OECD Reviews of Health Care Quality: Japan 2015

Raising Standards

In series:OECD Reviews of Health Care Qualityview more titles

Published on August 21, 2015

This report reviews the quality of health care in Japan, and seeks to highlight best practices, and provides a series of targeted assessments and recommendations for further improvements to quality of care. One of Japan’s foremost policy challenges is to create an economically-active ageing society. Excellent health care will be central to achieving this. A striking feature of the Japanese health system is its openness and flexibility. In general, clinics and hospitals can provide whatever services they consider appropriate, clinicians can credential themselves in any speciality and patients can access any clinician without referral. These arrangements have the advantage of accessibility and responsiveness. Such light-touch governance and abundant flexibility, however, may not best meet the health care needs of a super-ageing society. Japan needs to shift to a more structured health system, separating out more clearly different health care functions (primary care, acute care and long-term care, for example) to ensure that peoples’ needs can be met by the most appropriate service, in a coordinated manner if needed. As this differentiation occurs, the infrastructure to monitor and improve the quality of care must simultaneously deepen and become embedded at every level of governance –institutionally, regionally and nationally.


Foreword and Acknowledgements
Acronyms and abbreviations
Executive summary
Assessment and recommendations
Quality of health care in Japan
Primary and community care in Japan
Improving the quality of Japan's hospital care
Quality of mental health care in Japan
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  • The overarching policy priority in the Japanese health system has, for many years, been tight fiscal governance. Whilst this has worked well to contain costs and should not be relaxed, it is important that equal attention is now paid to quality governance. This will require a more consolidated approach to quality monitoring and continuous quality improvement.
  • Given Japan’s rapidly ageing population, a clear orientation toward preventive and holistic elderly care will be necessary. A specialist primary care sector, delivering comprehensive, continuous and coordinated care across the life-course will be essential to Japan’s reorientation toward more cost-effective preventive health care.
  • As differentiation of the hospital sectors occurs into acute beds and less intensive beds, with the aim of reducing inappropriate use, a sufficiently sophisticated quality monitoring and improvement architecture will need to be built to evaluate the reforms’ impacts. More data on outcomes, rather than just inputs and processes, are needed.
  • Japan must also continue to develop high quality care in the community for severe mental illness, while turning attention to improving care available for mild-to-moderate mental illness. Good mental health care should be at the heart of the new speciality of primary care.

  • Read the Assessment and recommendations (available both in English and in Japanese in the same document)



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