurance for theelderly aged 75 or over

40

30.6

20
10

48.6

For the benefit of
medical care by public
expenditure

Copayment by patients

6.8

Preferential
reductionmeasures0.5(physicians,
dentists,
pharmacists,
nurses, etc.)
47.9

60

14.7

50

Except for
hospitalization

40

37.4

50
Medical drugs
GeneralclinicInsured28.3

Medical professionals

40

22.2

22.7

30

30

Medical materials (treatment materials,
materials for food services, etc.)

6.2
Dental care

20
10

13.9

0

Insurance
premiums

30

30

35.6

36.8

Local
government

Worker’s
compensation, etc.
0.7
60

60

100

90

37.5

2.7

％

100

90

8.6
Mutual aid
association

24.8

48.1

Seamen’s
insurance
0.1

Cost structure in
medical institutions

％

％

100

80

Distribution of national
medical expenditure

Share of national medical
expenditure (by financial resource)

20
Copayment by
patients

Prescription inpharmacy

10

13.9

0

7.1

20
10

16.2

Outsourcing expenses 5.1
Miscellaneous
expenses, etc.
(utility charges,
rental charges, etc.)
18.6

Meals at hospitalization / life 2.300Home-visit nursing 0.2

 Insurance premiums of the National Health Insurance are included in the insurance payment of insured.

 Estimates based on the results of the Survey on
national medical expenditure and medical
economy in FY2009 (July 2009)11

Characteristics of Medical Expenditure for the Latter-stage Elderly People
 Per-person medical expenditure for the latter-stage elderly people, i.e. people aged 75 and over(medical care system for the latter-stage elderly people related medical expenditure) is885,000 yen; that is 4.6 times as much as the medical expenditure for young people, i.e. lessthan 75 years old, which is 191,000 yen per person.
[Comparison of Health Expenditures per Person (FY2009)]

4.6 times
Latter-stageelderly people
Young people

191,000 yen

885,000 yen

Inpatient: 61,000 yen

Inpatient: 438,000 yen (7.2 times)

Outpatient: 108,000 yen

Outpatient: 407,000 yen (3.8 times)◆ When looking at the difference of medical expenditure between the elderly and the young in various countries, that for theelderly is something around 3-4 times as much as the young in the US and Europe.
[Germany: 3.7 times (2006), the US: 3.7 times (2004), and France: 3.3 times (2006)][Note: The definition of “the elderly” for these three countries mentioned above is “people aged 65 and over”]
Source:“Latter-stage elderly people medical care program yearbook”, “OECD Health Data 2010”, “Federal Republic of
Germany/ Federal Statistics Agency Data,” etc.

12

Financial Situation of Health Insurance(Unit: 100 million yen)

FY2007National healthinsurance

Medical system for theelderly aged 75 andover

FY2009FY2010Remarks

Income127,797

124,589

125,993

128,019

Expenditure

129,087

124,496

125,927

127,726

Balance-1,290

93

66

293

Balance in consideration of
the amount transferred to
the general account(deficit portion)- 3,620- 2,383- 3,250(*)

71,052

71,357

69,73578,172

72,44273,64774,62875,632- 1,390- 2,290- 4,893

2,540

3,690

1,539

- 3,179- 638

Income62,00363,65861,71862,854 - Figures for FY2010 is estimated figures based on audit.

Expenditure

61,403

66,847

66,95267,008

Balance600- 3,189- 5,234- 4,154

IncomePublic-corporation-run
health insurance
Expenditurescheme(formerly governmentBalance
managed healthinsurance)
Remaining reserve fund

Association-managed
health insurance

FY2008-3,900(*)

Income98,517

111,691

116,434

Expenditure

95,510110,974

118,001

Balance

3,007

717

- 1,567- The “balance taking into consideration of the transfer fromgeneral account (compensation at account closing)” before
FY2008 did not include the transfer from general account(compensation at account closing) related to the financeequalization grants to Tokyo Metropolitan Government,
therefore, the definition is different from that of numericalvalues at account closing after FY2009.

- Balance calculated by subtracting current year’s National
Treasury Expenditure adjusted amount to be settled next
fiscal year (159.9 billion yen) from the balance of FY2008 is
140.8 billion yen.
- Balance calculated by adding the balance between current
year’s National Treasury Expenditure adjusted amount(180.9 billion yen) and previous year’s National Treasury
Expenditure adjusted amount (159.9 billion yen) to thebalance of FY2009 is 50.7 billion yen.
- Balance calculated by adding the balance between current
year’s National Treasury Expenditure adjusted amount (33.9
billion yen) and previous year’s National Treasury
Expenditure adjusted amount (180.9 billion yen) to thebalance of FY2010 is -9.7 billion yen.

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