Japan's Universal and Affordable Health Care: Lessons for the United States?

Health care has emerged as perhaps the most urgent issue in America, and health care reform as the most ambitious initiative in domestic policy since the New Deal. Japan, on the other hand, already boasts the world's lowest infant mortality rate and longest life expectancy, while achieving more success than America at containing medical costs: in 1991, spending on health care accounted for a mere 6.6 percent of Japan's total gross domestic product versus 13.4 percent of America's. How does Japan do it? What aspects of the Japanese model might be applicable to the United States?

    To explore these questions, on Friday, April 30, 1993, the Japan Society organized a one-day conference entitled Making Universal Health Care Affordable: How Japan Does It. Three distinguished panels of Japanese and American health care specialists discussed the management of Japan's universal health care coverage, ways to balance quality care and cost containment, and how the United States might profit from Japan's experience. Professor Victor Rodwin was one of the conference participants (see Appendix 3) and agreed to draw on the conference discussions as a starting point for this more extensive monograph.

    The Japan Society is grateful to KPMG Peat Marwick; New York Pharma Forum; the International Leadership Center on Longevity and Society (U.S.) of The Mount Sinai School of Medicine, an affiliate of The City University of New York; the Japanese Ministry of Health and Welfare; and the New York Academy of Medicine for their generous support of the conference and this publication.

    We offer special thanks to the conference participants for their valuable presentations. We also thank John Campbell and Michael Reich for their close reading and comments on this manuscript; Toshihiko Takeda and Masaru Hiraiwa (JETRO-Ministry of Health and Welfare) for providing details on the Japanese health system and for reviewing key parts of the document; and Frank Schwartz for his diligent editorial assistance. Finally, we gratefully acknowledge David Forbes at New York University's Wagner Graduate School of Public Service for his secretarial assistance; Jennifer Capson McManus for proofreading the manuscript; and Donna Keyser and Lou Montesano for assisting in its publication.