Japan: Universal Coverage in a Super Aging Society

Article 7 of 12

Japan’s health outcomes are among the world’s best — life expectancy of 84.1 years, preventable mortality among the lowest on Earth, and patient satisfaction well above the OECD norm — achieved at per-capita spending below most high-income peers.² But attributing these outcomes primarily to the healthcare system would be too simple. Diet, low obesity rates, social cohesion, and a cultural orientation toward collective wellbeing almost certainly play an equally significant role. The system manages and sustains these outcomes; it did not create them alone.

This article focuses on the healthcare system itself — how it is structured, how it performs across five core domains, and what other countries can learn from it. The comparative section draws on all six countries profiled to date. But Japan’s story has a dimension that system analysis alone cannot capture, and that thread is picked up in the Closing Perspective.  

1- Snapshot Overview

Japan’s system pairs near-universal, broad-benefit coverage with a nationally uniform fee schedule — a combination that delivers exceptional equity in access while keeping costs below peer nations.

Metric

Description / Value

System Type

Social health insurance (Bismarck model) with over 3,000 insurance funds across three schemes: employment-based insurance (EHI), residence-based National Health Insurance (NHI), and the Late-Stage Elderly Medical Care System for those aged 75+. The MHLW sets a nationally uniform fee schedule reviewed biennially.1

Population Coverage

~100% of residents, including foreign nationals with a residence card, are required by law to enroll in a health insurance program.1 Coverage extends to more than 5,000 medical procedures, dental care, and drugs.5

Benefit Coverage

Inpatient and outpatient hospital care, physician and specialist services, dental care, prescription drugs, mental health (primarily inpatient), maternity care, and preventive health checkups. Long-term care is covered under a separate mandatory Long-Term Care Insurance system for those aged 40+.1

Health Spending

10.6% of GDP (2023); $5,790 per capita (USD PPP), below the OECD average of $5,967. Out-of-pocket spending is 12.2% of total health expenditure.2

Provider Reimbursement

Nationally uniform fee schedule (Shinryo Hoshu) set by the MHLW; reviewed every two years. All licensed hospitals and clinics must comply; no provider may set independent prices for NHI-covered services.1 Approximately 70% of hospitals are privately owned.6

Financing

Premiums from employees, employers, and the self-employed; general tax revenues (approximately 50% of NHI benefit costs1); co-payments of 30% for most working-age adults, 20% for children under 6, and 10–30% for those aged 70+, with income-based monthly out-of-pocket caps.1

2- System Architecture

Japan’s health system is a social insurance model – the Bismarck model – in which coverage is mandatory, premiums are income-based rather than risk-based, and the state sets the terms under which insurers operate. Unlike Canada’s single-payer structure or the UK’s integrated public ownership, Japan achieves universality through a regulated multi-insurer framework with overwhelmingly private provision.

Financing

Health insurance premiums are income-based and split between employees and employers in the EHI schemes. For employment-based insurance, the average combined premium rate is approximately 10% of salary, capped at 13%, with employer and employee each contributing half in principle.7 For NHI – covering the self-employed, unemployed, and retirees under 75 – premium rates are set by individual municipalities, ranging from approximately $2,586 to $5,635 per year, and nearly 50% of NHI benefit expenditures are covered by tax subsidies.7

 

The Late-Stage Elderly Medical Care System (for those 75+) is funded approximately 50% by government subsidies, 40% by cross-subsidies from younger working-generation insurance schemes, and 10% by enrollee premiums.7

Out-of-pocket spending of 12.2% of total health expenditure is below the high-income country average, owing to mandatory enrollment and the monthly cap on patient cost-sharing.2

Coverage

The NHI benefit basket is notably broader than Canada’s Medicare: dental care, prescription drugs, and mental health inpatient services are included in the statutory benefit package.1 The MHLW reviews covered procedures and reimbursement conditions every two years. Patients are required to pay co-payments of 30% of costs for most working-age services, with lower rates for children and the elderly and income-graduated caps on monthly out-of-pocket exposure.1

 

In 2024–25, repricing plans and stricter cost controls targeted pharmaceutical spending specifically: the prices of nearly half of all publicly covered drugs were reduced in 2025, targeting savings of approximately ¥250 billion (USD 1.7 billion).6 Generic drug uptake has been actively promoted to manage pharmaceutical expenditure growth.6

 

Long-term care is governed by a separate mandatory Long-Term Care Insurance (LTCI) system, established in 2000, covering those aged 65+ (and qualifying individuals aged 40–64 with age-related conditions). LTCI is funded through a combination of premiums and public revenues and represents a structurally distinct program from health insurance proper.

Provider Mix

Japan has 2.6 practicing physicians per 1,000 population, well below the OECD average of 3.9, yet 7.5 medical graduates per 100,000 — approximately half the OECD average.2,6 The country relies almost entirely on domestically trained physicians; in 2022, only 2,349 foreign-trained doctors practiced in Japan.6 Hospital infrastructure is unusually dense: Japan had 1,191 hospital beds per 100,000 in 2025, compared to an OECD average of 420 per 100,0006 — a reflection of historically long average lengths of stay and a hospital-centric model of care. Japan also leads globally in diagnostic imaging density, with 184 CT scanners, MRI units, and PET scanners per million population versus an OECD average of 51.2

 

Approximately 70% of hospitals are owned by private medical corporations, which also operate 56% of all hospital beds.6 Public hospitals operate only 17% of beds. This private ownership concentration distinguishes Japan from the UK’s NHS model and differs markedly from Canada’s predominantly non-profit hospital sector. Japan has no formal primary care gatekeeping requirement — patients may present directly to any hospital or clinic, including tertiary facilities, which contributes to high outpatient volumes at specialist institutions.

Payment Models

The Shinryo Hoshu (national fee schedule) is the defining feature of Japan’s payment architecture. Set by the MHLW in negotiation with provider representatives and payers, it establishes uniform reimbursement rates for every covered procedure, drug, and service across all insurers and all providers. This national pricing mechanism is the primary tool for cost containment and is reviewed biennially, with explicit attention to pharmaceutical prices.

 

Fee schedule revisions: The 2024–25 revision included stricter cost-effectiveness-based pricing and market expansion repricing.6 Drug price reductions targeting ¥250 billion in savings were implemented in 2025.6

 

Long-term care insurance: LTCI provides a parallel fee schedule for home care, community services, and residential care facilities, reviewed separately from the health insurance fee schedule.

 

Mental health: Japan has one of the largest psychiatric hospital sectors in the OECD, with a long-term care model historically centered on institutional rather than community-based treatment. Reform toward community-based mental health services is ongoing but incomplete.

Technology & Data Infrastructure

Japan’s digital health transformation has been driven in large part by the geographic and demographic pressures its system faces. With approximately 30% of the population aged 65 or older, Japan confronts increasing regional healthcare disparities alongside a shrinking workforce — a combination that has made telemedicine a structural necessity rather than a convenience, particularly for rural and peripheral prefectures where physician shortages are most acute. Despite Japan’s reputation for technological innovation, its health system has been slower than peer nations to adopt digital solutions, and the government is now prioritizing integration of digital health records, telemedicine, and remote care.⁶

 

On the infrastructure side, the government’s 2023 “Timetable for the Promotion of Medical DX” set out a nationwide platform for cloud-based data-sharing across medical institutions, encompassing electronic prescriptions, vaccination records, EMRs, and other clinical data, with full-scale operation targeted for fiscal year 2025. The My Number Card transition reinforces this shift: following the discontinuation of traditional health insurance cards in December 2024, physicians can now access a patient’s prescriptions, checkup results, and medical history through the unified digital identification system, enabling more personalized care.⁸

 

On the clinical technology front, since 2020, when the first Software as a Medical Device received approval in Japan, the number of therapeutic app approvals has grown steadily, covering conditions from nicotine dependence and hypertension to insomnia and pediatric ADHD. Telemedicine guidelines revised in 2022 and 2023 clarified the conditions under which remote consultations are permissible, expanding access particularly for patients in underserved regions. AI integration in diagnostics is advancing under MHLW oversight frameworks that require physician supervision for all AI-assisted clinical decisions.⁸

3- Performance Across the Five Core Domains

Japan’s health system delivers exceptional outcomes (possibly due to cultural attributes) and broad financial protection relative to cost. Its most significant challenges lie in institutional overcapacity in hospital-based care, mental health provision, equity across prefectures, and the long-term fiscal sustainability of supporting an aging population through a workforce-funded insurance model.

Access to Care

Japan achieves near-universal formal coverage with no uninsured population. The mandatory enrollment requirement, broad benefit basket — including dental and pharmaceutical coverage — and income-graduated co-payment caps provide strong financial protection. Out-of-pocket spending at 12.2% of total expenditure is below the high-income country average.2

Access by timeliness is generally strong relative to Canada or the UK, supported by high facility density and the absence of formal gatekeeping. Patients can present directly to specialists without referral, and Japan’s 184 imaging units per million population ensures diagnostic access well beyond most OECD peers.2 Rural and peripheral regions, however, continue to face physician recruitment and retention challenges, creating geographic disparities in emergency care and comprehensive primary care.3

Care Process

Japan’s care process is characterized by high utilization of hospital-based services and long average lengths of stay, artifacts of a system with abundant beds and a historically institutional approach to both acute and mental health care. Average length of stay in acute hospitals is among the highest in the OECD.

Mental health care is an area of structural concern. Japan has one of the highest rates of psychiatric hospital beds globally, with care delivery still heavily centered on long-term inpatient treatment. Policy reforms have promoted community-based mental health services, but deinstitutionalization has proceeded slowly. Populations in the lowest-income groups have experienced more severe mental health impacts, and equity in mental health access remains a challenge.6

Japan’s biennial fee schedule revision process provides a systematic mechanism for updating clinical practice standards through reimbursement incentives — a distinctive tool for steering care process that has no direct parallel in the other systems profiled.

  • Strengths:
    • Nationally uniform fee schedule enables systematic care process steering;
    • High volume of diagnostic and specialist services;
    • Robust pharmaceutical supply chain with broadening generic uptake
  • Challenges:
    • Long hospital lengths of stay reflecting institutional care model;
    • Mental health delivery heavily centered on inpatient rather than community-based settings;
    • High outpatient hospital volumes without care coordination

Administrative Efficiency

Japan’s 3,000+ insurer structure introduces administrative complexity absent in Canada’s single-payer architecture. However, the nationally uniform fee schedule eliminates much of the complexity that characterizes multi-payer systems elsewhere: all insurers reimburse the same prices, reducing billing disputes and claims adjudication overhead significantly.

The My Number Card health insurance integration is designed to reduce administrative friction for both patients and providers by unifying insurance verification and medical records access in a single digital identification system. Implementation progress has been gradual, with the full card transition still underway as of 2025.

  • Strengths:
    • Nationally uniform fee schedule eliminates multi-payer pricing fragmentation;
    • My Number Card integration underway;
    • Standardized billing across 3,000+ insurers
  • Challenges:
    • Multi-insurer structure retains significant inter-scheme coordination overhead;
    • Cross-subsidization between schemes requires complex transfer mechanisms;
    • Incomplete digital record interoperability

Equity

Japan’s mandatory universal enrollment and income-graduated co-payment structure deliver strong formal equity in coverage. The breadth of the benefit basket — including dental and pharmaceuticals — reduces the income-based inequities that characterize Canada’s narrower Medicare model.

Geographic equity is a more significant challenge. Regional health outcomes vary sharply: prefectures such as Aomori, Akita, Kagoshima, and Okinawa show notably worse outcomes on key health indicators relative to urban centers.6 Physician distribution remains skewed toward metropolitan areas, despite government incentive policies that have incrementally increased young physician placement in underserved regions.3

Japan does not have an Indigenous population comparable to Canada’s First Nations, Métis, and Inuit communities, but it does face health equity issues related to socioeconomic status, with lower-income populations experiencing worse mental health outcomes and greater difficulty accessing care.6

  • Strengths:
    • Broad benefit basket including dental and pharmaceuticals supports equity across income groups;
    • Income-graduated co-payment caps limit financial barriers;
    • Mandatory enrollment eliminates coverage gaps
  • Challenges:
    • Rural-urban geographic disparities in physician supply and outcomes;
    • Socioeconomic gradients in mental health outcomes;
    • Population aging disproportionately affecting lower-income elderly without private savings

Health Outcomes

Japan’s health outcomes are among the best in the world. Life expectancy stands at 84.1 years, 3.0 years above the OECD average.2 Preventable mortality is 86 per 100,000 — among the lowest in the OECD, compared to an average of 158.2 Treatable mortality stands at 49 per 100,000, also below the OECD average of 79.2 Infant mortality is 1.8 per 1,000 live births, and maternal mortality is 3.8 per 100,000 live births – both among the lowest in the world.5  

Japan’s high self-rated poor health – 13.5% of adults rate their health as bad or very bad, compared to an OECD average of approximately 9% – is a cultural outlier often attributed to Japanese modesty norms in self-reporting rather than genuine health differences.5 Suicide mortality stands at 17.4 per 100,000, above the OECD average and a recognized public health concern.  

Thus, Japan presents a curious paradox: despite world-leading objective health outcomes, it reports among the highest rates of poor self-assessed health in the OECD. And while the system deserves credit, how much of Japan’s exceptional performance stems from the healthcare architecture itself versus cultural attributes such as diet and social cohesion?

  • Strengths:
    • Highest life expectancy among OECD nations;
    • Preventable and treatable mortality among the world’s lowest;
    • Among the best infant and maternal mortality rates globally
  • Challenges:
    • Suicide mortality above OECD average;
    • Mental health outcomes reflect treatment gaps;
    • Aging population is increasing the disease burden from dementia and chronic conditions

4- How Japan Compares

With six countries now profiled, Japan’s distinctive profile comes into focus: world-leading health outcomes at near-average spending, delivered through a pluralistic insurance model with broad benefit coverage and nationally uniform pricing. Its core challenges — demographic aging, geographic physician shortages, and an over-reliance on hospital-based care — are familiar ones. Most countries in this series face some version of all three. What makes Japan different is the intensity: no other country profiled is managing pressures of this magnitude all at once, against the backdrop of the world’s most rapidly aging society.

 

Japan and Canada: Broad Coverage vs. Narrow Basket

Japan and Canada both achieve near-universal coverage and both use a mix of public financing and predominantly private delivery. But their benefit baskets differ fundamentally. Canada’s Medicare excludes dental care, prescription drugs, and most non-physician mental health services — leaving approximately 69% of Canadians dependent on private insurance to fill these gaps.9 Japan’s statutory basket includes dental and pharmaceuticals, providing stronger formal equity across income groups.

Canada’s single-payer architecture is administratively simpler, but Japan’s uniform fee schedule achieves a comparable degree of pricing discipline across its 3,000+ insurer structure. The most striking contrast, however, is primary care: Canada has a declining primary care attachment rate and formal referral pathways to specialists, while Japan has no gatekeeping but faces a different problem — an excess of hospital-based care without strong community or primary care orientation.

 

Japan and Australia: Two Universal Systems, Different Architectures

Australia and Japan both achieve strong outcomes and broad coverage, but through different structural paths. Australia’s Medicare Benefits Scheme is a single payer for outpatient services, while its pharmaceutical benefits (PBS) parallel Japan’s drug coverage model. Both countries face similar challenges with digital health fragmentation and geographic access disparities. Japan’s hospital bed density, however, is dramatically higher than Australia’s — 12.5 vs. approximately 3.8 per 1,000 population — reflecting different institutional histories and average length-of-stay patterns.

 

Japan and the United Kingdom: Different Ownership Structure

Japan and the UK have fundamentally different ownership structures. The NHS directly employs its providers and owns most hospitals; Japan’s providers are overwhelmingly private. The UK’s workforce distribution challenges, particularly GP shortages, have a parallel in Japan’s rural physician distribution problem despite the very different governance architectures.

 

Japan and the Netherlands: Bismarck Cousins

Japan and the Netherlands are the two social insurance (Bismarck) systems in the series so far, and the comparison is instructive. Both achieve universal coverage through regulated private insurers with income-based premiums. Both use national fee schedules. Both include broad benefit baskets. The Netherlands’ managed competition model gives insurers more pricing latitude than Japan’s rigidly uniform fee schedule allows — and the Dutch annual deductible introduces cost-sharing that Japan’s graduated co-payment structure also delivers, though differently structured.

 

5 – Challenges and Pressure Points

The Demographic Crisis

Japan’s population aging is the defining pressure on its health system. By September 2025, 29.4% of the population was aged 65 or older — the highest proportion in the OECD.3 The demand for inpatient care is projected to peak by 2040, at which point medical and welfare workers are expected to become Japan’s largest industry.4 Healthcare expenditures are projected to reach ¥89 trillion by 2040 — 1.6 times the 2023 level — with an estimated ¥27 trillion shortfall at current tax rates.4 The working-age population that funds insurance premiums is simultaneously shrinking, compressing both the revenue base and the labor supply for care delivery.

Physician Distribution: Specialty and Geographic Imbalances

Japan has 2.6 practicing physicians per 1,000 population, — well below the OECD average of 3.92 — and produces only 7.5 medical graduates per 100,000 people, roughly half the OECD average.6 Critically, distribution is severely uneven: urban centers hold the majority of physicians, while rural and peripheral regions struggle to recruit and retain practitioners, particularly in emergency medicine, obstetrics, and pediatrics.3 The government has introduced incentive policies that have shown incremental progress, but maldistribution remains unresolved.

Hospital Overcapacity and Institutional Care Model

Japan’s 1,191 hospital beds per 100,000 population – nearly three times the OECD average – reflect a care model built around long hospital admissions rather than community-based or primary care management. Average hospital length of stay is among the highest in the OECD. This bed-heavy model is simultaneously a resource for a rapidly aging population and a fiscal inefficiency as chronic disease management increasingly calls for outpatient, community, and home-based approaches. Restructuring away from institutional care is a stated policy priority but structurally difficult given the predominantly private hospital ownership.

Mental Health: Institutional Legacy

Japan remains a significant outlier among OECD nations in its reliance on long-term psychiatric inpatient care, with psychiatric bed density roughly four times the OECD median. Beds and average length of stay have declined gradually, but deinstitutionalization has proceeded far more slowly than in comparable countries, and the reform agenda toward community-based mental health services remains a work in progress.

The reform agenda toward community-based services has proceeded more slowly than in comparable nations. Socioeconomic disparities in mental health outcomes are documented, with lower-income populations experiencing disproportionate impacts.6 Suicide mortality at 17.4 per 100,000 remains above the OECD average and is a recognized public health priority.

Fiscal Sustainability of the Insurance Model

Japan’s multi-insurer structure creates cross-subsidization challenges. The NHI — covering the self-employed, unemployed, and retirees under 75 — runs a structural deficit, with nearly 50% of benefit costs covered by tax subsidies.7 As the retiree share of NHI enrollees grows and the working-population contribution base shrinks, the inter-scheme transfer mechanisms require increasingly large tax-funded transfers. Premium increases, pharmaceutical price controls, and generic substitution policies represent the primary cost-management levers available within the current architecture.

Digital Transformation: Incomplete but Accelerating

Japan’s My Number Card health insurance integration represents an ambition to unify patient identity, insurance records, and clinical data in a single digital infrastructure. Progress has been slower than planned, with the traditional health insurance card transition still underway. Interoperability between the hospital-centric electronic record systems of Japan’s 3,000+ facilities remains limited, constraining care coordination and system-level learning. AI integration in diagnostics is advancing under MHLW regulatory frameworks, but physician-oversight requirements appropriately slow deployment.

6 – What Other Countries Can Learn from Japan

Uniform Fee Schedules Can Deliver Pricing Discipline Across Multi-Payer Systems

Japan’s Shinryo Hoshu demonstrates that price discipline does not require single-payer financing. By setting a nationally uniform fee schedule that all 3,000+ insurers must apply, Japan eliminates multi-payer pricing fragmentation while preserving the competitive and administrative features of a pluralistic system. Countries considering multi-insurer models can look to Japan’s fee schedule architecture as a proven mechanism for cost containment without consolidation.

Broad Benefit Baskets Are Central to Equity

Japan’s inclusion of dental care, pharmaceuticals, and inpatient mental health within the statutory benefit basket — rather than relegating these to private insurance or provincial discretion as in Canada — provides meaningfully stronger financial protection across income groups. The lesson for countries with narrow public baskets is that coverage breadth, not just coverage universality, determines real equity in access.

Income-Graduated Co-Payments With Monthly Caps Can Coexist With Equity

Japan’s co-payment structure — 30% for working-age adults, lower for children and the elderly, with income-graduated monthly caps — demonstrates that patient cost-sharing does not necessarily undermine equity when accompanied by robust catastrophic protection. The Netherlands’ annual deductible and Japan’s co-payment model are both preferable equity architectures to unmanaged out-of-pocket exposure.

Aging Population Challenges Are a Preview, Not an Outlier

Japan’s demographic trajectory is shared, at varying paces, by virtually every high-income country. Japan’s experience managing a super-aged society — including its Long-Term Care Insurance system, its efforts to shift care from institutional to community settings, and its biennial fee schedule revisions to control pharmaceutical costs — offers a preview of challenges that other countries will face within decades. Japan’s policy experimentation in this space has global relevance.

Closing Perspective

Japan’s health system is one of the most studied in the world, and for good reason. It delivers exceptional outcomes — the longest-lived population among OECD nations, preventable mortality among the lowest on earth — at below-average per-capita cost, through a pluralistic, privately delivered architecture that most health policy frameworks would not predict to perform this well.

But the numbers tell only part of the story. Japan’s remarkable population health almost certainly owes as much to what happens outside the clinic as within it — diet, social cohesion, community structure, and a cultural orientation toward collective wellbeing that suppresses chronic disease burden before it reaches the healthcare system. In that sense, Japan’s outcomes are not purely a health policy achievement. They are a societal one.

The same cultural forces, however, cast a long shadow. The pressures of an intensely demanding work culture, social stigma around mental illness, and a deeply ingrained ethic of silent endurance contribute to a suicide rate that sits well above the OECD average — a striking anomaly in an otherwise exceptionally healthy society. Japan’s high psychiatric bed density and slow progress on deinstitutionalization reflect not just a policy gap but a cultural one. Mental health remains the system’s most underdeveloped domain, and closing that gap will require more than regulatory reform.

The system’s defining fiscal challenge — sustaining insurance financing for the world’s oldest society on a shrinking workforce — is, as has often been observed, a consequence of success. A society kept healthier and longer-lived produces an older age structure. How Japan manages that arithmetic over the coming decades will be watched closely by every high-income country in this series, all of whom face some version of the same trajectory. Japan is simply further along.

7. Summary Box

Strengths

  • Life expectancy of 84.1 years — 3.0 years above the OECD average and among the highest in the world2
  • Near-universal coverage including dental care, pharmaceuticals, and inpatient mental health within the statutory basket1
  • Income-graduated co-payments with monthly caps provide strong catastrophic financial protection1
  • Nationally uniform fee schedule (Shinryo Hoshu) enables pricing discipline across 3,000+ insurers1
  • Preventable mortality of 86 per 100,000 — among the lowest in the OECD compared to an average of 1582
  • High patient satisfaction: 80% satisfied with availability of quality care, versus 64% OECD average2

 

Challenges

  • 4% of population aged 65+ by 2025 — highest proportion in the OECD; projected ¥27 trillion financing shortfall by 2040 at current tax rates3,4
  • 6 practicing physicians per 1,000 population versus OECD average of 3.9; severe rural-urban maldistribution persists3
  • 1,191 hospital beds per 100,000 population — nearly three times the OECD average; long average lengths of stay reflect institutional care model6
  • Mental health care remains heavily inpatient-focused; suicide mortality at 17.4 per 100,000 above OECD average5
  • NHI structural deficit requires 50% tax subsidy of benefit costs; fiscal pressure intensifying as retiree enrollment grows7
  • My Number Card digital integration incomplete; interoperability between hospital systems remains limited

 

Surprising Fact

Japan spends less per capita on health care than the OECD average yet achieves the world’s longest life expectancy and preventable mortality rates among the lowest on Earth. Perhaps more surprising: a country with more hospital beds per capita than almost any other, a suicide rate above the OECD average, and a mental health system that lags most peers still manages to outperform virtually every nation on the metrics that matter most. Japan’s health story cannot be told through policy architecture alone — what happens outside the clinic may matter just as much as what happens within it.

 

Takeaway

What makes Japan distinctive is not its structure but its outcomes, and what makes those outcomes remarkable is that the healthcare system is only part of the explanation. The system’s great unresolved challenges — financing care for the world’s oldest society and closing a generations-long gap in mental health — will define its next chapter.

Sources:

This country profile draws on comparative health system analyses from the Commonwealth Fund, the OECD, Japan’s Ministry of Health, Labour and Welfare, the World Health Organization, and peer-reviewed literature. Data reflect the most recent publications available as of 2024–2026.

 

1  Japan Health Policy NOW. Health Insurance System. japanhpn.org. https://japanhpn.org/en/hs1/

2  Organisation for Economic Co-operation and Development (OECD). Health at a Glance 2025: Japan Country Note. Paris: OECD Publishing. https://www.oecd.org/en/publications/health-at-a-glance-2025_15a55280-en/japan_319bfc39-en.html

3  Yamamura M et al. Japan’s high-quality healthcare system despite physician shortages. PMC, 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC12932065/

4  Kinoshita S, Kishimoto T. Updating the Japanese Healthcare System to Meet the Needs of an Aging Society. PMC, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11543291/

5  World Health Systems Facts. Japan: Health System Overview. healthsystemsfacts.org. https://healthsystemsfacts.org/national-health-systems/bismarck-model/japan/japan-health-system-overview/

6  Commonwealth Fund. International Health Care System Profile: Japan. New York: Commonwealth Fund, 2026. https://www.commonwealthfund.org/international-health-policy-center/countries/japan

7  Health Policy in Japan – Current Situation and Future Challenges. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC7930804/

8  Chambers and Partners. Digital Healthcare 2025 – Japan. https://practiceguides.chambers.com/practice-guides/digital-healthcare-2025/japan/trends-and-developments

9  Commonwealth Fund. International Health Care System Profile: Canada. New York: Commonwealth Fund, May 2026. https://www.commonwealthfund.org/international-health-policy-center/countries/canada