International Healthcare Models: Japan

Here is my earlier review of the Japanese healthcare system.  Additional information on medical care in Japan is below.


  • The system is largely funded through payroll taxes.  Employees pay a larger share of the payroll tax than employers.    
  • Insurance is bought from public sector sources.
  • There is no private sector insurance companies.
  • Co-pays are generally 30%.


  • Government managed plans cover 30% of workers.
  • Society plans cover 25% of workers.
  • Mutual Aid Association Insurers cover government employees and teachers.
  • There are separate insurance plans for certain groups of workers (e.g., day laborers, seamen).


  • Physicians generally work on a fee-for-service basis.  Physicians with positions in a hospital, however, are on salary.
  • Physicians can sell prescriptions directly to patients.  Unsurprisingly, Japan has the highest consumption rate of pharmaceuticals per capita in the world.
  • There is no private sector practice.
  • There are no GPs.  All physicians are specialized, (except for physicians in rural areas)
  • Physicians do not emphasize prevention (e.g., periodic physical exams are not encouraged).  The government is the institution that takes the lead in providing preventive education.
  • Students move immediately to their internship following 6 years of college with no medical school in between.
  • Physician ratio: 1:500.


  • The Japanese Medical Association provides malpractice insurance for 45% of Japanese physicians.
  • Few claims are filed (less than 1 per 100 physicians).  Because of this, malpractice insurance is only about $500/year


  • There are no community health centers, only clinics offering specialized services.
  • Patients entering a hospital have been required to find a sponsor who will agree to pay for the services delivered when the patient cannot.
  • When patients seek treatment in a hospital, they are expected to pay part of the bill in advance, with their insurance reimbursing them later.


  • All fees for all procedures are set by a government-organized panel including insurers, providers and citizens.

Source: Roth, WF (2010) Comprehensive Healthcare for the U.S.: An Idealized Model. Productivity Press, 174 pages.


  1. Very interesting.

    Japan is often mentioned as a good model in terms of quality of care, access to care, overall mortality/life expectancy and cost.

    Which attributes of their health care model do you believe are most influential in their relative success?


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