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Telecast in NHK Series of "Points in View and at Point" on July 6, 2011,
in commemoration of the 50th Anniversary of the founding of the All People's Health Insurance Scheme

Preserving Our "Treasure": 50-year-old National Health Insurance Scheme
IROHIRA Tetsuro

Produce your health insurance certificate, and you will be able to receive 
medical treatment.

Exactly 50 years ago, or immediately after World War II, when people in Japan 
were eking out their existence, the Japanese Medical Association got together 
with the Government in establishing a "health insurance for all" system. 
Today, worldwide attention is focused on this system.

Told of this system, all of you may probably feel it only natural that all 
the Japanese people should universally be benefitted under a universal 
medical insurance scheme. 

For the last fifty years since its inception, the Japanese people have come 
to consider it only "natural" to have this system, but this kind of scheme 
has yet to take root in other countries. 

All you need to consult with any hospital or physician is nothing but 
a health insurance certificate here in Japan. That's something 
utterly surprising to people in other countries. 

This is a wonderful system? amazingly wonderful as a matter of fact.

Private insurance schemes, such as cancer and life insurance systems, 
are also available. This kind of insurance policy is something 
that is bought for use just in case of emergency. It is utterly different
in kind from "public medical insurance" or a scheme in which all 
the people are involved without exception. 
That's something I hope you bear in mind while listening to my lecture.

Corporate employees join the Health Insurance Scheme, public servants 
join the Mutual Aid Scheme and independent businessmen 
join the National Health Insurance Scheme. 
Which means that all the people pay social insurance fees. 
When the insured or their family members get sick or are wounded, 
they can receive treatment with a less economic burden and 
without any anxiety. 

The whole system is such that all the insured prepare themselves 
for all the possible risks. 
Indeed, the system in which all the people are universally involved
is really something they can be proud of in the world. 

The other day, I attended a WHO convention in Bangkok with the participation 
of 1,000 delegates. Aside from the Great East Japan Earthquake, 
the world's attention is focused on two other things.

One is whether the health insurance scheme for all the Japanese people 
is really sustainable in the rest of the 21st Century, 
and the other is how the movement of the population will evolve 
during the same period. 

Why is the world's attention focused on Japan's health insurance scheme 
involving the whole people? 

This is because some 50 countries around the world adopt a health 
insurance-for-all system, and they are striving to increase 
the offer of services step by step. 

Each nation has its own troubles, to say the least of the sources of revenue. 

It is extremely difficult to keep physicians and nurses who want to continue 
working in the rural setting. 

Unless medical workers are on hand, the health-insurance-for-all system 
will not function even in a situation where health insurance certificates 
and hospital buildings are available.

At the WHO convention, heated discussions were evolved on how to keep 
medical manpower in the rural setting. 

I would assume that I was invited to the conference because I engage 
in the delivery of medical care deep in the mountains. 

The medical insurance system which covers all the Japanese people is 
something natural in their eyes. Globally, it would be considerably 
difficult to adopt it elsewhere in the world.

In rural Japanese communities, it has been a practice for farmers to 
make monetary contributions for the construction of hospitals and 
the employment of physicians. 
The official appellation of the hospital to which I am assigned is 
called the Saku Central Hospital Affiliated with the Nagano Prefectural 
Federation of Agricultural Cooperatives for Health and Welfare
(JA Kouseiren). 

(Panel 1: Photograph of the Saku Central Hospital and the Japanese 
abbreviation of the hospital's name)

Kouseiren is established by local agricultural cooperatives to 
have medical institutions in the rural setting.  

The idea was to eliminate "doctor-less" villages and enable villagers 
to have access to relatively less costly medical care. 
Constructed by farmers' unions as "public hospitals,"
more than 110 hospitals are available throughout Japan, 
many of them being in the rural communities. 

Known as the founder of "rural medicine," the late Dr. Toshikazu Wakatsuki 
emphasized community medicine while serving as director of the Saku Central 
Hospital. It is with this philosophy in mind that he strived hard to 
develop his medical institution. 

(Panel 2: Dr. Wakatsuki's photograph)

Today, attention is focused on community medicine presumably because 
medical care remains aloof from the realities of communities. 

In other words, is it not because medical care is isolated from the 
needs of communities?

I have served as chief of a clinic in the mountains over a period of 
10-odd years. 

Situated in a quiet mountain village, the clinic received more than 
100 medical and nursing students for on-the-job training every year.

 (Panel 3: Trainees in the village)

Japan's heath insurance-for-all system is 50 years old. 
Nowadays, there arise many difficult issues, such as financial deficits,
defaulting, arrears and increases in the non-insured. 

There is apprehension around the world about those domestic issues which 
could play a role in financially collapsing the precious health care system. 
I briefed visiting students on those problems.

There also are other things that cause unrest.

What is commonly known as "medical tourism," or trips abroad to receive 
sophisticated medical treatment, is getting popular. 
Another example is the Trans-Pacific Partnership (TPP) designed for 
completely free trade with Japan studying the advisability of its 
participation. 

In other words, Japan is likely to be adversely affected by not just domestic 
issues but international pressure. 

Many Japanese people are aware of, but not concerned about, the fact that 
Japan's official system of medical insurance remains risky. 

By the way, where does man's mortality rate stand?

(Panel 4: Photograph of mine, a Buddhistic monk or a physician?)

The mortality rate stands at 100%. 

Everybody will eventually die.
 
This is a picture of the monk.

That is why medical insurance schemes are used by all the people.

Is it not that almost all Japanese people will consult with medical doctors 
before their death?

If that is the picture, then, should we not think more seriously about 
the system of medical care at all times.

The same thing goes with aging. 

Dynamic trends in population reveal that aging is under way in Japan 
on the worldfs greatest scale and at the worldfs fastest pace. 

The seniors' population will reach an all-time high 20 years 
later or in the 2030s. 

Japanese society as a whole must take into serious account 
how to cope with this inevitable eventuality.

All sorts of knotty issues will engulf Japanese society, to say the least 
of increases in persons having difficulty in walking, 
problems on town building and rises in people living by themselves. 

You will be unable to spend your last days without any caregivers. 

There is no way to get around this issue. It is because this is something
with which mankind is confronted for the first time in history.

With aging in progress, the day will come when medical technology alone 
can no longer serve as panacea.

To say the least of dementia, there will appear incurable diseases 
one after another.

On social welfare and care, there are many people who seek counsel from 
physicians, who after all are mere experts in medical technology and 
regrettably unable to foresee what "super-aging"society 
in the future really looks like. 

Minutes ago, I talked about trips abroad to receive sophisticated medical 
treatment. Not only do Japanese people go to foreign countries for 
medical treatment, but also foreign patients come to Japan to receive it. 

Suppose, for instance, that a wealthy man comes to Japan 
for computerized tomography (CT). 

As he had to wait for the screening for a long time, a Japanese 
rich man would show up and ask, "Why donft you take mine before the foreigner
, 
as I will pay you the same amount you charge him?"

If that happened, the situation would be unbearable. 

Which means visits by rich people would be lucrative. 
Physicians and nurses would want to work only at those urban hospitals. 
What would happen to local hospitals?

Locals entertain an acute sense of danger about TPP.

Urbanites have little interest in TPP, 
where attention is focused on nothing but farming problems. 

The truth of the matter is that TPP will directly affect the lives of the 
Japanese people, to say the least of the aged.

I feel it necessary to think carefully about TPP, 
even though I do not mean to say that I am opposed to it.

I have yet to determine my position on this problem, 
because I still do not have a good reason to support TPP as yet.

Not a single explanation has ever been provided as to why Japan has to 
become a TPP member despite the possibility that the systems in which medical 
and financial services are offered as well farming would be impaired. 

In exploring the feasibility of Japan's TPP membership, I strongly urge 
the Japanese government not to expose the public system of medical 
insurance to the waves of "liberalization." 

What gets on my nerves is the fact that there is no national debate 
under way on this issue.

In national elections, all political parties appeal for the necessity of 
holding fast to the sustenance of a medical insurance-for-all system.

Already before the outbreak of the Great East Japan Earthquake, 
Japan had been confronted with two crises? the finances worsened 
by swelling medical care outlays and the introduction of 
market principles to the sector of medical care. 

If some people attempt to steal a march, the precious insurance-for-all 
system will institutionally fall apart. 

People around the world are envious of the Japanese type of medical 
insurance for all people.

It is to be hoped that the whole nation will continue giving serious thought 
to the sustainability of the universal system of medical insurance. 

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