Funding sources for healthcare systems in Japan
The health financial systems can be identified as the total of the procedures which are run within a country to look out for the financing of the health care needs of the citizens. This refers to the allocation and use of the financial resources present within the health care system. To ensure Universal Health coverage, the health financing systems are reviewed as a major policy relevant to achieving better health facilitations (1). However, due to the disparity, all countries have a separate healthcare system as per their budget. The focus of the report is to critically discuss the healthcare systems of Malaysia and Japan to identify and understand the key way in which both countries manage their healthcare system.
In Japan, the financing sources for the healthcare systems have engaged taxes and individual contributions. The statutory healthcare services provide complete coverage. The different plans which are covered under this type of healthcare system may be identified as residence-based or employment-based. Fukawa (2008) mentions that the different benefits which are available under this healthcare system may be identified as hospital, primary, specialty, and related mental healthcare. Moreover, prescription drugs are also provided under the same. One critical aspect is that low-income older adults and young children have coinsurance rates. Another key concept within the healthcare system may be identified as the annual out-of-pocket maximum for healthcare and long-term welfare based on income and age alongside the monthly out-of-pocket maximums (2). The government is responsible for setting the fee standard whereas the residents generally have a private healthcare system. In Japan, a majority of the population around 58.69% is essentially covered by Employee Health insurance. The JHIA covered a majority of the population. Sakamoto e al. (2018) also mentions that as per the WHO global health data, the expenditure on health as a proportion of the GDP has increased from 7% in 1995 to 10% in 2014. Hence, 84% was paid by the public whereas 16% was paid by private sources. The government health expenditure in this case as a proportion of the total expenditure has increased considerately from 15% to 20% in 2014. Moreover, the out of pocket payments has gone down from 16% to 14% in 2014 (14).
In Malaysia, healthcare systems financing is generally fulfilled by five different sources. These can be identified as direct taxes, indirect taxes, contributions to the provident funds, social security schemes, private insurance, and out-of-pocket. It can be identified that in Malaysia, the predominantly tax-financed system is largely progressive and the overall health system may be identified as the two-tiered system which is heavily subsidized public sector, and the user-based private sector which has led to a progressive health care system at large. Malaysia heavily relies on the equity impact which ensures that the overall system can be made rather sustainable in nature (3). Healthcare is driven by demand. The estimated per capita spending on health was identified to be $641 which was a value higher than the average $589 paid by people in middle-income countries. Here it is critical to note that a majority of the healthcare expenditure was 56% done by the public whereby 42% was borne by the ministry of health and 34% accounted for the out-of-pocket expenditure (15).
Key aspects of the healthcare system in Japan
Undertaking healthcare reforms concerning the healthcare system can be identified to be integrally very crucial. This is because the healthcare system has been revolving consistently and the countries are required to undertake key initiatives for better welfare and related engagements. Hence, in Japan, some of the key initiatives which have taken place may be identified as the Health-care Structural Reform Package Act (enacted in 2008), the Late-stage medical care system for the elderly, the Future map of health-care demand for 2025 announced by the National Council on Social Security, Comprehensive Reform of Social Security and Tax, Bipartisan agreement, Social security Reform Program Act and the Act for securing comprehensive medical and long term care in the community which is largely focused on improving the overall healthcare and medical systems which are existent within the public health and medical systems which within the developing nations (14). Moreover, the introduction of social health insurance, user fees, and the implementation of activity-based functioning are largely applicable.
On the other hand, in Malaysia, the healthcare system in Malaysia has been undergoing a successful change. Here the focus lies to ensure that being a nation with limited funds, One Care for One Malaysia is applied. Moreover, training-g the healthcare professionals, strengthening public health, and regulating pharmaceutical and food concerns are critical (15). About this, the newly improved as well as reorganized healthcare plan gives away better efficiency, effectiveness, and equity. This has brought about sufficient changes for the country from pre-independence to the current health state and also revolved around the overall health and socio-economic achievement as a country(10). In consideration of this, the key focus lies to overcome the challenges faced as a nation at large. The equity-based financing system and the provision of government and private health insurance schemes can be identified to be the highlight of the system.
According to Ikegami (2019), the healthcare plans of japan provide an adequate level of medical services and insurance plans which comprise primary and specialty care which gives way to prescription drugs and hospice care for the elderly. Moreover, to bring about parity in the treatment, women, and individuals with disabilities often get aid from the government and can make use of the subsidiary to pay for any related equipment (11). Hence, Japan has ensured that healthcare can be made accessible and comprehensive which will look out for the poor and disadvantaged groups. In line with this, when the income of the people is considerably low, it does not have any influence on the related quality of care in Japan as compared to other countries (4). This is because the fees paid by the different citizens are fixed (9). Moreover, the physicians receive the same amount of fees from all the citizens without any disparity. In consideration of this, it becomes critical that all individuals receive equal treatment and access to medical resources regardless of their social class (8). This allows the poor to achieve good access to medical resources irrespective of their related condition.
On the other hand, in Malaysia, 46% of adults do not have any form of financial coverage for their needs and have to rely on the existing tax-funded healthcare coverage. About this, 71% of the 20% poorest in the country do not have an access to a sufficient type of healthcare coverage besides the ones which are given by the government at large. Hence, a majority of the Malaysians use their income to pay for their bills while 36% use their savings (6). Therefore, the government had a comprehensive plan to provide healthcare systems for the poor and help them in gaining access to higher quality healthcare (12).
Although Japan has a comprehensive healthcare system that seeks to serve the poor population as well, however, the healthcare system in Malaysia needs to be more proactive in nature about which better healthcare engagements can be assured. Some recommendations which can be applied may be identified as follows:
- Engaging in policies to help the poor may be identified as a well-suited technique to bring about better welfare and overall security.
- Secondly, ensuring better engagement for the poor in form of equal health systems will lead to better results. When the rich, as well as the poor, would be required to be engaged in the same system, it would result in better opportunities (7).
- Undertaking advances from the rich can be another technique using which better healthcare facilities may be provided to the different citizens. This will build a socialistic structure thus giving opportunities to the poor for better welfare (13). This would also contribute toward building a society of equals.
Conclusion
Therefore, the report outlines the different healthcare plans and systems which are existent within the different nations such as Japan and Malaysia to compare how both these countries have been managed. From the analysis, it could be identified that the healthcare system of Japan is rather comprehensive and looks out for the poor as well, however, the same is not the case in Malaysia, and to improve the same, certain recommendations have been made. These recommendations are focused on improving the health facility and financial provisions for the poor and other diverse classes in Malaysia.
References
- Guinness, L. and V. Wiseman (2011). Introduction to Health Economics London, Open University Press. Chapter 9.
- WHO (2010). The world health report 2010: Health systems financing – the path to universal coverage. Geneva, World Health Organization. Chapter 2 https://apps.who.int/iris/bitstream/handle/10665/44371/978924156402 1_eng.pdf?sequence=1
- Kutzin, JA. Ibraimova, M. Jakab and S. O’Dougherty (2009). “Bismarck meets Beveridge on the Silk Road: coordinating funding sources to create a universal health financing system in Kyrgyzstan.” Bull World Health Organ 87(7): 549-554. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704031/
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