日本の国民皆保険制度-harvardschoolofpublichealth.pptx

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1、MichaelR.ReichGlobalHealth&Population,HSPH26April2012ReflectionsonJapan’s50YearsofUniversalHealthCoverage“Reflections”NotafocusedresearchpresentationMoreofapersonalperspectiveJapanhashaduniversalcoveragesince1961,kokuminkaihokenseido(国民皆保険制度)=50yearsJapanhashadMichaelcov

2、eragesince1971=40years2FieldResearchinJapan,1971-74MePresentationBasedonLancetJapanSeriesLeadersoftheJapanResearchGroupProf.K.TakemiProf.N.IkegamiProf.K.Shibuya50YearsSinceAchievingUniversalHealthCoverageMajorimprovementsinhealthstatusinthepostwarperiodJapanesewomenhav

3、erankedasnumberoneinlifeexpectancyfor25years7LifeExpectancyofWomenForG7Countriessource:MHLW.Japan’sUnder-5Morality（1950-2008）9BoysGirlsMDG4:Reduceby2/3’s(1950-1965)92(1950)24(1965)Source:ランセット日本特集号PopulationHealthIn50YearsSinceAchievingUniversalHealthCoverageAlsoexcell

4、entcontrolofnationalmedicalexpendituresinJapanTodayJapan’sNMErepresentonly8.1%ofGDP,placingthematnumber20amongOECDcountriesCostcontrolhascontinued,evenwithrapidagingofthepopulation10MedicalExpenditureamongOECDCountries(2005）source:MHLW.ReasonsforJapan’sSuccessesNoteasyt

5、oexplainPublichealthpolicies,Highliteracyratesandeducationallevels,Dietandexercise,Economicgrowth,andAstablepoliticalenvironment12PerryandhisBlackShips“Open”Japanin1853RecentHistoricalContext-1About3.2milliondeathsduringWW2HiroshimaaftertheBombRecentHistoricalContext-2Un

6、dertheOccupation,socialchangeanddemocratizationNewpublichealthpoliciesintroducedEffectivecontrolofinfectiousdiseasesandtuberculosisFrom1947to1955,averagelifeexpectancyincreasedby14yearsSeriouspollutionproblemsin1960s15ExpandingCoverageJapan’sAchievements“GoodHealthatLowC

7、ostwithEquity”Fourmainpoints:UniversalcoveragewithincreasingequityCostcontainmentandservicequalityPoliciesforageingImpressivegainsinpopulationhealth17GrowingSocialChallengestheriseofpart-timeandtemporaryemploymentforyoungworkersgrowingnumberofyoungwomenwhopostponemarriag

8、eandchild-bearingever-expandingnumberofelderlyincreasingsenseofwideningincomeinequalityanddiversityinva