In Japan, all-payer rate setting under tight government control has proved to be an effective approach to containing costs

Health Affairs
Naoki Ikegami, Gerard F Anderson

Abstract

In Japan's health insurance system, the prices paid by multiple payers for nearly all health care goods and services are codified into a single fee schedule and are individually revised within the global rate set by the government. This single payment system has allowed total health care spending to be controlled despite a fee-for-service system with its incentives for increased volume of services; Japan's growing elderly population; and the regular introduction of new technologies and therapies. This article describes aspects of Japan's approach, as well as how that nation has expanded payment for inpatient hospital care based on case-mix. The result of the payment system is that Japan's rate of health spending growth has been well below that of other industrial nations. The percentage of gross domestic product spent on health increased from 7.7 percent in 2000 to 8.5 percent in 2008, compared to an increase from 13.7 percent to 16.4 percent in the United States. Japan's approach confirms that enlightened government regulation can maintain access to care, avoid rationing, make use of the latest technology, and allow for multiple insurance plans and an aging population--all while restraining the growth of health care spending.

References

Jul 1, 1999·Health Affairs·N Ikegami, J C Campbell
May 22, 2003·Health Affairs·Gerard F AndersonVarduhi Petrosyan
May 27, 2004·Health Affairs·Naoki Ikegami, John Creighton Campbell
Jan 11, 2007·Journal of Health Politics, Policy and Law·Naoki Ikegami
Apr 12, 2007·BMC Health Services Research·Kiyohide FushimiShinya Matsuda
Sep 3, 2011·Lancet·Hideki HashimotoMichael R Reich
Sep 3, 2011·Lancet·Naoki IkegamiYasuki Kobayashi

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Citations

Jun 14, 2013·The New England Journal of Medicine·Gerard F AndersonRobin Osborn
Feb 17, 2015·Asian Pacific Journal of Cancer Prevention : APJCP·Rei GotoWon-Chul Lee
Aug 21, 2013·Health Policy·Joseph White
Sep 30, 2016·Inquiry : a Journal of Medical Care Organization, Provision and Financing·Bradley Chen, Victoria Y Fan
Jun 10, 2015·Health Affairs·Ge Bai, Gerard F Anderson
Oct 19, 2017·Expert Review of Pharmacoeconomics & Outcomes Research·Jörg MahlichRosarin Sruamsiri
Dec 25, 2019·Annual Review of Public Health·So-Yeon KangGerard F Anderson

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