This paper focuses on the Japanese health care system which has been identified as a system that provides some of the best outcomes on an aggregate basis when compared with other developed nations that maintain universal approaches to health care insurance. A careful examination of this high-performing health care system will provide insights and information that will be useful in the Canadian debate over the future of Medicare.

This paper is part of a series that examines the way health services are funded and delivered in other nations. The nations profiled all aim to achieve the noble goal of Canada?s health care system: access to high quality care regardless of ability to pay. How they organize to achieve that goal differs markedly from the Canadian approach. So do their performances and results.

This paper focuses on the Japanese health care system which has been identified as a system that provides some of the best outcomes on an aggregate basis when compared with other developed nations that maintain universal approaches to health care insurance. A careful examination of this high-performing health care system will provide insights and information that will be useful in the Canadian debate over the future of Medicare.

Health system performance: Canada compared to Japan

Looking at factors such as the ability of the health care system to provide healthy longevity, low levels of mortality from disease, and effective treatment for both chronic and terminal illnesses, it seems that the Japanese health care system performs at a level similar, if not superior, to that in Canada. Specifically, the Canadian health care system outperforms the Japanese health care system in one of eight measures examined: in-hospital mortality from acute myocardial infarction (heart attack). Conversely, the Japanese health care system outperforms the Canadian health care system in five measures: infant mortality, mortality amenable to health care, one of three measures of cancer survival, and two of three measures of in-hospital mortality.

Lessons for Canada

The combination of potentially superior access to health care and potentially superior outcomes from the health care process with substantially fewer resources committed to health care suggests there is much Canadians can learn from the Japanese health care system. It must be recognized that emulating Japan?s approach to health care would require substantial reform of the Canadian system including, most significantly, a shift from a tax-funded government insurance scheme to a system of independent insurers within a statutory enrollment framework. While that may be a large undertaking, the evidence presented above suggests there may be significant benefits to doing so.

The Japanese health care system departs from the Canadian model in the following important ways:

• Cost sharing for all forms of medical services
• Largely private provision of acute care hospital and surgical clinic services
• Activity-based funding for hospital care
• Permissibility of privately funded parallel health care
• A system of statutory independent insurers providing universal services to their insured populations on a largely premium-funded basis (commonly known as a social insurance system).