Medical care in Japan, yesterday, today, and tomorrow

Abstract

Abstract The medical care delivery system of modern Japan seems to be more complicated than in western countries. Modern Japan has been westernized since the beginning of the 18th century, and the present medical care delivery system relates directly to the western system. However, the origin of Japanese medicine owed most to Chinese and other oriental medicine. Therefore, the details of the system and practical operation of medical care differ from those in western countries. Since the Meiji era (1867–1912 the national government has made great efforts to establish a reasonable medical care system. At this time, however, the government has administered the infectious disease eradication programme and reformed sanitary conditions. The medical care system and established policy have suffered accordingly. Through the period of industrialization (from the end of the Taisho-era until just before the Second World War), medical care had gradually improved by the efforts of the private sector under the free market mechanism. In 1922, the government enacted the Health Insurance Scheme for industrial employees and in 1938 the National Health Insurance Scheme for residents. Japan is the first Asian country to establish such programmes. After the second world war, the schemes were administered compulsorily by the government. The compulsory health insurance schemes spread medical care among the people. On the other hand, these programmes are the cause of conflict or competition between the private sector and the public sector. The Japanese Medical Association, which is the strongest medical/health policy making body in Japan, has recommended many changes in medical planning. The author briefly describes them and analyses their influence on the national policy of medical care. Finally, the transition of medical care relating to the introduction of the systems concept is discussed and the development of community medicine by the private sector is described.