Japan: Universal Health Care at 50 Years 2 Japanese universal health coverage: evolution, achievements, and challenges
Japan: Universal Health Care at 50 Years 2 Japanese universal health coverage: evolution, achievements, and challenges
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DOI：
10.1016/s0140-6736(11)60828-3
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发表时间：
2011-09-17
期刊：
影响因子：
168.9
通讯作者：
Kobayashi, Yasuki
中科院分区：
文献类型：
--
作者：
Ikegami, Naoki;Yoo, Byung-Kwang;Kobayashi, Yasuki
日本通过建立以社区为基础的社会健康保险制度，展示了推行全民健康保险的优势和局限性。从积极的方面来看，1961年几乎所有人都参加了保险;对所有计划和几乎所有提供者执行相同的收费表，保持了公平并控制了成本;除老人和儿童外，所有人的共同支付率都相同。实现这一公平的办法是，从一般收入中向招收低收入者的计划提供补贴，并在各计划之间实行交叉补贴，为老年人的保健费用提供资金。消极的一面是，将参保人数分散到3 500个计划中，导致作为保险费支付的收入比例相差三倍以上，并出现了未参保人口的问题。鉴于社会老龄化和就业模式的变化，我们主张合并都道府县内的所有计划，以保持普遍和公平的覆盖面。计划实现基于就业和居民身份的社会健康保险普遍覆盖的国家应意识到此类计划的局限性。
Japan shows the advantages and limitations of pursuing universal health coverage by establishment of employee-based and community-based social health insurance. On the positive side, almost everyone came to be insured in 1961; the enforcement of the same fee schedule for all plans and almost all providers has maintained equity and contained costs; and the co-payment rate has become the same for all, except for elderly people and children. This equity has been achieved by provision of subsidies from general revenues to plans that enrol people with low incomes, and enforcement of cross-subsidisation among the plans to finance the costs of health care for elderly people. On the negative side, the fragmentation of enrolment into 3500 plans has led to a more than a three-times difference in the proportion of income paid as premiums, and the emerging issue of the uninsured population. We advocate consolidation of all plans within prefectures to maintain universal and equitable coverage in view of the ageing society and changes in employment patterns. Countries planning to achieve universal coverage by social health insurance based on employment and residential status should be aware of the limitations of such plans.