How Japan is building a resilient society through equitable healthcare

As we mark World Health Day, it is essential to recognize the importance of equitable access to healthcare. As global populations age, the extension of "healthy longevity", or living in good health without illness or injury, has become a critical challenge for building a resilient society. Early detection and treatment of diseases are key, making equitable access to necessary healthcare indispensable.

Japan’s universal health insurance system, implemented in 1961, ensures equal access to healthcare for all citizens. Before its introduction, around one-third of the population, or 30 million people, were uninsured, leading to the loss of many lives due to unaffordable medical expenses. Today, individuals pay premiums based on income and cover 30% of medical costs, ensuring healthcare access for all.

Now, with the fastest-ageing population in the world, Japan is facing a significant demographic shift. While the proportion of people aged 20-64 to 65 and older was 5.1 to 1 in 1990, it is estimated to change to 1.8 to 1 by 2025. This indicates that the proportion of elderly population to working-age population more than doubled over the course of 35 years. This shift has led to increased demand for more advanced treatment and long-term care.

As Japan's population continues to age, national healthcare expenditures have been rising steadily as well. In 2000, healthcare costs totalled around JPY30 trillion ($280 million), but by 2022, this figure had exceeded JPY46 trillion ($316 million). During the same period, the percentage of GDP allocated to healthcare increased from 5.7% to 8.24%. This rise in costs highlights the urgent need to update insurance coverage and to improve the efficiency of the healthcare system.

In response, the Japanese government has been updating its healthcare insurance system to maintain equitable access to healthcare services. Recent changes include the introduction of the Data Health Plan and the postponement of raising the “high-cost medical expense benefit” cap.

Additionally, the efforts to digitize healthcare operations from both the public and private sectors have improved efficiency, helping to alleviate the strain on the system. These public-private collaborations ensure that all individuals in Japan can access healthcare equally.

As Japan’s population ages and rural areas experience depopulation, the demand for healthcare services is changing. To ensure equal access to healthcare for all citizens, Japan is updating its medical insurance systems.

Launched in 2013, the Data Health Plan is designed to enhance healthcare effective and efficient. It analyzes medical expenses and health check data from insured individuals to optimize health services. By stratifying health risks based on actual data, the plan helps identify individuals who would benefit most from healthcare interventions, improving the overall effectiveness of healthcare delivery.

In 2018, Japan's Ministry of Health, Labour and Welfare (MHLW) shifted the primary financial responsibility for national health insurance from municipalities to prefectures. This change was prompted by challenges faced by municipalities in maintaining stable finances due to rising healthcare costs and depopulation. By transferring responsibility to prefectures, MHLW aimed to achieve more stable financial management and improve the implementation of better services.

In March 2025, the government postponed raising the cap for the high-cost medical expense benefit. This benefit helps prevent excessive financial strain on individuals by setting a monthly cap on medical expenses based on age and income. Any excess is reimbursed.

This is particularly crucial for those requiring costly treatments, including cancer or rare diseases, ensuring they can access necessary care. While the proposal had been a focal point in addressing rising healthcare costs, its postponement protects individuals from potentially losing access to essential high-cost treatments amidst rising healthcare expenses.

While the ageing population is placing increasing strain on healthcare services, digitization is improving operational efficiency.

Since 2021, the My Number Card, which serves as an electronic identity card, has also functioned as the national health insurance card. It stores digital records of prescriptions and health checkups, enabling healthcare providers to access a patient’s complete medical history in one place. MHLW anticipates that the widespread use of this card will reduce administrative burdens and ease pressure on healthcare services.

Companies are also providing digitized services that improve the efficiency of healthcare operations. Aly offers a service that uses generative artificial intelligence (AI) to automatically generate medical documents, including discharge summaries. This simplifies processes and helps reduce the burden on healthcare workers.

Similarly, Ubie provides AI-powered services that offer pre-consultation questions for patients, contributing to both the efficiency and quality of medical consultations and alleviating pressures on healthcare facilities.

According to the Japan Medical Association, the introduction of universal healthcare after World War II allowed the Japanese people to work with greater peace of mind.

The association notes that this system played a key role in Japan's post-war economic growth, contributing to the nation’s rise as a global economic leader.

Accessible healthcare not only enhances public health, but also supports a resilient society and economy. Japan's universal health insurance and medical innovations can serve as best practices in global efforts to improve healthcare systems.