One Health Concept and the Uninsured in Japan

     Objectives. The purposes of this research are: to provide a general overview of Japan’s universal health insurance coverage system, to examine the social factors that explain the rise in the number of uninsured individuals using Geographic Information System (GIS) mapping, and to discuss the future universal health insurance agenda.

     Background. Due to its universal health insurance coverage system, Japan’s health and medical services are among the world’s highest quality. Japan’s system requires that all residents belong to either the national insurance system or an employer-based insurance system. However, total population coverage is not the reality. In Japan, 18.8% of households with national insurance fail to pay their premiums, and those who fail to pay their premiums for 12 months become uninsured, including the children in these households. In fact, a Japanese government survey (2008) revealed that more than 30,000 children under the age of 16 are uninsured.

     Analysis and Discussion. One key social factor that explains the rise in the number of uninsured individuals is the increase in labor mobility, which was expanded by the 1985 Worker Dispatch Law and its legal amendment. In addition, the 2008 economic crisis increased unemployment and the numbers of unstable and low-income workers. Currently, one in three workers is a non-regular, contractual employee, and the wage gap between regular and non-regular workers is growing.

     GIS analysis indicates that the uninsured rate by prefecture is related to the unemployment and urbanization rates within those prefectures. Big cities, such as Tokyo, offer a range of job opportunities; however, the cost of living is high and upward economic mobility is difficult, so many low-wage workers forego paying their insurance premiums. The number of uninsured children is a crucial issue. Therefore, the United States’ State Children's Health Insurance Program (SCHIP) should be evaluated for its use in Japan.