ＮＨＫ 「視点・論点」、国民皆保険５０年 ２０１１年７月６日放映 英語版
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 world’s greatest scale and at the world’s 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 don’t 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. =======