2017 Volume 9 Issue 2 Pages 53-62
The Japanese health insurance system is divided into employment―based plans （EBPs） （including plans of health insurance societies, mutual societies, and the Japan Health Insurance Association （Zenkoku Kenko Hoken Kyokai） and residence―based health plans （including National Health Insurance （NHI） plans managed by municipalities and Health Insurance for Very Old Citizens）. Premiums of NHI plans are much higher than those of employment―based plans because senior citizens move from EBPs to NHI plans when retiring. NHI plans, which also cover non―regular employees ineligible for EBPs, continuously run deficits. The EBPs use the ability―to―pay principle and their premiums are based on employee income ; NHI plans, covering low―income persons, use both the ability―to―pay principle and the benefit principle. Meanwhile, the financial burden of health insurance societies, usually having better financial standing than NHI plans, has been increasing. This paper exams these issues while considering the principles of social insurance, and discusses possible directions for reforming the health insurance system.
Annals of the Society for the Study of Social Policy
