Page 57 - 20211214_OHKF_Health_Finance_Research_Report_E (1)

Table 2.3
Japan and China comparison

Country Key Features of Health Strategic Purchasing Policies & Frameworks
Financing System

Japan How is the healthcare Purchasing for PHC and NCDs: Since 2008, the
system financed? Japanese government introduced the specific health
check-up (Tokutei kenshin) to the population aged
Financed mainly through SHI between 40 and 74 with the goal of promoting and
and taxation preventing chronic diseases. Based on the check-up
results, specific health guidance (Tokutei hoken shidou)
Statutory Health Insurance is provided to those who are identified as having high
System (SHIS) covers 98.3% risk of developing lifestyle-related diseases.
of population; Public Social
Assistance Program covers • Who is the purchaser?
remaining 1.7%
All health insurers in Japan.
• What to purchase?
The health check-ups include a medical consultation
which collects information including medical history
and smoking habits, and examinations of a nationwide
set of items. People with risks of developing lifestyle-
related diseases are invited to undergo one of the two
types of specific health guidance, either intensive
health guidance (sekkyokuteki shien) or motivational
health guidance (doukizuke shien).
• From whom to purchase?
Private healthcare providers.
• How to purchase?
Fee-for-service schedules are set by the national
government and provides subsidies to local
governments, insurers, and providers.
Incentives under the Continuous Care Fees scheme are
given to PHC GPs for coordinating care of patients with
chronic diseases thus subsidising care for patients.
Providers sometimes can choose to be paid on a
per-case basis or on a monthly basis.

China How is the healthcare The Chinese government made great investment into
system financed? establishing primary care system. Managing diabetes
and hypertension has been included as one of the
Financed mainly through SHI main public health functions of primary care
facilities, i.e., community health stations and
Three public insurance community health centres. In some areas, chronic
programmes: disease patients are getting higher reimbursement for
getting treatment in the primary care level rather than
1. New Rural Cooperative going to hospitals.
Medical Scheme (NRCMS);
• Who is the purchaser?
2. Urban Residents Basic
Medical Insurance (URBMI); The Chinese government and social medical insurers.

3. Urban Employee Basic • What to purchase?
Medical Insurance (UEBMI) Screening and management of hypertension and
diabetes.
(In 2016, the urban resident
and rural schemes merged • From whom to purchase?
to form the Urban Rural
Resident Basic Medical Community healthcare facilities, i.e., community health
Insurance (URRBMI) to stations and community health centres, which can be
improve administrative owned by either public or private providers.
efficiency)
• How to purchase?
These 3 major social health Mainly paid by fee-for-service. Some areas have
insurance schemes cover introduced capitation payment.
more than 95% of the
population.

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