Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Japan.
Lancet. 2011 Oct 1;378(9798):1265-73. doi: 10.1016/S0140-6736(11)61098-2. Epub 2011 Aug 30.
Japan's premier health accomplishment in the past 50 years has been the achievement of good population health at low cost and increased equity between different population groups. The development of Japan's policies for universal coverage are similar to the policy debates that many countries are having in their own contexts. The financial sustainability of Japan's universal coverage is under threat from demographic, economic, and political factors. Furthermore, a series of crises-both natural and nuclear-after the magnitude 9·0 Great East Japan Earthquake on March 11, 2011, has shaken up the entire Japanese social system that was developed and built after World War 2, and shown existing structural problems in the Japanese health system. Here, we propose four major reforms to assure the sustainability and equity of Japan's health accomplishments in the past 50 years-implement a human-security value-based reform; redefine the role of the central and local governments; improve the quality of health care; and commit to global health. Now is the time for rebirth of Japan and its health system.
日本在过去 50 年中取得的一项主要卫生成就，是以较低成本实现了全民健康，并且不同人群之间的公平性有所提高。日本全民覆盖政策的发展与许多国家在各自背景下进行的政策辩论相似。人口、经济和政治因素对日本全民覆盖的财务可持续性构成了威胁。此外，2011 年 3 月 11 日发生的 9.0 级东日本大地震之后的一系列危机，包括自然和核危机，动摇了二战后建立的整个日本社会体系，并暴露出日本卫生系统存在的结构性问题。在此，我们提出了四大改革措施，以确保日本在过去 50 年中取得的卫生成就的可持续性和公平性：实施基于人的安全价值的改革；重新定义中央和地方政府的作用；提高医疗保健质量；致力于全球卫生。现在是日本及其卫生系统重生的时候了。
