When the Japanese government adopted Western medicine in the late nineteenth century, it left intact the infrastructure of primary care by giving licenses to the existing practitioners and by initially setting the hurdle for entry into medical school low. Public financing of hospitals was kept minimal so that almost all of their revenue came from patient charges. When social health insurance (SHI) was introduced in 1927, benefits were focused on primary care services delivered by physicians in clinics, and not on hospital services. This was reflected in the development and subsequent revisions of the fee schedule. The policy decisions which have helped to retain primary care services might provide lessons for achieving universal health coverage in low- and middle-income countries (LMICs).
Ikegami N, Campbell JC. Dealing with the medical axis-of-power: the case of Japan. Health Economics, Policy and Law. 2008;3:107-113. doi:10.1017/S1744133108004428
Filmer D, Hammer JS, Pritchett LH. Weak links in the chain: a diagnosis of health policy in poor countries. World Bank Research Observer. 2000;15(2):199-224. doi:10.1093/wbro/15.2.199
George A, Iyer A. Socially embedded informal health providers in northern Karnataka, India. Soc Sci Med. 2013;96:297-304. doi:10.1016/j.socscimed.2013.01.022
Lewin S, Lavis JN, Oxman AD, et al. Alma-Alta: Rebirth and Revision 2: Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systemic reviews. Lancet. 2008;372(9642):928-939. doi:10.1016/s0140-6736(08)61403-8
Sakai S. History of Medical Care in Japan. Tokyo: Tokyo Shoseki; 1982:432
Hashimoto H, Ikegami N, Shibuya K, et al. Universal health care at 50 years 3. Cost containment and quality of care in Japan: is there a trade-off? Lancet. 2011;378(9797):1174-1182. doi:10.1016/S0140-6736(11)60987-2
Ikegami N, Yoo BK, Hashimoto H, et al. Japanese universal health coverage: evolution, achievements, and challenges. Lancet. 2011;378(9796):1106-1115. doi:10.1016/S0140-6736(11)60828-3
Shah NM, Brieger WR, Peters DH. Can interventions improve health services from informal private providers in low and middle-income countries? A comprehensive review of the literature. Health Policy Plan. 2011;26:275-287.
Ikegami N. Fee-for-service payment － an evil practice that must be stamped out? Int J Heath Policy Manag. 2015;4(2):57-59. doi:10.15171/ijhpm.2015.26