Hatanaka Takashi, Eguchi Narumi, Deguchi Mayumi, Yazawa Manami, Ishii Masami
Chief Senior Researcher, Japan Medical Association Research Institute (JMARI), Tokyo, Japan (
Chief Senior Researcher, Japan Medical Association Research Institute, Tokyo, Japan.
Japan Med Assoc J. 2015 Sep 1;58(3):78-101. eCollection 2015 Sep.
The Japanese government at present is implementing international health and medical growth strategies mainly from the viewpoint of business. However, the United Nations is set to resolve the Post-2015 Development Agenda in the fall of 2015; the agenda will likely include the achievement of universal health coverage (UHC) as a specific development goal. Japan's healthcare system, the foundation of which is its public, nationwide universal health insurance program, has been evaluated highly by the Lancet. The World Bank also praised it as a global model. This paper presents suggestions and problems for Japan regarding global health strategies, including in regard to several prerequisite domestic preparations that must be made. They are summarized as follows. (1) The UHC development should be promoted in coordination with the United Nations, World Bank, and Asian Development Bank. (2) The universal health insurance system of Japan can be a global model for UHC and ensuring its sustainability should be considered a national policy. (3) Trade agreements such as the Trans-Pacific Partnership (TPP) should not disrupt or interfere with UHC, the form of which is unique to each nation, including Japan. (4) Japan should disseminate information overseas, including to national governments, people, and physicians, regarding the course of events that led to the establishment of the Japan's universal health insurance system and should make efforts to develop international human resources to participate in UHC policymaking. (5) The development of separate healthcare programs and UHC preparation should be promoted by streamlining and centralizing maternity care, school health, infectious disease management such as for tuberculosis, and emergency medicine such as for traffic accidents. (6) Japan should disseminate information overseas about its primary care physicians (kakaritsuke physicians) and develop international human resources. (7) Global health should be developed in integration with global environment problem management. (8) Support systems, such as for managing large-scale disasters of international scale or preventing the spread of infectious diseases, should be developed and maintained. (9) International healthcare policy, which the Japanese government is trying to promote in accordance with international trends, and international development of Japanese healthcare industry should be reconsidered.
目前，日本政府主要从商业角度实施国际卫生与医疗发展战略。然而，联合国将于2015年秋季制定2015年后发展议程；该议程可能将实现全民健康覆盖（UHC）作为一项具体发展目标。日本的医疗体系以全国性公共全民健康保险计划为基础，受到了《柳叶刀》杂志的高度评价。世界银行也称赞其为全球典范。本文针对日本的全球卫生战略提出了建议和问题，包括一些必须进行的国内前期准备工作。总结如下：（1）应与联合国、世界银行和亚洲开发银行协调推进全民健康覆盖的发展。（2）日本的全民健康保险体系可成为全民健康覆盖的全球典范，应将确保其可持续性视为国家政策。（3）《跨太平洋伙伴关系协定》（TPP）等贸易协定不应扰乱或干涉全民健康覆盖，全民健康覆盖在每个国家（包括日本）都有其独特形式。（4）日本应向海外（包括各国政府、民众和医生）传播有关日本全民健康保险体系建立过程的信息，并努力培养参与全民健康覆盖政策制定的国际人力资源。（5）应通过精简和集中孕产妇保健、学校卫生、结核病等传染病管理以及交通事故等急诊医疗，推进单独医疗计划的制定和全民健康覆盖准备工作。（6）日本应向海外传播有关其初级保健医生（签约医生）的信息，并培养国际人力资源。（7）全球卫生应与全球环境问题管理相结合发展。（8）应建立和维护诸如应对国际规模的大规模灾害或防止传染病传播的支持系统。（9）应重新审视日本政府根据国际趋势试图推动的国际医疗政策以及日本医疗行业的国际发展。
