page_title: Health care system in Japan
section_title: History
hierarchical_section_title: Health care system in Japan / History
context_page_description: The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered by a universal health care insurance system that provides relative equality of access, with fees set by a government committee. All residents of Japan are required by the law to have health insurance coverage. People without insurance from employers can participate in a national health insurance programme, administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians.
  Medical fees are strictly regulated by the government to keep them affordable. Depending on the family’s income and the age of the insured, patients are responsible for paying 10%, 20%, or 30% of medical fees, with the government paying the remaining fee.
context_section_description: The modern Japanese Health care system started to develop just after the Meiji Restoration with the introduction of Western medicine. The statutory insurance, however,  had not been established  until 1927 when the first employee health insurance plan was created.
  In 1961, Japan achieved universal health insurance coverage, and almost everyone became insured. However, the copayment rates differed greatly. While those who enrolled in employees' health insurance needed to pay only a nominal amount at the first physician visit, their dependents and those who enrolled in National Health Insurance had to pay 50% of the fee schedule price for all services and medications. From 1961 to 1982, the copayment rate was gradually lowered to 30%.
  Since 1983, all elderly persons have been covered by government-sponsored insurance.
  In the late 1980s, government and professional circles were considering changing the system so that primary, secondary, and tertiary levels of care would be clearly distinguished within each geographical region. Further, facilities would be designated by level of care and referrals would be required to obtain more complex care. Policy makers and administrators also recognised the need to unify the various insurance systems and to control costs.
  By the early 1990s, there were more than 1,000 mental hospitals, 8,700 general hospitals, and 1,000 comprehensive hospitals with a total capacity of 1.5 million beds. Hospitals provided both out-patient and in-patient care. In addition, 79,000 clinics offered primarily out-patient services, and there were 48,000 dental clinics. Most physicians and hospitals sold medication directly to patients, but there were 36,000 pharmacies where patients could purchase synthetic or herbal medication.
  National health expenditures rose from about 1 trillion yen in 1965 to nearly 20 trillion yen in 1989, or from slightly more than 5% to more than 6% of Japan's national income.
  One problem has been an uneven distribution of health personnel, with rural areas favored over cities.
  In the early 1990s, there were nearly 191,400 physicians, 66,800 dentists, and 333,000 nurses, plus more than 200,000 people licensed to practice massage, acupuncture, moxibustion, and other East Asian therapeutic methods.
caption: National Cancer Center Hospital in the Tsukiji district of Tokyo.
exif: {"Image Make": "FUJIFILM", "Image Model": "FinePix S5200", "Image XResolution": "72", "Image YResolution": "72", "Image ResolutionUnit": "Pixels/Inch", "Image Software": "Digital Camera FinePix S5200   Ver1.00", "Image DateTime": "2007:02:22 11:01:40", "Image YCbCrPositioning": "Co-sited", "Image Copyright": "", "Image ExifOffset": "354", "Image CustomRendered": "Normal", "Image ExposureMode": "Auto Exposure", "Image WhiteBalance": "Auto", "Image SceneCaptureType": "Standard", "Image Sharpness": "Normal", "Image SubjectDistanceRange": "0", "Image PrintIM": "[80, 114, 105, 110, 116, 73, 77, 0, 48, 50, 53, 48, 0, 0, 2, 0, 2, 0, 1, 0, 0, 0, 1, 1, 0, 0, 0, 0]", "Thumbnail Compression": "JPEG (old-style)", "Thumbnail Orientation": "Horizontal (normal)", "Thumbnail XResolution": "72", "Thumbnail YResolution": "72", "Thumbnail ResolutionUnit": "Pixels/Inch", "Thumbnail JPEGInterchangeFormat": "1252", "Thumbnail JPEGInterchangeFormatLength": "8979", "Thumbnail YCbCrPositioning": "Co-sited", "EXIF ExposureTime": "1/680", "EXIF FNumber": "71/10", "EXIF ExposureProgram": "Program Normal", "EXIF ISOSpeedRatings": "200", "EXIF ExifVersion": "0220", "EXIF DateTimeOriginal": "2007:02:22 11:01:40", "EXIF DateTimeDigitized": "2007:02:22 11:01:40", "EXIF ComponentsConfiguration": "YCbCr", "EXIF CompressedBitsPerPixel": "3", "EXIF ShutterSpeedValue": "949/100", "EXIF ApertureValue": "57/10", "EXIF BrightnessValue": "93/10", "EXIF ExposureBiasValue": "0", "EXIF MaxApertureValue": "17/5", "EXIF MeteringMode": "Pattern", "EXIF LightSource": "Unknown", "EXIF Flash": "Flash did not fire, compulsory flash mode", "EXIF FocalLength": "63/10", "EXIF FlashPixVersion": "0100", "EXIF ColorSpace": "sRGB", "EXIF ExifImageWidth": "480", "EXIF ExifImageLength": "640", "EXIF FocalPlaneXResolution": "1096", "EXIF FocalPlaneYResolution": "1096", "EXIF FocalPlaneResolutionUnit": "3", "EXIF SensingMethod": "One-chip color area", "EXIF FileSource": "Digital Camera", "EXIF SceneType": "Directly Photographed"}