[Social health insurance for all: can we learn from Japan?].

In the current German health care reform debate, the only foreign experiences discussed are from the USA or UK even though other countries have systems much more similar to that of Germany. Based on the German model of statutory health insurance. Japan has developed a similarly financed health system which has been quite successful in cost containment since the early 1980's. Unlike Germany, Japan has included the whole population in its statutory insurance scheme and refrains from private health insurance and upper limits on contributory income. Other features include the inclusion of pharmaceuticals in the Uniform Value Scale for all services, bi-annual revisions of that scale based upon utilization and technological innovation, government subsidies to health care which serve as a quasi global budget, and lastly a steadily growing GDP. Differences in the systems include the Japanese mixture of the ambulatory, in-patient and pharmaceutical sectors with physicians both in private practice and hospitals offering all three kinds of services. In-patient utilization is characterized by high numbers of hospital beds, very long lengths of stay, and few cases. Problems of the Japanese systems include the relatively low satisfaction of both population and patients, and the lack of quality assurance measures, clinical guidelines, and continuing education.