Final Project for
Comparative healthcare systems in Asia

Japanese Health Care System

Focusing on so-called“Free-access System”
Yuki Izumi, D1

Lancet 2011
Japan: universal healthcare
at 50 years

What does “free-access” mean?
Patients are free to choose
when and where to see a doctor
regardless of the size of the hospitaland the specialties.

Search by “Free access, health care”
in English???

“Free-access system”
Specialists

Specialists

Specialists

Tertiary Care HospitalSpecialists

Specialists

Specialists

Secondary Care HospitalSpecialists

Specialists

Gatekeepingsystem
Free to choose “the level”
Primary Care“Free-access system”
Specialists

Specialists

Tertiary Care HospitalSpecialists

Specialists

Specialists
Secondary
Hospital
Free tochooseCare“theprovider”

Specialists

Specialists

Registration system
Specialists

Primary Care

Organization of health care delivery
in OECD countries

Primary care physicians
referral tosystemaccess secondary care
Gatekeeping
Required

Required
Are patients requiredor encouraged toIncentives
Registration
registerwith aprimary care
physician?

Incentives

Denmark, Finland,Ireland(1), Italy,
Netherlands, Portugal,
Slovenia, SpainNo requirement, noincentive
Czech Republic

Australia, New Zealand, Belgium, France,Norway, Poland,
Switzerland

No requirement, Canada, Chile, United
Kingdomno incentive

MexicoAustria, Germany,Greece, Iceland, Israel,Japan, Korea

OECD HEALTH SYSTEM CHARACTERISTICS SURVEY 2012

PC registration required and Referral to secondary care
Specialists

Specialists

Tertiary Care HospitalSpecialists

Specialists

Specialists

Specialists

Secondary Care HospitalSpecialists

Specialists

Primary Care

Organization of health care delivery
in OECD countries

Primary care physicians referral to access secondary care
Required

Required
Are patients requiredor encouraged toIncentives
register with a
primary care
physician?

IncentivesDenmark, Finland,Ireland(1), Italy,Netherlands, Portugal,Slovenia, SpainNo requirement, noincentive
Czech Republic

Australia, New Zealand, Belgium, France,Norway, Poland,
Switzerland

No requirement, Canada, Chile, United
Kingdomno incentive

MexicoAustria, Germany,
Greece, Iceland, Israel,Japan, Korea

OECD HEALTH SYSTEM CHARACTERISTICS SURVEY 2012

No registration of PC but Referral to secondary care
Specialists

Specialists

Tertiary Care HospitalSpecialists

Specialists

Specialists

Specialists

Secondary Care HospitalSpecialists

Specialists

Primary Care

Organization of health care delivery
in OECD countries

Primary care physicians referral to access secondary care
Required

Required
Are patients requiredor encouraged toIncentives
register with a
primary care
physician?

Incentives

Denmark, Finland,Ireland(1), Italy,Netherlands, Portugal,
Slovenia, SpainNo requirement, no
incentive
Czech Republic

Australia, New Zealand, Belgium, France,
Norway, Poland,
Switzerland

No requirement, Canada, Chile, United
Kingdomno incentive

MexicoAustria, Germany,Greece, Iceland, Israel,
Japan, Korea

OECD HEALTH SYSTEM CHARACTERISTICS SURVEY 2012

“Free-access system”
Specialists

Specialists

Tertiary Care HospitalSpecialistsSpecialists

Specialists

Specialists

Secondary Care Hospital

180,396

Specialists

Specialists

clinics and hospitals throughout Japan
Primary Care

MHLW report on medical facilities, 2021

Doctor’s consultations per capita in G20 countries
South Korea

JapanUSCanadaItaly

https://data.oecd.org/healthcare/doctors-consultations.htm

Do we really have“free-access” system in Japan?

Introduction of ”選定医療費”SENTEI RYOYOHI
2016

If a patient would like to be seen at Special Functioning Hospitals or
hospitals with >500 beds, he/he has to pay SENTEI RYOYOHI,
additional 5,000 yen.

Tertiary Care HospitalPrimary CareIntroduction of SENTEI RYOYOHI
2016

If a patient would like to be seen at Special Functioning Hospitals orhospitals with >500 beds, he/he has to pay SENTEI RYOYOHI,additional 5,000 yen.

2018

The scope of hospitals designated for Sentei Iryohi was expanded tothe hospitals with > 400 beds

2020

The scope of hospitals designated for Sentei Iryohi was expanded tothe hospitals with > 200 beds

2022

The Sentei iryouhi was increased to 7,000 yen

Introduction of SENTEI RYOYOHI
for Follow-up visits
Tertiary Care
Hospital

Primary CareTertiary Care
Hospital
3,000 yenPrimary Care“Negative incentive to selectsecondary and Tertiary care”
Specialists

Specialists

Tertiary Care HospitalSpecialists

Specialists

Specialists

Specialists

Secondary Care HospitalSpecialists

Specialists

Primary Care

Incentives for primary care doctors
Specialists

Specialists

Tertiary Care HospitalSpecialists

Specialists

Specialists

Specialists

Secondary Care HospitalSpecialists

Specialists

Primary Care

Incentive for primary care providers
2014

Community-based integrated care fee is introduced for the
managements of patients with multiple chronic conditions

2016

Pediatric primary care fee is introduced for the continuous careincluding the management of vaccination scheduleIncentives for primary care doctors
Specialists

Specialists

Tertiary Care HospitalSpecialists

Specialists

SpecialistsSpecialists

Secondary Care HospitalSpecialists

Specialists

Primary Care

Organization of health care delivery
in OECD countries

Primary care physicians referral to access secondary care
Required

Required
Are patients requiredor encouraged toIncentives
register with a
primary care
physician?

Incentives

Denmark, Finland,Ireland(1), Italy,
Netherlands, Portugal,
Slovenia, SpainNo requirement, noincentive
Czech Republic

Australia, New Zealand, Belgium, France,
Norway, Poland,
Switzerland

No requirement, Canada, Chile, United
Kingdomno incentive

MexicoAustria, Germany,
Greece, Iceland, Israel,
Japan, Korea

OECD HEALTH SYSTEM CHARACTERISTICS SURVEY 2012

Organization of health care delivery
in OECD countries

Primary care physicians referral to access secondary care
Required

Required
Are patients requiredor encouraged toIncentives
register with a
primary care
physician?

Incentives

Denmark, Finland,Ireland(1), Italy,
Netherlands, Portugal,Slovenia, SpainNo requirement, noincentive
Czech Republic

Australia, New Zealand, Belgium, France,Norway, Poland,Switzerland

No requirement, Canada, Chile, United
Kingdomno incentive

MexicoAustria, Germany,Greece, Iceland, Israel,Japan, Korea

OECD HEALTH SYSTEM CHARACTERISTICS SURVEY 2012

Do we really have“free-access” system in Japan?
Weak incentives have been introduced
to move away from free-access system

The role and function of the facilities
must be clear from the patients.
Specialists

Specialists

Tertiary Care HospitalSpecialists

Specialists

Specialists

Specialists

Secondary Care HospitalSpecialists

Specialists

Primary Care

Japanese patients’ view of the medical facilities
Specialists

Specialists

Specialists

Specialists

SpecialistsPrimaryCare

PrimaryCare
SecondaryCare
Hospital

Tertiary
Care
Hospital

SecondaryCare
Hospital
PrimaryCare
Specialists

Specialis

This reminds me of something...
Japan

Western countries

Specialists

Specialists

Specialists

Specialists

Tertiary Care Hospital

Secondary Care HospitalSpecialists

Specialists

Specialists

Specialists

Specialists
Specialists

Specialists

Secondary Care
Hospital

Primary Care

Specialists

Tertiary Care
Hospital
Secondary Care
Hospital

Primary Care

Primary Care

Primary Care

Specialists

Specialists

Specialists

Western countries

Manhattan, NYJapan

Shinjyuku, Tokyo

Western countries

JapanBritish Gardens

Japanese gardens

“We believe that“muddling through” is the approach
best suited to Japanese health policy,
because in the realm of power,
Japan’s health care system will always bedominated by interest-group politics,
and in the realm of knowledge,
real-world experience isconsiderably more valuable
than theories and models.”
Ikegami N, Campbell JC. Health care reform in Japan: the virtues of muddling through. Health Aff (Millwood). 1999;18(3):56-75

The government would liketo organize the system.

https://www.japantimes.co.jp/news/2022/05/18/national/doctor-system-reform/

Doctors are cautious about
the change

https://japannews.yomiuri.co.jp/politics/politics-government/20220626-41015/

Thank you for your attention