Japanese healthcare reform and health economic agenda

Transcription

1 Japanese healthcare reform and health economic agenda ~Toward the well-being society~ Fumiaki YASUKAWA, PhD (Yokohama City University)

2 In 1979

3 Historical trend of GDP per capita Japan V.S. world wide Japan GDP per capita($) Japan-world ratio World wide

4 of Aged society Japan Japan Including Lao

5 What happened behind hyper aged society

6 Japanese health system Key attributes Universally providing services with social insurance scheme all Japanese nationals obligatorily join social health insurance Assuring non-regulated access to health institutes (hospitals, clinics) there is no segment by income in receiving care Official pricing applied for almost all of health service provision mix of FFS(fee for service) and PPS(prospect payment scheme)

7 Key attributes(cont.) Extreme Inflation of health care costs Great number of beds, shortage of physicians Private operation of health facilities rather than public Weak linkage between primary care and acute care Great gap between cure and care

8 Trillion Yen Per GDP ratio National National health health expenditure expenditure 厚生労働省 国民医療費の概況 H25 年度

9 post html Total 順位 国名 2011 年 1アメリカ USA 2,650,908 2 日本 411,463 3ドイツ Gr 365,743 4フランス Fr 268,327 5イギリス Gb 210,322 6イタリア It 182,900 7カナダ Ca 155,922 8スペイン Es 137,742 9 韓国 SKr 109,440 10メキシコ Me 105,858 11オランダ Ne 85,243 12オーストラリア Au 83,849 13トルコ Tk 64,872 14ポーランド Po 55,953 15ベルギー Bl 44,869 16スイス Hr 44,646 17オーストリア As 38,285 18スウェーデン Sw 37,079 19ノルウェー Nr 28,071 20ポルトガル Pr 27,646 21チリ Ch 27,053 22ギリシャ Gr 26,677 23デンマーク De 24,779 24チェコ Ck 20,635 25フィンランド Fi 18,179 26イスラエル Is 17,354 27アイルランド Ir 16,925 28ハンガリー Hu 16,875 29ニュージーランド Nz 14,014 30スロバキア 10,337 31スロベニア 4,968 32ルクセンブルグ 3,059 33エストニア 1,745 34アイスランド 1,054 Per capita 順位 国名 2011 年 1アメリカ US 8, ノルウェー Nr 5, スイス Hr 5, オランダ Ne 5, オーストリア As 4, カナダ Ca 4, ドイツ Gr 4, デンマーク De 4, ルクセンブルグ Lx 4, フランス Fr 4, ベルギー Bl 4, スウェーデン Sw 3, オーストラリア Au 3, アイルランド Ir 3, イギリス Gb 3, フィンランド Fi 3, アイスランド Ic 3, 日本 3, ニュージーランド Nz 3, スペイン Es 3, イタリア It 3, ポルトガル Pr 2, スロベニア Sl 2, ギリシャ Gr 2, イスラエル Is 2, 韓国 SKr 2, チェコ Ck 1, スロバキア 1, ハンガリー 1, チリ 1, ポーランド 1, エストニア 1, メキシコ トルコ

10 Ratio Nurse/Physician (OECD stat.2012) Gr As Nr Pr Gr Sw Hr It Es Ck Ic De Fr Au Fi p h y s i c i a n Per 1000 pop. N u r s e Ne Hu Gb Ir Nz Ca US JP Po Mx SKr Ch Tk

11 Estimated physician demand-supply projection thousand 供給推計 supply Demand Demand Demand 需要推計 ( 大 ) 需要推計 ( 中 ) 需要推計 ( 小 ) maximum moderate minimum source:mhlw board meeting release 2016

12 Health expenditure per 1000 pop. Countries CDP ratio (%) Public per capita expense(%) (USD) Physicians Nurse/Midwifery Hospital beds ~ ~2012 Japan , South Korea , Singapore , China USA , Canada , UK , Italy , Austria , Netherland , Swiss , Sweden , Spain , Denmark , Germany , Norway , France , Belgium , Australia d 9.4 d 66.6 d 6, New Zealand ,

13 Excess bed capacity expands apparent workforce shortage ALS Bed/1000 Dr/100b NS/100b Japan Germany France UK US

14 High hospital beds / low health resources if account bed bounded! Policy change from hospital bed to community is expected Comprehensive regional care system launched from 2014 For building well-being society

15 Medical care at hospital Comprehensive regional care system Long-term care at nursing home Living home/care group home The regional unit where all services should be provided within 30 min is set out Community relationship between aged people

16 Challenge for realizing well-being society We face Expected population shrink Reduction of labor productivity? Expected health / welfare costs increase Difficulty of fund raising for social security system? Unexpected risk of natural disasters Difficulty of appropriate resource allocation among risks? Unexpected high tension of diplomatic relations between neighbors Strong pressure of revising Constitution and enforcing military power?

17 Projected population shrink to 2060

18 Trend index of social benefit and GDP per capita 1, , , , FY1973= Social benefit per capita GDP per capita

19 Imbalanced tax/premium burden ratio by household income level % ~25000 ~40000 ~60000 ~75000 ~ income tax inhabitant tax pension premium health/ltc insurance premium Income level/

20 Estimated number of patients during 30 years, by age group ~4 5~9 10~14 15~19 20~24 25~29 30~34 35~39 40~44 45~49 50~54 55~59 60~64 65~

21 Trend of morbidity. by age group Mysterious behavior? Inpatient Outpatient 0~14 15~34 35~64 65~ 0~14 15~34 35~64 65~

22 Doubled or tripled visiting to medical facilities Doctor shopping by patients Efficiency of health care resource use might be distorted Efficient provision of primary care might not be established

23 Another fundamental question Does massive investment into healthcare (reform) induce really good health and well-being society?

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26 Good health status and income inequality in OECD countries 100 % USA r = South Korea Japan Gini index

27 More heathier people prefer to receive more healthcare services! That induces less sustainability of healthcare budget and higher personal expense for social health system How to secure sustainability and satisfactory health delivery with smaller amount of money under population shrinking society is the challenge for Japan