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JAPAN The author would like to acknowledge David Squires as a contributing author to earlier versions of this profile. References English Regulatory Information Task Force: Japan Pharmaceutical Manufacturers Association (2012). Pharmaceutical Administration and Regulations in Japan. http://www.jpma.or.jp/english/parj/pdf/2012.pdf. Accessed Aug. 20, 2013. Life Insurance Association of Japan (2014). Life Insurance Fact Book 2014, http://www.seiho.or.jp/english/statistics/trend/ pdf/2014.pdf. Ikegami, N., and Anderson, G. F. (2012). “In Japan, All-Payer Rate Setting Under Tight Government Control Has Proved to Be an Effective Approach to Containing Costs.” Health Affairs 31(5):1049–1056. Japan Institute of Life Insurance (2013). FY2013 Survey on Life Protection. FY2013 Survey on Life Protection (Quick Report Version. http://www.jili.or.jp/research/report/pdf/FY2013_Survey_on_Life_ Protection_(Quick_Report_Version).pdf. Japan Pharmaceutical Association (2014). Annual report of JPA. http://www.nichiyaku.or.jp/e/data/anuual_report2014e.pdf. Kwon, S. (2014). Research on income security of in-home caregivers. Unpublished thesis (in Japanese). Matsuda, S., K. B. Ishikawa, K. Kuwabara et al., (2008). “Development and use of the Japanese case-mix system.” Eurohealth 14(3):25–30. Ministry of Health, Labor and Welfare (MHLW) (2012a). Survey of Medical Institutions, 2012. Ministry of Health, Labor and Welfare (2012b). “A basic direction for comprehensive implementation of national health promotion” (Ministerial notification no. 430 of the Ministry of Health, Labor and Welfare) (tentative English translation) (http://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000047330.pdf, accessed Oct. 15, 2014). Ministry of Health, Labor and Welfare (2013). “The current situation and future direction of the Long-Term Care Insurance System in Japan, with a focus on housing for the elderly.” http://www.mhlw.go.jp/english/policy/care-welfare/care-welfareelderly/dl/ri_130311-01.pdf. Accessed Aug. 20, 2014. Ministry of Health, Labor and Welfare (2014a). 2012 Survey of Long-Term Care Providers, 2012. Ministry of Health, Labor and Welfare (2014b). Estimates of National Medical Care Expenditure, Summary of Results for FY2012. Ministry of Health, Labor and Welfare (2014c). Survey of Medical Institutions, 2013 Summary. National Institute of Population and Social Security Research (2014). Social Security in Japan 2014. http://www.ipss.go.jp/sinfo/e/ssj2014/index.asp. Accessed Aug. 20, 2014. OECD (2009). Health-care reform in Japan: Controlling costs, improving quality and ensuring equity. OECD Economic Surveys: Japan 2009. OECD Publishing. OECD (2015). OECD Health Data 2015. Organisation for Economic Co-operation and Development (2015b). OECD.Stat (database). DOI: 10.1787/data-00285-en. Accessed July 2, 2015. Tatara, K., and Okamoto, E. (2009). “Japan: Health system review.” Health systems in Transition 11(5). 114 The Commonwealth Fund
The Dutch Health Care System, 2015 Joost Wammes, Patrick Jeurissen, and Gert Westert Radboud University Medical Center What is the role of government? In the Netherlands, the national government has overall responsibility for setting health care priorities, introducing legislative changes when necessary, and monitoring access, quality, and costs. It also partly finances social health insurance for the basic benefit package (through subsidies from general taxation and reallocation of payroll levies among insurers through a risk adjustment system) and the compulsory social health insurance system for long-term care. Prevention and social support are not part of social health insurance but are financed through general taxation. The 2015 national reforms to long-term care made municipalities and health insurers responsible for most outpatient long-term services and all youth care under a provision-based approach (with a great level of freedom at the local level). Who is covered and how is insurance financed? Publicly financed health insurance: In 2013, the Netherlands spent 12 percent of GDP on health care, and 78 percent of curative health care services were publicly financed. All residents (and nonresidents who pay Dutch income tax) are mandated to purchase statutory health insurance from private insurers. People who conscientiously object to insurance, as well as active members of the armed forces (who are covered by the Ministry of Defense), are exempt. Insurers are required to accept all applicants, and enrollees have the right to change their insurer each year. Apart from acute care, long-term care, and obstetric care, undocumented immigrants have to pay for most health care themselves (they cannot take out health insurance). However, some mechanisms are in place to reimburse costs that undocumented immigrants are unable to pay. For asylum seekers, a separate set of policies has been developed. Permanent residents (for more than 3 months) are obliged to purchase private insurance coverage. Visitors are required to purchase insurance for the duration of their visit if they are not covered through their home country. Statutory health insurance is financed under the Health Insurance Act, through a nationally defined, incomerelated contribution, a government grant for the insured below age 18, and community-rated premiums set by each insurer (everyone with the same insurer pays the same premium, regardless of age or health status). Contributions are collected centrally and issued among insurers in accordance with a risk-adjusted capitation formula that considers age, gender, labor force status, region, and health risk (based mostly on past drug and hospital utilization). Insurers are expected to engage in strategic purchasing, and contracted providers are expected to compete on both quality and cost. The insurance market is dominated by the four largest insurer conglomerates, which account for 90 percent of all enrollees. Currently, there is a ban on the distribution of profits to shareholders. Private (voluntary) health insurance: In addition to statutory coverage, most of the population (84%) purchases a mixture of complementary voluntary insurance covering benefits such as dental care, alternative medicine, physiotherapy, spectacles and lenses, contraceptives, and the full cost of copayments for medicines (excess costs above the limit for equivalent drugs—an incentive for using generics). Premiums for voluntary insurance are not regulated; insurers are allowed to screen applicants based on risk factors and offer both statutory and voluntary benefits. Nearly all of the insured purchase their voluntary benefits from the same (mostly nonprofit) insurer that provides their statutory health insurance. People with voluntary coverage do not International Profiles of Health Care Systems, 2015 115
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JANUARY 2016 2015 International Pro
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2015 International Profiles of Heal
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Table 1. Health Care System Financi
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Table 3. Selected Health System Per
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The Australian Health Care System,
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AUSTRALIA low-income adults, childr
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AUSTRALIA In 2013, the federal gove
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What is being done to reduce dispar
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References AUSTRALIA Australian Bur
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CANADA What is covered? Services: T
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CANADA funding to 145 not-for-profi
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CANADA Organization of the Health S
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CANADA provides recommendations to
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CANADA Health Council of Canada (20
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CHINA Private health insurance: Com
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CHINA is not substantially more exp
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CHINA Organization of the Health Sy
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CHINA References Chen, X. (2014).
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DENMARK In addition, nearly 1.5 mil
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DENMARK Social psychiatry and care
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DENMARK Quality data for a number o
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DENMARK portion is small, it makes
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48
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ENGLAND immunization, and vaccinati
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ENGLAND Hospitals: Publicly owned h
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ENGLAND Organization of the Health
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ENGLAND How are costs contained? Ra
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ENGLAND Organisation for Economic C
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FRANCE VHI finances 13.8 percent of
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FRANCE The average income of primar
Page 64 and 65: FRANCE What are the key entities fo
Page 66 and 67: FRANCE inequities in prevention rel
Page 68 and 69: FRANCE Nolte, E., C. Knai, and M. M
Page 70 and 71: GERMANY There were 42 substitutive
Page 72 and 73: GERMANY The 16 state governments de
Page 74 and 75: GERMANY management system, by the s
Page 76 and 77: GERMANY What major innovations and
Page 78 and 79: INDIA Private health insurance: The
Page 80 and 81: INDIA provide after-hour care, reim
Page 82 and 83: INDIA are provided by other ministr
Page 84 and 85: INDIA How are costs contained? Ther
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Page 88 and 89: ISRAEL Together, these two types of
Page 90 and 91: ISRAEL Primary care physicians are
Page 92 and 93: ISRAEL Organization of the Health S
Page 94 and 95: ISRAEL • Using electronic health
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Page 98 and 99: ITALY during hospitalization (Thoms
Page 100 and 101: ITALY Some regions are promoting ca
Page 102 and 103: ITALY Organization of the Health Sy
Page 104 and 105: ITALY although the degree of evolut
Page 106 and 107: ITALY The author would like to ackn
Page 108 and 109: JAPAN What is covered? Services: Al
Page 110 and 111: JAPAN incentives for providers to c
Page 112 and 113: JAPAN Organization of the Health Sy
Page 116 and 117: THE NETHERLANDS receive faster acce
Page 118 and 119: THE NETHERLANDS Hospital payment ra
Page 120 and 121: THE NETHERLANDS Organization of the
Page 122 and 123: THE NETHERLANDS References Organisa
Page 124 and 125: NEW ZEALAND provided in GP clinics.
Page 126 and 127: NEW ZEALAND management (e.g., clean
Page 128 and 129: NEW ZEALAND including such informat
Page 130 and 131: NEW ZEALAND largely through efficie
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Page 134 and 135: NORWAY Primary, preventive, and nur
Page 136 and 137: NORWAY Patients are free to choose
Page 138 and 139: NORWAY What are the major strategie
Page 140 and 141: NORWAY The National System for the
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Page 144 and 145: SINGAPORE Medifund is the governmen
Page 146 and 147: SINGAPORE Public hospital funding i
Page 148 and 149: SINGAPORE Public consultation: The
Page 150 and 151: SINGAPORE To keep demand for servic
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Page 154 and 155: SWEDEN What is covered? Services: T
Page 156 and 157: SWEDEN Hospitals: There are seven u
Page 158 and 159: SWEDEN Care, which promotes use of
Page 160 and 161: SWEDEN What major innovations and r
Page 162 and 163: SWITZERLAND Insurers offer premiums
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SWITZERLAND Hospitals: About 70 per
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SWITZERLAND Organization of the Hea
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SWITZERLAND To control pharmaceutic
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170
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UNITED STATES What is covered? Serv
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UNITED STATES Administrative mechan
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UNITED STATES The Institute of Medi
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UNITED STATES adopted at least a ba
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The COMMONWEALTH FUND Affordable, q
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