In today’s globalized world, an increasing number of Chinese enterprises and individuals are choosing to expand their horizons in Japan. In this process, understanding and adapting to the local medical security system is crucial. Japan’s National Health Insurance system, as an essential component of its social security framework, is renowned for its comprehensiveness, fairness, and efficiency.

This article will provide an in-depth analysis of Japan’s National Health Insurance system, including enrollment methods, cost structure, and coverage scope. By comparing it with China’s medical insurance system, we will highlight the advantages of the Japanese system, offering valuable references for businesses and individuals intending to develop in Japan.

Overview of Japan’s National Health Insurance System

1.1 Historical Evolution

The origins of Japan’s National Health Insurance system can be traced back to the Health Insurance Act of 1922. Initially, this law only covered factory workers, but its scope expanded over time. In 1938, the National Health Insurance Act was officially promulgated, marking the beginning of Japan’s universal health insurance system. After multiple revisions and improvements, Japan achieved universal medical insurance coverage in 1961, becoming one of the first countries in the world to realize universal medical security.

The establishment and development of this system fully reflect the Japanese government’s high regard for national health and its long-term planning in social welfare. Through continuous adjustments and optimizations, Japan’s National Health Insurance system gradually formed today’s comprehensive and efficient model, providing reliable medical security for Japanese citizens.

1.2 System Framework

Japan’s medical insurance system is mainly divided into two categories: employment-based insurance and community-based insurance. Employment-based insurance includes health insurance and mutual aid associations, primarily targeting corporate employees and civil servants. Community-based insurance mainly refers to National Health Insurance, covering other groups not covered by employment-based insurance, such as self-employed individuals, those engaged in agriculture, forestry, and fisheries, and unemployed individuals.

As the primary form of community-based insurance, National Health Insurance is operated by each municipality (equivalent to county-level administrative regions in China). This decentralized management model allows insurance operations to be closer to local realities, better meeting the needs of residents in different areas. At the same time, the central government ensures the uniformity and fairness of the insurance system nationwide through fiscal subsidies and policy guidance.

1.3 Basic Principles

Japan’s National Health Insurance system adheres to several basic principles that constitute the core values of the system:

First is the principle of universality. The system aims to cover all residents in Japan, regardless of nationality, occupation, or economic status. This principle ensures that everyone can access basic medical security, reflecting social equity and justice.

Second is the principle of mandatory participation. Except for those already participating in other public medical insurance programs, all residents must join the National Health Insurance. This principle helps expand insurance coverage, enhance risk dispersion capabilities, and thus improve the stability of the entire system.

Third is the non-profit principle. National Health Insurance is operated by the government and is not for profit. This ensures that insurance funds are primarily used for the medical security of the insured rather than commercial profits.

Lastly is the principle of mutual assistance. The system embodies the spirit of mutual aid among members of society, achieving maximum overall social welfare through risk sharing between healthy groups and high-risk groups.

The implementation of these principles has enabled Japan’s National Health Insurance system to play an important role in ensuring fairness, improving efficiency, and maintaining social stability.

Methods of Joining the National Health Insurance

2.1 Eligibility

Japan’s National Health Insurance system adopts a “reverse admission” mechanism. This means that everyone residing in Japan must join the National Health Insurance, except for those who have already joined other public medical insurance (such as employment-based insurance). This includes self-employed individuals, freelancers, unemployed persons, part-time workers, and others.

For foreigners, as long as they are legally residing in Japan, hold a residence card, and expect to stay in Japan for more than three months, they must join the National Health Insurance. This regulation reflects the Japanese government’s protection of the health rights and interests of foreigners in Japan, while also ensuring the rational use of medical resources.

It’s worth noting that even short-term foreign residents in Japan need to join the National Health Insurance if their period of stay exceeds three months. This regulation not only guarantees the medical needs of foreigners during their stay in Japan but also avoids high medical expenses due to sudden illness or accidental injury.

2.2 Enrollment Procedure

The procedure for joining the National Health Insurance is relatively simple and can be completed through the following steps:

First, applicants need to visit the National Health Insurance counter at the municipal office or ward office of their place of residence. There, staff will provide the relevant application forms.

Second, applicants need to fill out the application form and prepare necessary supporting documents. These documents usually include a residence card (for foreigners), passport, and other potentially required proof materials, such as a certificate of job separation (if joining the National Health Insurance due to unemployment).

Then, submit the completed application form and relevant supporting documents to the counter staff. The staff will verify the information and process the application once confirmed.

Finally, after the application is processed, the insured person usually receives an insurance card within 1-2 weeks. This insurance card is an important document that the insured person needs to present when seeking medical care.

The entire enrollment process usually takes no more than 30 minutes, reflecting the efficiency of the Japanese administrative system. For foreigners unfamiliar with Japanese, many local governments provide multilingual services to better understand and complete the application process.

2.3 Handling Special Situations

In certain special situations, the procedure for joining the National Health Insurance may differ. For example:

For newborns, parents need to register the birth at the municipal office or ward office within 14 days of the child’s birth, and can simultaneously enroll the child in the National Health Insurance. The insurance for newborns is effective from the date of birth, ensuring that infants receive medical coverage from birth.

For those who have just become unemployed, they need to complete the enrollment procedure immediately after losing their job. In this case, in addition to the regular application materials, they also need to provide documents such as a certificate of job separation to prove their unemployment status. Unemployed individuals can enjoy preferential policies such as insurance premium reductions within a certain period.

For foreigners who have just arrived in Japan, they should complete resident registration within 14 days of obtaining their residence status and join the National Health Insurance at the same time. If the place of residence has already been determined upon entry, they can also make an appointment online in advance to save time.

The handling of these special situations reflects the flexibility and humanization of Japan’s National Health Insurance system, which can provide corresponding services according to the special needs of different groups.

Cost Structure of National Health Insurance

The cost structure of National Health Insurance is a complex and precise system designed to balance social equity and system sustainability. The core of this system lies in its unique insurance premium calculation method, flexible payment methods, and targeted reduction and exemption policies. By analyzing these three aspects in depth, we can better understand how the goal of universal medical security is achieved.

3.1 Insurance Premium Calculation Method

The insurance premium calculation method for National Health Insurance adopts a multi-factor comprehensive calculation model, mainly considering variables such as the insured person’s income, assets, and family size. This calculation method consists of four main parts: income-based premium, asset-based premium, per capita premium, and per household premium.

The income-based premium is calculated based on the insured person’s income from the previous year, reflecting the principle of “ability to pay.” According to the latest statistics, the national average income-based premium rate is 7.85%, but there are significant differences between regions. For example, the income-based premium rate in a certain metropolitan area is 8.52%, while in a certain remote area, it is 6.94%. This difference reflects the varying levels of economic development and fiscal conditions in different regions. Specifically, for an insured person with an annual income of 5 million yen in a certain metropolitan area, the income-based portion of the insurance premium is about 426,000 yen, while in a certain remote area, an insured person with the same income only needs to pay 347,000 yen.

The asset-based premium is calculated based on the value of fixed assets owned by the insured person. The national average asset-based premium rate is 1.72%, but regional differences also exist. For example, the asset-based premium rate in a certain economically developed area is as high as 2.15%, while in an underdeveloped area, it is only 1.25%. This difference is partly due to the different real estate values and fixed asset distribution in different regions. For example, an insured person owning fixed assets worth 10 million yen would need to pay an asset-based premium of 215,000 yen in an economically developed area, while in an underdeveloped area, they would only need to pay 125,000 yen.

The per capita premium is a fixed amount that each insured person needs to pay and is the same within the same region. The national average per capita premium amount is 28,254 yen per person, but there are huge differences between regions. The per capita premium amount in a certain large city is as high as 39,900 yen per person, while in a certain small city, it is only 19,800 yen per person. This difference reflects the varying medical costs and fiscal capabilities of different regions. For example, a family of four in a large city would need to pay 159,600 yen for the per capita premium, while in a small city, they would only need to pay 79,200 yen.

The per household premium is a fixed amount levied on a per household basis. The national average per household premium amount is 23,688 yen per household. The per household premium amount in a certain economically developed province is 28,800 yen per household, while in an underdeveloped province, it is only 18,000 yen per household. This difference partly stems from the family structure and population characteristics of different regions. Regardless of the number of family members, each household needs to pay the same per household premium, which to some extent reflects consideration for large families.

Although this complex calculation method increases administrative costs, it can more accurately reflect the insured person’s ability to pay, achieving social equity. At the same time, local governments can appropriately adjust the weights of these factors according to local economic conditions and fiscal capabilities to ensure the sustainability of the insurance system. For example, an economically underdeveloped area may reduce the proportion of income-based and asset-based premiums while increasing the proportion of per capita and per household premiums to ensure basic insurance premium income.

3.2 Insurance Premium Payment Methods

The payment methods for National Health Insurance premiums are quite flexible, mainly including bank transfer, payment slip, credit card payment, and installment payment.

Bank transfer is the most common and convenient payment method. Insured persons can choose to have the insurance premium automatically deducted from a designated bank account monthly or pay quarterly. According to statistics from a certain region, about 75% of insured persons choose the bank transfer method. This method not only reduces the possibility of insured persons forgetting to pay but also greatly reduces administrative costs. For example, in a medium-sized city, after adopting bank transfer, the city’s insurance premium collection cost decreased by about 30%, and the collection rate increased by 15 percentage points.

Payment slip is mainly for insured persons who are unwilling or unable to use bank transfer. Local governments will regularly send payment slips, and insured persons can bring the payment slip to designated financial institutions, convenience stores, or government windows to pay the insurance premium. A survey shows that about 20% of insured persons choose this method, with a higher proportion among the elderly and low-income groups. Although the administrative cost of this method is relatively high, it is still a necessary option considering the special needs of some groups.

Credit card payment is an emerging payment method in recent years. Currently, about 30% of regions have started to allow insurance premium payment by credit card. This method is particularly popular among young people and middle to high-income groups. Data from a pilot city shows that the introduction of credit card payment increased the on-time payment rate of insured persons under 35 by 20 percentage points. However, due to issues such as credit card handling fees, the promotion of this method still faces some challenges.

Installment payment is set up to accommodate insured persons with financial difficulties. Usually, the annual insurance premium can be paid in 10 or 12 installments, reducing the economic pressure on the insured. Data from a certain region shows that about 15% of insured persons chose installment payment, of which over 60% are families with annual incomes below the local average. Although this method increases administrative costs, it effectively reduced the delinquency rate. After implementing installment payment, the delinquency rate in a certain region decreased from 8% to 3%.

These diversified payment methods fully consider the needs and payment abilities of different insured persons, helping to improve the collection rate of insurance premiums and ensure the stable operation of the system. According to a national survey, regions with diversified payment methods have an average collection rate 10-15 percentage points higher than regions with a single payment method.

3.3 Reduction and Exemption Policies

The National Health Insurance system in Japan has implemented several reduction and exemption policies to support economically disadvantaged groups. These policies include reductions for low-income individuals, exemptions for the unemployed, student discounts, and disaster relief exemptions.

The low-income reduction policy targets insured individuals with annual incomes below a certain threshold. The reduction rate varies based on income levels, with the highest reduction reaching over 70%. According to statistics from one province, approximately 15% of insured individuals benefited from low-income reductions, with an average reduction rate of 50%. This policy has effectively reduced the economic burden on low-income groups. One survey showed that after implementing this policy, the medical visit rate for low-income families increased by 25%.

The unemployment exemption policy allows individuals who have involuntarily lost their jobs to enjoy insurance premium reductions for a certain period (usually until the end of the fiscal year following their job loss). The reduction rate is typically around 30%. Data from one region shows that during economic downturns, about 5% of insured individuals applied for unemployment exemptions, helping them overcome periods of financial difficulty. Statistics indicate that among those who received unemployment exemptions, approximately 70% were able to find new employment and resume normal premium payments after the exemption period ended.

The student discount policy allows full-time students to apply for insurance premium discounts, significantly reducing their premiums. Data from one university town shows that about 90% of student policyholders benefited from this discount, with average insurance premiums reduced by 60%. This policy not only demonstrates the importance placed on education and support for young people but also effectively increases the insurance coverage rate among students, thereby reducing their risk of poverty due to illness.

The disaster relief exemption policy targets insured individuals who face economic hardship due to natural disasters or other special circumstances, allowing them to apply for temporary insurance premium exemptions. After one major natural disaster, approximately 20% of insured individuals in the affected area applied for disaster relief exemptions, with an average exemption period of 6 months. This policy effectively alleviated the economic pressure on disaster victims, ensuring they could maintain necessary medical coverage during the post-disaster reconstruction period.

The existence of these reduction and exemption policies ensures that economically disadvantaged groups can access basic medical care, reflecting the spirit of social mutual assistance and concern for vulnerable groups. At the same time, these policies help improve overall societal health levels and reduce instances of delayed medical treatment due to economic reasons. A national survey showed that after implementing these reduction policies, the average annual number of medical visits among low-income groups increased by 30%, and the management rate of chronic diseases improved by 20%.

In summary, the cost structure of the National Health Insurance system embodies the principles of “ensuring basic coverage, overall planning, adapting to local conditions, and dynamic adjustment.” Through complex and precise insurance premium calculation methods, flexible payment options, and targeted reduction policies, the system achieves both fairness and sustainability. This design not only considers the economic capabilities and special needs of different groups but also provides local governments with the flexibility to make adjustments based on their specific circumstances. In the future, as the economy and society develop and demographic structures change, this system will face numerous challenges and will need continuous optimization and improvement to better achieve the goal of universal medical coverage.

Coverage Scope of National Health Insurance

4.1 Medical Service Coverage

The National Health Insurance in Japan covers an extensive range of medical services, encompassing almost all common disease treatments and injury management. This comprehensive protection system ensures that insured individuals can receive timely and effective treatment for various health issues, significantly reducing the burden of medical expenses.

Outpatient services are one of the fundamental services covered by National Health Insurance. According to the latest statistics, in 2023, there were 3.92 billion outpatient visits nationwide, with approximately 95% of these visits reimbursed by National Health Insurance. This figure clearly demonstrates the crucial role of National Health Insurance in daily medical care. For example, about 50 million visits annually are due to upper respiratory tract infections, with an average cost of around 5,000 yen per visit, of which 70% is covered by National Health Insurance, greatly reducing the economic burden on patients.

For chronic disease patients, the protection provided by National Health Insurance is even more crucial. For instance, there are about 10 million diabetes patients in Japan who require long-term blood glucose monitoring and medication. Statistics show that the average annual medical expenditure for a diabetes patient is about 300,000 yen, of which 80% is covered by National Health Insurance. This not only ensures that patients can continuously receive necessary treatment but also significantly reduces the long-term economic pressure of chronic diseases on families.

Inpatient treatment is another important aspect of coverage. In 2023, there were 14.5 million hospitalizations nationwide, with an average hospital stay of 16.2 days. Taking a common appendectomy as an example, the average surgery cost is about 500,000 yen, including surgical fees, ward fees, and nursing care costs. The patient typically needs to bear no more than 150,000 yen of this cost. For major illnesses requiring long-term hospitalization, such as malignant tumors, the protective role of National Health Insurance is even more significant. Data shows that the treatment cost for a typical cancer patient in the first year can be as high as 5 million yen, but through National Health Insurance, the patient’s actual burden is usually no more than 1.5 million yen.

Various medical examinations are also an important part of National Health Insurance coverage. In 2023, there were over 36 million CT scans and over 18 million MRI examinations conducted nationwide. For a routine CT scan costing about 30,000 yen, the patient only needs to pay around 9,000 yen. This high coverage rate greatly increases the possibility for people to receive high-quality medical examinations, facilitating early disease detection and treatment.

Medication costs are also within the coverage scope of National Health Insurance. In 2023, the national pharmaceutical expenditure reached 9.8 trillion yen, of which about 70% was paid by National Health Insurance. For example, for common hypertension treatment, a patient’s monthly medication cost is about 5,000 yen, but through National Health Insurance, the actual out-of-pocket expense is only about 1,500 yen. This drug coverage greatly improves medication adherence among chronic disease patients, effectively enhancing treatment outcomes.

Rehabilitation therapy is another crucial aspect covered by National Health Insurance. For instance, a typical rehabilitation program for post-stroke patients may last 3-6 months, with total costs potentially reaching 2 million yen. Through National Health Insurance, the patient’s actual burden can be controlled within 600,000 yen, greatly increasing the possibility for patients to receive comprehensive rehabilitation treatment, which is beneficial for improving rehabilitation outcomes and quality of life.

Although obstetric services are not categorized as diseases, they receive special attention from National Health Insurance. In 2023, there were approximately 800,000 newborns in Japan. The cost of a normal delivery is about 500,000 yen. While the delivery itself is not covered by insurance benefits, through the one-time childbirth allowance system, each delivery can receive a subsidy of 420,000 yen, greatly reducing the economic burden on new families.

Preventive healthcare services are also an important part of National Health Insurance coverage. In 2023, the specific health check-up rate for the population aged 40 and above reached 55%, with about 35 million people receiving this free health examination. This preventive service not only helps in early detection of health problems but also aids in controlling long-term medical expenditures.

4.2 Cost-Sharing Mechanism

Although National Health Insurance covers most medical expenses, a reasonable cost-sharing mechanism has been adopted to prevent overuse of medical services and ensure the sustainability of the system. This mechanism ensures that insured individuals can receive necessary medical services while controlling excessive use of medical resources through moderate personal contributions, maintaining the balance of the entire system.

Generally, insured individuals need to bear 30% of medical expenses, with insurance covering 70%. This ratio applies to most adult policyholders. For instance, for a common cold consultation costing 5,000 yen, the insured person needs to pay 1,500 yen out of pocket. This moderate co-payment ratio ensures the accessibility of medical services while also encouraging insured individuals to maintain a cautious attitude towards the use of medical resources.

For children under 6 years old, the personal contribution ratio is reduced to 20%, reflecting special attention to children’s health. For example, for a child’s pneumonia treatment costing 100,000 yen, the family actually needs to bear only 20,000 yen. This policy effectively lowers the economic threshold for children’s medical services and improves children’s health levels. Data shows that since the implementation of this policy, the medical visit rate for children under 6 has increased by 15%, while the rate of severe cases in children has decreased by 8%.

For the elderly aged 70 and above, the cost-sharing mechanism is more flexible. If the elderly are still working and their income exceeds a certain standard (e.g., annual income exceeding 2.8 million yen), the personal contribution ratio is 30%; otherwise, depending on income levels, the ratio may be reduced to 20% or 10%. For example, for an elderly person’s heart disease hospitalization costing 1 million yen, a low-income elderly person may only need to bear 100,000 yen, which greatly reduces the medical burden on the elderly. Statistics show that after the implementation of this policy, the willingness of the elderly to seek medical care has significantly increased, and the control rate of chronic diseases has improved by 12%.

To avoid excessive economic burdens caused by major illnesses, National Health Insurance has also established a high-cost medical expense subsidy system. When the monthly personal medical expense burden exceeds a certain amount, subsidies can be applied for the excess portion. This upper limit varies according to age and income level, generally ranging from 80,000 to 250,000 yen. For example, for a major surgery costing 5 million yen, without the high-cost medical expense subsidy, the patient would need to bear 1.5 million yen. However, through this system, the actual burden may be reduced to around 500,000 yen. In 2023, about 2 million people nationwide benefited from this system, receiving an average subsidy of about 400,000 yen per person, effectively preventing poverty due to illness.

4.3 Non-Covered Items

Although the coverage of National Health Insurance is extensive, there are still some items that are not within the scope of benefits. The existence of these limitations is partly to concentrate resources on necessary medical services, and partly to control medical costs and ensure the sustainability of the system.

Cosmetic surgery is a typical non-covered item. Purely aesthetic plastic surgeries are not covered by insurance. However, it should be noted that plastic surgeries performed due to medical needs such as diseases or injuries may be covered by insurance. For example, skin grafting surgery due to severe burns is within the insurance coverage. Data shows that in 2023, about 50,000 insurance-covered plastic surgeries were performed nationwide, mainly concentrated in areas such as burn treatment and congenital malformation correction.

Non-therapeutic dental services are also not covered. This includes teeth whitening, unnecessary orthodontics, etc. However, it’s worth noting that treatments for diseases such as dental caries and periodontal disease are within the insurance coverage. Statistics show that in 2023, about 100 million dental treatments covered by insurance were received nationwide, with an average treatment cost of about 15,000 yen, of which 70% was paid by insurance.

Preventive medications, such as contraceptives and erectile dysfunction drugs, are not covered by insurance. Although these drugs may improve quality of life, they are not considered necessary for disease treatment. Data shows that the market size for such drugs in 2023 was about 300 billion yen, all of which was purchased at the consumer’s own expense.

The cost difference for high-grade hospital rooms also needs to be borne by the patient. For example, the daily cost of a standard double room is about 15,000 yen, while a single high-grade room may cost up to 50,000 yen. This 35,000 yen difference needs to be paid by the patient. In 2023, about 15% of hospitalized patients chose high-grade rooms, increasing their out-of-pocket expenses by an average of 200,000 yen per person.

Experimental treatments that have not been officially approved are usually not covered by insurance. This is mainly due to safety and efficacy considerations. However, it’s worth noting that some new therapies that have undergone rigorous clinical trials may be quickly included in the insurance coverage. For example, in 2023, five new cancer treatment methods were included in the insurance coverage, benefiting about 20,000 patients.

Health foods and supplements, even if recommended by doctors, are not covered by insurance benefits. The market size for these products is huge, reaching about 1.5 trillion yen in 2023, but all need to be purchased at the consumer’s own expense.

For these non-covered items, if insured individuals have a definite need, they can choose to pay out of pocket or purchase commercial supplementary medical insurance. According to statistics, in 2023, about 30% of the population purchased some form of supplementary medical insurance, paying an average premium of about 50,000 yen per person per year, which to some extent fills the coverage gap of National Health Insurance.

Overall, the coverage of Japan’s National Health Insurance is extensive and reasonable, ensuring basic medical needs while maintaining the sustainability of the system through reasonable limitations. This balanced system design provides comprehensive and reliable medical protection for Japanese citizens, effectively improving the overall national health level.

Characteristics and Advantages of Japan’s National Health Insurance System

5.1 Universal Coverage

One of the most prominent features of Japan’s National Health Insurance system is the achievement of universal coverage. Whether corporate employees, civil servants, self-employed individuals, unemployed persons, or even foreigners residing in Japan, all can enjoy basic medical protection. This comprehensive coverage not only reflects social equity but also lays the foundation for improving the health level of the entire country.

The realization of universal coverage relies on the principle of mandatory participation. Except for those who have already joined other public medical insurance schemes, all residents must join the National Health Insurance. This compulsory nature ensures full risk dispersion, enhancing the entire system’s risk resistance capacity. At the same time, it also avoids the problem of “adverse selection,” where only high-risk groups participate in insurance, thereby maintaining the financial balance of the system.

Moreover, universal coverage is also reflected in the accessibility of medical services. Japan has a dense network of medical institutions, and insured individuals can freely choose where to seek medical treatment without geographical restrictions. This freedom of choice not only protects patients’ rights but also promotes healthy competition among medical institutions, which is conducive to improving the overall quality of medical services.

5.2 Low Co-payment Ratio

Compared to many countries, Japan’s National Health Insurance has a relatively low personal co-payment ratio. Generally, insured individuals only need to bear 30% of medical expenses, with the remaining 70% covered by insurance. This low co-payment ratio significantly reduces the financial burden on patients, enabling people to seek medical treatment promptly when ill without delaying treatment due to economic reasons.

For special groups, such as children and the elderly, the co-payment ratio is even lower. Children under 6 years old only need to bear 20% of the costs, while those over 70 years old may only need to pay 10% or 20% depending on their income. This differentiated co-payment ratio reflects special care for vulnerable groups.

More importantly, Japan has also established a high-cost medical expense subsidy system. When monthly personal medical expenses exceed a certain amount, subsidies can be applied for the excess portion. This system effectively prevents family economic collapse due to major illnesses, embodying the essence of social security.

The low co-payment ratio not only reduces the financial burden on patients but also promotes the development of preventive medicine. People won’t delay check-ups or early treatment due to concerns about high medical costs, which helps in early detection and treatment of diseases, ultimately reducing overall medical costs in the long run.

5.3 Flexible Reduction Policies

Another notable feature of Japan’s National Health Insurance system is its flexible reduction policies. These policies fully consider the economic conditions and special needs of different groups, ensuring that even economically disadvantaged groups can obtain basic medical security.

For low-income individuals, insurance premium reductions can be applied for, with reduction rates up to 70% or more. This policy ensures that economic difficulties do not become a barrier to accessing medical services, reflecting social equity.

Unemployed individuals can also enjoy insurance premium reductions for a certain period, usually around 30%. This policy not only provides economic support for the unemployed but also helps maintain social stability.

Student groups can apply for special discounts, significantly lowering insurance premiums. This policy reflects the emphasis on education and support for young people, contributing to the cultivation of a healthy future workforce.

Additionally, insured individuals who encounter special circumstances such as natural disasters can apply for temporary insurance premium reductions. This flexibility allows the insurance system to respond quickly to emergencies and provide timely assistance to affected populations.

These flexible reduction policies not only reflect the spirit of mutual assistance in Japanese society but also enhance the inclusiveness and adaptability of the entire system. It ensures that even during periods of economic hardship, people will not lose medical security due to inability to afford insurance premiums.

5.4 Efficient Operational Management

The efficient operation of Japan’s National Health Insurance system is another key factor in its success. This efficiency is mainly reflected in the following aspects:

First is the decentralized management model. National Health Insurance is mainly operated by individual municipalities, allowing insurance operations to be closer to local realities and better meet the needs of residents in different regions. At the same time, the central government ensures nationwide uniformity and fairness of the insurance system through financial subsidies and policy guidance.

Second is advanced information management. Japan widely uses electronic medical records and insurance card systems, greatly improving the efficiency of medical services and insurance claims. Patients only need to present their insurance card when seeking medical care, and medical institutions can immediately access their insurance information, simplifying administrative procedures and reducing the possibility of errors and fraud.

Third is strict cost control. Japan implements a strict pricing system for drugs and medical services, regularly adjusting prices to control the rapid growth of medical costs. At the same time, measures such as encouraging the use of generic drugs further control medical expenditures.

Finally, there is a high degree of transparency. All data and policies related to insurance operations are made public and subject to social supervision. This transparency not only improves the credibility of the system but also helps in timely identification and resolution of problems.

This efficient operational management not only ensures the sustainability of the system but also improves the satisfaction of the insured, serving as an important guarantee for the success of Japan’s National Health Insurance system.

Comparison of Medical Insurance Systems between China and Japan

6.1 Comparison of Coverage

Both Japan and China have made significant achievements in medical insurance coverage, but there are differences in implementation methods and effects. Japan’s National Health Insurance system has achieved true universal coverage. According to statistics from the Japanese Ministry of Health, Labour and Welfare, as of 2023, Japan’s medical insurance coverage rate reached 99.9%. This high coverage rate is due to its mandatory participation policy, where everyone residing in Japan must join public medical insurance regardless of employment status. This system design ensures full risk dispersion and enhances the stability of the entire medical security system.

In contrast, while China’s medical insurance system has continuously expanded its coverage, there are still some structural differences. According to data from the National Healthcare Security Administration, by the end of 2023, the number of people participating in basic medical insurance in China exceeded 1.35 billion, with a participation rate of over 95%. However, this figure masks some noteworthy details. For example, among the three major systems – urban employee basic medical insurance, urban and rural resident basic medical insurance, and the new rural cooperative medical system – some groups are still not fully included, especially flexible employment workers and some migrant workers.

In terms of accessibility to medical services, Japan’s system is more flexible. Japanese insured individuals can freely choose any medical institution nationwide for treatment, without geographical restrictions. This freedom of choice greatly improves the efficiency of medical resource utilization and patient satisfaction. In comparison, the use of medical insurance in China is usually subject to certain geographical restrictions. Although the scope of direct settlement for medical treatment in different locations has been expanding in recent years, as of the end of 2023, the number of designated medical institutions for direct settlement of medical treatment in different locations only accounted for about 30% of the total number of medical institutions nationwide. The reimbursement procedures for medical treatment in different locations are relatively complex, still posing certain obstacles for patients.

Moreover, there are significant differences in the range of medical services and drugs covered by insurance. Japan’s medical insurance coverage is very broad, including the vast majority of common medical services and drugs. According to data from the Japanese Ministry of Health, Labour and Welfare, in 2023, Japan’s medical insurance drug list included about 17,000 drugs, covering the treatment needs of the vast majority of common diseases. In contrast, the coverage of basic medical insurance in China is relatively narrow. Although the national medical insurance drug list has been continuously expanding, covering 2,967 drugs as of the end of 2023, there are still many high-priced drugs and new treatment methods that require patients to pay out of pocket or purchase commercial insurance.

Taking cancer treatment as an example, Japan’s medical insurance covers almost all approved anti-cancer drugs, with patients only bearing 30% of the cost. In China, although many new anti-cancer drugs have been included in medical insurance through negotiations in recent years, data from 2023 shows that about 40% of new anti-cancer drugs are still not covered by medical insurance, placing a significant economic burden on patients.

6.2 Comparison of Cost-Sharing Mechanisms

In terms of cost-sharing mechanisms, Japan and China have adopted different strategies, reflecting different considerations in balancing medical accessibility and cost control.

Japan adopts a fixed proportion self-payment mechanism, where insured individuals generally bear 30% of medical expenses, with 70% covered by insurance. This simple and clear sharing mechanism allows patients to clearly estimate their medical expenses. Notably, Japan sets lower self-payment ratios for special groups such as the elderly, children, and low-income individuals, reflecting the principle of social equity. For example, the self-payment ratio for people over 70 is 20%, 20% for children under 6, and 10% for specific chronic disease patients.

In contrast, China’s medical insurance cost-sharing mechanism is more complex, usually adopting a combination of deductibles and reimbursement rates, with different reimbursement rates for different levels of hospitals. Taking Beijing as an example, the 2023 policy for urban employee basic medical insurance shows that the deductible for tertiary hospitals is 1,300 yuan with a reimbursement rate of 85%; for secondary hospitals, the deductible is 800 yuan with a reimbursement rate of 88%; for primary hospitals and community health service centers, the deductible is 500 yuan with a reimbursement rate of 90%. This differentiated reimbursement policy aims to guide patients to seek medical care rationally and alleviate the pressure on large hospitals.

In controlling personal medical expenses, Japan has a high-cost medical expense subsidy system. When monthly personal medical expenses exceed a certain amount (ranging from 35,400 yen to 252,600 yen depending on age and income), subsidies can be applied for the excess. This effectively sets a cap on personal medical expenses, preventing poverty due to illness. According to data from the Japanese Ministry of Health, Labour and Welfare, about 15% of medical expenses were subsidized through this mechanism in 2023, greatly reducing the burden on patients.

China has also established a catastrophic illness insurance system aimed at addressing the medical expense burden of patients with severe and major diseases. However, compared to Japan’s system, the coverage and subsidy strength of China’s catastrophic illness insurance are relatively limited. Taking 2023 data as an example, the annual maximum payment limit for catastrophic illness insurance is generally between 200,000 and 300,000 yuan, and the reimbursement rate for some high-cost medical expense items is low, resulting in significant economic pressure for some severely ill patients.

In terms of insurance premium collection, Japan and China have also adopted different methods. Japan’s National Health Insurance premium calculation considers multiple factors such as income, assets, and family size, reflecting a stronger progressivity. For example, in a certain district in Tokyo, the insurance premium calculation formula for 2023 is: Basic fee 7,200 yen + Income-based fee (Total income – 330,000 yen) × 10.65% + Asset-based fee (Fixed asset tax amount – 350,000 yen) × 24.85% + Equal distribution amount 14,300 yen × Number of family members. This complex calculation method aims to achieve a fairer distribution of costs.

In comparison, China’s medical insurance contributions are mainly based on wage income or fixed amounts, with relatively weak progressivity. Taking Beijing in 2023 as an example, the contribution rate for urban employee basic medical insurance is 10% of the total wage paid by the employer and 2% of the individual’s wage paid by the employee. While this method is simple and easy to implement, it is less significant in terms of income distribution effects compared to Japan’s system.

6.3 Comparison of Operational Management

In terms of operational management, the medical insurance systems of Japan and China present different characteristics, reflecting the differences in administrative systems and management philosophies between the two countries.

Japan’s National Health Insurance is mainly operated by municipalities (equivalent to county-level administrative units in China). This decentralized management model allows insurance operations to be closer to local realities and formulate more suitable policies based on local characteristics. For example, in areas with severe population aging, insurance premium rates and subsidy policies can be adjusted accordingly. According to statistics from Japan’s Ministry of Internal Affairs and Communications, as of 2023, a total of 1,718 municipalities participated in medical insurance management nationwide, with each municipality responsible for medical insurance affairs for an average of about 75,000 people. Although this small-scale, decentralized management model may lead to some increase in management costs, it also brings higher flexibility and specificity.

In contrast, China’s medical insurance is mainly coordinated at the provincial level, with some areas implementing city-level coordination, resulting in relatively centralized management. This centralized management model is conducive to achieving economies of scale and reducing management costs, but may face issues of not being responsive enough to local special needs. According to data from the National Healthcare Security Administration, as of the end of 2023, there were 333 coordinated regions nationwide, with an average population coverage of about 4 million per coordinated region.

In terms of informatization, Japan is at the forefront. Japan widely uses electronic medical records and insurance card systems, greatly improving the efficiency of medical services and insurance claims. According to statistics from the Japanese Ministry of Health, Labour and Welfare, as of 2023, over 95% of medical institutions have implemented electronic medical record systems, and more than 80% of insurance claims are completed through electronic systems, with the average claim processing time reduced to within 3 working days. This high degree of informatization not only improves efficiency but also provides valuable data support for medical quality management and medical policy formulation.

China has also made significant progress in medical insurance informatization construction, but there is still room for improvement in nationwide interconnection and data sharing. According to a report from the National Healthcare Security Administration, by the end of 2023, the unified national medical insurance information platform had covered all coordinated regions, achieving direct settlement of cross-provincial medical treatment. However, there are still regional differences in the level of informatization within medical institutions and their integration with the medical insurance system.

In terms of cost control, Japan implements a strict pricing system for drugs and medical services, conducting a comprehensive adjustment of medical service prices every two years to control the rapid growth of medical costs. For example, in the 2022 medical fee revision, the overall medical fee level was reduced by 0.94%. This regular adjustment mechanism has effectively controlled the growth of medical expenses, with Japan’s medical expenses as a percentage of GDP remaining basically stable over the past decade, at about 10.8% in 2023.

China is also continuously improving its medical price formation mechanism, controlling drug and medical device prices through measures such as centralized volume-based procurement. According to statistics from the National Healthcare Security Administration, by the end of 2023, national drug centralized procurement had covered 350 drugs, with an average price reduction of over 50%. However, challenges remain in controlling the rapid growth of medical costs. In 2023, China’s total health expenditure accounted for about 7% of GDP, which is lower than Japan but growing at a faster rate.

In terms of transparency and public participation, Japan’s insurance operation data and policy-making processes are open to the public and subject to social supervision. For example, the content and resolutions of the Central Social Insurance Medical Council (commonly known as “Chuikyo”) meetings are promptly published, and the public can express opinions through various channels. This high degree of transparency and public participation not only enhances the credibility of the system but also contributes to continuous policy improvement.

China is also making continuous improvements in this area, but there is still room for improvement in public participation and information transparency. Although medical insurance departments at various levels have begun to regularly release work reports and statistical data in recent years, the public participation mechanism in the policy-making process is not yet well-developed. For example, in the process of adjusting the medical insurance catalog in 2023, although a public opinion collection phase was established, the specific decision-making process and considerations were not fully disclosed.

Through an in-depth comparison of the medical insurance systems of China and Japan, we can see the different strategies adopted and challenges faced by the two countries in pursuing the goal of universal medical security. Japan’s system is more mature and comprehensive, demonstrating characteristics worth learning from in terms of coverage, cost-sharing, and operational management.