Abstract
Japan's universal health insurance coverage is now threatened by rising medical cost. In 2008, so-called specific health examination was induced with the hope of preventing ischemic heart diseases, strokes, and diabetes, along with the new public medical insurance system for the elderly people aged 75 and over. Health examination policy in Japan originated from the tuberculosis control program and nowadays some health insurance societies voluntarily offer comprehensive medical examination for their members. Besides, nationwide health promotion movement was first launched in 1978 and currently promoted as Health Japan 21 programs.
Occupational health service in Japan was also initiated aiming to combat tuberculosis and, in 1938, factory owners were legally obligated to implement screening of their work forces. Industrial Safety and Health Law promulgated in 1972 started to require employers to perform both periodic measurement of working environment and general health examination of all workers. The law has been repeatedly amended to strengthen the health surveillance function on work-related disease. So-called total health promotion plan (THP) for workers has also been promoted since 1989. In 2008, the list of clinical test items for specific health examination and those for general health examination were unified and employers are asked to report the results of health examination to health insurance societies. This employers' obligation on handing health information of their workers is peculiar to Japan.
To enhance affiliation between employers and health insurance societies, Japanese government should financially aid small enterprise, pursue unification of the resource and the information on health examination, evaluate and disclose the effectiveness of the specific health examination to prevent lifestyle-related diseases, activate alliance councils of local community and workplace, and plan to reduce the dual burdens of health professionals on-site. This new policy is expected to enable occupational health professionals to focus on their essential function at workplace.
