Hi everyone, welcome to the last lecture of our series on global health policy and governance. I'm Kenji Shibuya, professor of Global Health Policy at the University of Tokyo. We started from the key current issues in global health policy and governance and we then shifted our focus on health security and health system with an emphasis on universal health coverage and its sustainability in aging population. Finally, we will discuss today what Japan has achieved and future challenges it has to tackle. Japan is facing a huge demographic and fiscal challenge to the sustainability of its health systems. I believe that we can share important lessons in the current debate on global health policy and governance from our experiences. As discussed previously there's momentum in global health towards universal health coverage, UHC. UHC ensures that all people can use the health promotion, preventive, curative, rehabilitative and palliative health services they need of sufficient quality to be effective, while also ensuring that the use of these services doesn't expose the user to financial hardship. As introduced in the UHC lecture, the definition of UHC embodies three related objectives. First equity in access to health services. Those who need the services should get them not only those who can pay for them. Second quality of health services good enough to improve the health of those receiving services. And finally, financial risk protection. To ensure that the cost of using care doesn't put people at risk of financial hardship. In particular country health system will need to mobilize more domestic resources. Japan achieved UHC in 1961 which has in part contributed to good health at low cost, with equity. This happened at the beginning of Japan's period of rapid economic development, while the country was still relatively poor. At the time Japan's GDP was half of that in the UK. In the next half century, Japan's economy grew rapidly, at the same time as its health outcomes improved. And equity in health also improved. Now, however, Japan faces serious fiscal pressure due to rapid aging, low fertility and a sluggish economy. Here we are going to review the historical context for Japan's health system achievement, examine current challenges to these successes and examine ongoing effort to sustain Japan's health system. Here is a summary of the key achievements of the Japanese universal health coverage. First, egalitarian health system. Second, excellent population health. For example, in 2013 life expectancy at birth for males and females was 80.1 and 86.4 years, respectively. Healthy life expectancy for males and females was 71.1 and 75.6 years, respectfully. And finally, relatively low health care costs in 2012, 10.1% of total GDP. It is well known that achieving the three goals listed here, universal access, low costs, and high-quality service, is very difficult with limited resources. Japan has achieved universal access to basic services. Japan has also managed to contain costs to a single fee schedule for medical services. But access alone cannot ensure patient outcome or value. Putting aside demographic change, costs continue to increase primarily due to medical technologies. So it is time to shift from the provision of identical services to a diverse population and regions toward the provision of services appropriate to individual needs that undergo ongoing quality and efficiency improvement. Also, Japan needs a shift from management and a variation based on the quantity of inputs such as physical infrastructure, human resources, and service provided toward management and evaluation based on how efficiently these inputs are used and their related outcomes. The success in reducing mortality has combined with a continuing decline in fertility. Transforming Japan into the most rapidly aging society globally. Now it's a shrinking population size, the proportion of people over age 65 has increased from 12% in 1990 to 25% in 2013. And the proportion of older people has exceeded the proportion of younger people aged zero to 14 years since 1997. Japan’s population began falling in 2004. This demographic transition has created huge fiscal and health care challenges for Japan. As the cover of the economist articulated, Japan is not only aging but shrinking, which imposes a huge fiscal pressure on the sustainability of its health system. However, such changes will take place across Asia in the next two to three decades. Including South Korea, China and Thailand, which are rapidly aging. Japan's population began falling in 2004. Other Asian country with rapid aging will also follow that path in the next decades. Japan marked the 50th anniversary of universal health coverage on April 1, 2011. To celebrate and consider Japan's achievement in health The Lancet, the British medical journal, publishes a series on universal healthcare after 50 years in Japan. The series aimed to describe Japan's actions. And provide an opportunity to translate that experience to other settings. As Dr. Richard Horton, Editor in Chief of The Lancet journal wrote in his comment that the success of Japan's health system matters not only because of its importance to Japanese citizens, but also because Japan is a barometer of western health. And also he noted that the country now seeks to marshal its considerable resources to claim its rightful place globally, as well as to improve its policy making domestically. So to summarize, Japan achieved universal health coverage in 1961 which has in part contributed to good health at low cost with equity. And this happened at the beginning of Japan's period of rapid economic development, while the country was still relatively poor. But now Japan faces serious fiscal pressure due to rapid aging, low fertility, and a sluggish economy, and major challenges to sustain its health system.
