Redesigning how health services are delivered in Japan would better meet the needs of a super-ageing population, says OECD


05/11/2014 - Elderly individuals with complex, chronic diseases need continuous and tailored care to maintain their health and maximise their ability to participate in society. Japan must change the way it delivers health services for older citizens by strengthening its specialist primary care and making mental health care services more widely available, according to a new OECD report.


OECD Health Care Quality Review of Japan says that the country achieves good health at relatively low cost. Life expectancy is famously long, at 83.2 years compared to an OECD average of 80.2 years, and increasing.  Some indicators of the quality of health care are amongst the best in the OECD: five-year relative survival estimates after a diagnosis of breast, cervical or colorectal cancer are all high, for example. Yet health spending is very near OECD averages, at 3 484 USD PPP per capita per year.


These outcomes are achieved by a health system that is characterised by its flexibility and light-touch governance. While this makes the system accessible and responsive, it also brings challenges:


  • The average length of stay in Japan is very long and 17.9 days for acute care while the OECD average is 6.6 days. This suggests potential to deliver more care outside expensive hospital settings and closer to people’s homes and family.
  • There are few quality initiatives embedded at system-level. As one steps away from system-level, a proliferation of quality-related activities is found, haphazardly applied.
  • Japan’s payment systems, while sophisticated, do not reward quality in a particularly sophisticated or consistent way. Quality-benchmarking projects are often voluntary and public awareness of the benchmarking results is still low although increasing.
  • Japan’s high suicide rate (20.9 deaths per 100 000 population vs. the OECD average of 12.3), high numbers of psychiatric beds, and long average length of stay in psychiatric institutions suggest potential for significant gains in the quality and outcomes of mental health care.


To meet these challenges, Japan needs to shift to a more structured health system and strengthen quality governance. Delivery of the key services of primary care, acute care and long-term care should be better separated, to make sure that care takes place in the right setting. 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. 


The OECD report also recommends that:

  • Given Japan’s rapidly ageing population, a clear orientation toward preventive and holistic elderly care should be developed. Addressing the lack of a distinct speciality of primary care in Japan will be critical here.
  • The number of hospital beds in Japan should be reduced, whilst expanding nursing home or alternative facilities for patients in post-acute phase. Developing the role of care co-ordinators to effectively transfer patients from acute care to community setting will be instrumental.
  • In the mental health system, more patient-centred care should be promoted, by making a wider range of services in the community. Establishing ways to make service user views better heard and reflected in policy is an urgent need.


Journalists can find the report’s Assessment and Recommendations at


The full report will be released in Spring 2015. For further information about OECD’s Health Care Quality Review of Japan please contact, Francesca Colombo (tel. + 33 1 45 24 93 60) or Rie Fujisawa (tel. + 33 1 45 24 14 09) or Ian Forde (tel. + 33 1 45 24 81 24) of the OECD’s Health Division.


Further information 

OECD Reviews of Health Care Quality examine what works and what doesn’t in countries, benchmarking their efforts and providing advice on reforms to improve quality of health care. The country reviews will be followed by a final summary report on the lessons and good practices relevant to all governments. 


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