Healt lth h Ca Care re Refo form rm in in Japan ～ for Un Unpreceden cedented ed Agi ging g So Socie iety ～ New York Pharma Forum March 4th, 2004 Councilor for Health Insurance and Health Policy Minister’s Secretariat, Ministry of Health, Labour and Welfare Masaharu NAKAJIMA, M.D.,Ph.D.
Compar 1998 ) arison of Me Medical al C Car are Se Servi vice Sy Syste tem ( ( 1 Number of beds Number of doctors Number of nursing Average length Consultation rate of Country per 1000 persons per 100 beds staffs per 100 beds of hospital stay outpatient ( 1996 ) Japan １３．１ １２．５ ４３．５ ３１．８ １６．０ ９．３ ３７．６ ９９．８ １２．０ ６．５ Germany ６９．７ １０．８ ８．５ ３５．２ ６．５ France (1997) (1997) ９．８ ４．２ ４０．７ １２０ ６．１ U.K (1996) ７．５ ３．７ ７１．６ ２２１ ５．８ U.S.A (1996) －１－
Japanese Health Insurance Scheme 1. Universal Coverage : all national 2. Free access : all medical facilities 3. Universal Benefit: Inpatient, Outpatient, Pharmaceuticals, Devices 4. Fund: ・ Premium (Employer 50% : Employee 50%) ・ Tax ・ Co-payment (30% with upper limit) －２－
Medical Expenditure Total ME per GDP （ % ） Per Capita ME（\） Aging Population （ % ） Nation (1998) (1998) Order Order 2000 2025 289,813 9 7.1 19 17.4 28.7 Japan 352,906 5 10.3 3 16.4 24.6 Germany 303,688 8 9.3 4 16.0 22.2 France 216,509 17 6.8 23 15.8 21.9 UK 546,900 1 12.9 1 12.3 18.5 USA （ notes ）・ order is among ＯＥＣＤ countries ・” Aging Population”: the ratio of the population aged 65 years and over ・ＯＥＣＤ “ ＨＥＡＬＴＨ DATA 2002 ” －３－
Evaluation of Japan’s Health Care System ・ Japan is ranked as No. 1 in “The World Health Report 2000” by WHO , which made comprehensive assessment of the quality and equality of health care system of 191 countries . Japan France U.K Germany U.S.A ９ ６ １４ １ １ 5 Healthy Life Expectancy （ male and female average ） Rank Healthy life expectancy （ years ） Country １ Japan 74.5 ２ Australia 73.2 France 73.1 ３ Sweden 73.0 ４ ５ Spain 72.8 （ The World Health Report 2000 ） －４－
1. Current situation of Medical Care in Japan ① Evaluation by WHO ・ Access （ Convenience of consultation ） ・ Quantity ・ Cost ・ Quality ② Advance in medical technology ・ Advanced medical technology ・ Reduction of length of hospital stays ③ Low co-payment ④ Less number of malpractice suits －５－
2. Current issues ① Medical expenditure ② Quality of medical care ③ Health delivery system ④ Provision of medical information ⑤ Technology development －６－
Changes in the National Medical Expenditure （ \trillion ） (%) Ratio of national medical expenses to national income (%) 40 9 8.5 8.3 8.0 7.4 7.8 8 35 7.3 30.4 31.3 7.2 21.8 23.5 24.4 25.8 27.0 28.5 29.1 29.8 30.9 6.9 7 6.6 30 6.3 6.2 5.9 5.8 6 25 5 20.6 20 4 National medical expenditure 16.0 15 11.8 3 11.7 11.2 10.9 10.3 9.7 8.9 10 8.2 7.5 2 6.9 6.4 5.9 4.1 5 1 Medical expenditure for the elderly 25.4% 28.8% 29.4% 29.5% 30.6% 31.6% 33.1% 34.1% 35.4% 36.5% 38.2% 36.9% 37.2% 0 0 FY 85 90 91 92 93 94 95 96 97 98 99 00 01 Notes ：１） With the implementation of Long-Term Care Insurance System from April 2000,of the expenses subject to the previous national medical expenditure and medical expenditure for the elderly,the costs for long – term care insurance have been transferred. ２） Source of National Income: “National accounting” by Cabinet Office （ 2002.12 ） －７－
Breakdown of General expenditure （ Budget plan for 2004 FY ） （ Unit:100milionJPY, （） - ％） Transfer to the special account for Industrial investment Reserve fund 3,500(0.7) Medical care 81,445 988 ( 0.2 ) Stable supply of food Pension 58,246 ( 12.2 ) （ 17.1 ） 6,749 ( 1.4 ) 17,921 ( 3.8 ) Long-term care Energy-related measures Welfare 40,358 ( 8.5 ) Miscellaneous etc. 5,065 ( 1.1 ) expenses Measures for small and medium 52,784 -sized enterprises ( 11.1 ) 1,738 （ 0.4 ） Social security Economic Cooperation 197,970 ( 41.6 ) 7,686 （ 1.6 ） General expenditures Public works 47,632 billion 78,159 ( 16.4 ) (100.0) Defense 49, 030 Culture, education, ( 10.3 ) and science promotion ) 61,330 ( 1 2.9 Compulsory education 25,128 （ 5.3 ） Science promotion 12,841 （ 2.7 ） Public Servants’ Pensions Cultural and educational facilities 1,443 （ 0.3 ） 11,321 ( 2.4 ) Education promotion 20,572 （ 4.3 ） Educational projects 1,346 （ 0.3 ） －８－
International comparison of national contribution ratio ［ National Contribution Ratio = Tax Burden Ratio ＋ Social Security Burden Ratio ］ ［ Potential National Contribution Ratio = National Contribution Ratio +the Ratio of Financial Deficit to National Income] （％） 76.5 80 The ratio of financial deficit to national income Potential National Contribution Ratio 66.7 Social security burden ratio 70 National Contribution Ratio 22.1 Tax burden ratio 1.8 56.5 60 51.2 47.1 25.0 50 9.8 25.3 37.0 11.0 76.5 40 64.8 1.1 9.8 56.5 30 15.2 54.4 51.2 41.4 39.8 20 36.1 35.9 31.2 26.2 20.9 10 0 United States of Japan United Kingdom Germany France Sweden America （ FY2003 ） （ 2000 ） （ 2000 ） （ 2000 ） （ 2000 ） （ 1997 ） Notes １ .Figures for Japan are based on FY 2003buget.Figures for other countries is actual performance of calendar year ２． The ratio of financial deficit to national income for Japan and U.S.A are based on general government account excluding social security funds. Ratios for other countries are based on general government account. －９－
Changes in population composition 100～ 100～ 100～ 95 95 95 90 90 90 85 85 85 80 80 80 75 75 75 70 70 70 65 65 65 60 60 60 55 55 55 50 50 50 45 45 45 40 40 40 35 35 35 30 30 30 25 25 25 20 20 20 15 15 15 10 10 10 5 5 5 0 0 0 0 500 1,000 1,500 2,000 2,500 0 500 1,000 1,500 2,000 2,500 0 500 1,000 1,500 2,000 2,500 １９８０ ２０００ ２０２５ Sources ：１９８０、２０００－“ National Census” by Ministry of Public Management, Home Affairs, Posts and Telecommunications ２０２５－“ Projection of Japanese Population” （ Estimated January 2002 ） by the National Institute of Population and Social Security Research －１０－
100.0 96.6 （ ten thousand Medical Care Expenditure and co-payment per capita by the age bracket （ average annual amount ） yen ） 90.0 （ Estimated figure based on figures of undertakings for FY2000 ） 83.0 80.0 Medical Expenditure Co-payment 72.5 70.0 60.6 60.0 50.0 44.2 40.0 32.4 30.0 25.4 19.3 20.0 16.1 15.5 12.3 10.4 10.1 9.6 8.8 8.2 10.0 7.2 6.9 7.4 6.6 6.4 6.2 3.8 5.2 5.6 4.7 4.0 3.2 2.3 2.5 2.1 2.1 1.7 1.8 1.4 1.4 0.0 （ age ） ０－４ ５－９ １０－１４ １５－１９ ２０－２４ ２５－２９ ３０－３４ ３５－３９ ４０－４４ ４５－４９ ５０－５４ ５５－５９ ６０－６４ ６５－６９ ７０－７４ ７５－７９ ８０－８４ ８５－ －１１－
Future estimation of medical expenditure Future estimation of population (related with health insurance, in JPY ） （ in year ） 128 million ６５．６ trillion 121 million 12million 75 （ 9.7 ％ ） 20million years （ 16.7 ％ ） 15million （ 11.4 ％ ） ３４．３ trillion 65 14million ３４．７ trillion years （ 52.3 ％） （ 11.9 ％ ） １２．２ trillion （ 35.2 ％） １１．０ trillion 101million 75 years （ 16.7 ％） ６．６ trillion 8,600million （ 78.9 ％ ） （ 19.1 ％） （ 71.3 ％ ） 65 years ２０．３ trillion １５．９ trillion （ 31.0 ％） （ 45.7 ％） FY2007 FY2025 FY2007 FY2025 －１２－
3 ． Health Care Reform : What do we achieve? ① Health Promotion, Disease Prevention ② Health delivery system （１） Improvement of the quality and efficiency of medical services （２） Promotion of information provision （３） Securing patient comfort and public confidence in medicine （４） Infrastructure development of medical services －１３－
Lifestyle-related diseases with age and medical expenditure （ Concept ） Medical care Risk factor of expenditure per disease （ subject to person Increase in medical expenditure for intervention ） the elderly Aggravation Number of Lost Teeth Disease Threshold level 17teet eeth Accumulation of risk （ 11 teeth h rem emain ） 11teet eeth factors （ 17 teeth h remain ） age ６５ ７５ Medical Medical Care Services Employees Insurance Services for for Retired Employees the Elderly National Health Insurance －１４－
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