TY - JOUR
T1 - Cost containment and quality of care in Japan
T2 - Is there a trade-off?
AU - Hashimoto, Hideki
AU - Ikegami, Naoki
AU - Shibuya, Kenji
AU - Izumida, Nobuyuki
AU - Noguchi, Haruko
AU - Yasunaga, Hideo
AU - Miyata, Hiroaki
AU - Acuin, Jose M.
AU - Reich, Michael R.
N1 - Funding Information:
We thank Keizo Takemi, Sudhir Anand, and Takahiro Higashi for their valuable comments, Shinya Matsuda, Hiroya Ogata, and Zaiken Nishida, and David Evans and Mitsuhiko Noda for reference, Susan Hubbard for her technical edits, and Hiyuko Fujita, Tomoko Suzuki, and Tadashi Yamamoto (Japan Centre for International Exchange) for their administrative support. This work is in part funded by the Bill & Melinda Gates Foundation and the China Medical Board, and in part by a research grant from the Ministry of Health, Labour and Welfare (H22-seisaku-shitei-033), and by a research grant from the Japan Society for the Promotion of Science (JSPS) (Funding Program for Innovative R&D on Science and Technology; FIRST program, initiated by the Council for Science and Technology Policy). The views and opinions expressed by the independent authors in this publication are provided in their personal capacity and are their sole responsibility.
PY - 2011
Y1 - 2011
N2 - Japan's health indices such as life expectancy at birth are among the best in the world. However, at 8•5% the proportion of gross domestic product spent on health is 20th among Organisation for Economic Co-operation and Development countries in 2008 and half as much as that in the USA. Costs have been contained by the nationally uniform fee schedule, in which the global revision rate is set fi rst and item-by-item revisions are then made. Although the structural and process dimensions of quality seem to be poor, the characteristics of the health-care system are primarily attributable to how physicians and hospitals have developed in the country, and not to the cost-containment policy. However, outcomes such as postsurgical mortality rates are as good as those reported for other developed countries. Japan's basic policy has been a combination of tight control of the conditions of payment, but a laissezfaire approach to how services are delivered; this combination has led to a scarcity of professional governance and accountability. In view of the structural problems facing the health-care system, the balance should be shifted towards increased freedom of payment conditions by simplifi cation of reimbursement rules, but tightened control of service delivery by strengthening of regional health planning, both of which should be supported through public monitoring of providers' performance. Japan's experience of good health and low cost suggests that the priority in health policy should initially be improvement of access and prevention of impoverishment from health care, after which effi ciency and quality of services should then be pursued.
AB - Japan's health indices such as life expectancy at birth are among the best in the world. However, at 8•5% the proportion of gross domestic product spent on health is 20th among Organisation for Economic Co-operation and Development countries in 2008 and half as much as that in the USA. Costs have been contained by the nationally uniform fee schedule, in which the global revision rate is set fi rst and item-by-item revisions are then made. Although the structural and process dimensions of quality seem to be poor, the characteristics of the health-care system are primarily attributable to how physicians and hospitals have developed in the country, and not to the cost-containment policy. However, outcomes such as postsurgical mortality rates are as good as those reported for other developed countries. Japan's basic policy has been a combination of tight control of the conditions of payment, but a laissezfaire approach to how services are delivered; this combination has led to a scarcity of professional governance and accountability. In view of the structural problems facing the health-care system, the balance should be shifted towards increased freedom of payment conditions by simplifi cation of reimbursement rules, but tightened control of service delivery by strengthening of regional health planning, both of which should be supported through public monitoring of providers' performance. Japan's experience of good health and low cost suggests that the priority in health policy should initially be improvement of access and prevention of impoverishment from health care, after which effi ciency and quality of services should then be pursued.
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U2 - 10.1016/S0140-6736(11)60987-2
DO - 10.1016/S0140-6736(11)60987-2
M3 - Review article
C2 - 21885098
AN - SCOPUS:80053250816
SN - 0140-6736
VL - 378
SP - 1174
EP - 1182
JO - The Lancet
JF - The Lancet
IS - 9797
ER -