29
National Health
Insurance System
(Employment–based Insurance)
(Region-based Insurance)
Government-Managed
Health Insurance
Association-managed
Health Insurance
Seamen’s Insurance (1939)
National Health Insurance
(1938)
People’s Health Insurance Cooperative
Medical Union
Figure 1: Japanese Health Insurance System in 1945
Health Insurance
(1922)
programs to participate in it. As seen in table 4, the increase of the number of the insured
from 1941 and 1942 was tremendous. By the time Japan surrendered, the people’s
national health insurance cooperatives existed in 95 percent of all the cities, towns, and
villages.
101
The rapid increase of the coverage later amazed an officer in American
occupational government in Japan, and he said, “There were no other examples in the
world like this.”
102
The rapid expansion of the
national health insurance system
from 1938 to 1945 demonstrated
that the longer and deeper the war
mobilization became, the more
likely the Japanese government
produces policies to improve
people’s health. Some categorical
insurance programs were
established for the special groups.
More workers became eligible for the Health Insurance. The National Health Insurance
expanded to cover the rest of the population as much. Since private hospitals and private
medical doctors dominated Japanese medicine, these events did not come easily. The
fifteen-year-long war and the very deep war mobilization formed and consolidated a
nearly comprehensive national health insurance system with a unique structure (see figure
1). The basis of the system remained through the period of American occupation and
Japan completed the comprehensive national health insurance in 1961.
103
Conclusion: Japan-US Comparison
101
Sugaya, Nihon iry seisaku shi, 201.
102
Cited in Sugaya, Nihon iry seisaku shi, 266.
103
To understand the development of Japanese health insurance policy, as this paper argues, the fifteen-
year war was critical. However, it is also important to understand why the American occupation did not
have much influence on the fragmented structure of policy administration from 1945 to 1952. This
argument will be discussed in Adam Sheingate and Takakazu Yamagishi, “Reformers Abroad: The Impact
of the U.S. Occupation on Postwar Japanese Health Insurance Policy,” paper prepared for delivery at the
2003 Annual Meeting of the Social Science History Association, November 13-16, 2003.
Convention