3
However, his work did not prompt further comparative study as scholars turned their
attention to other variables in the discussion of welfare state development, such as
industrialization, labor power, culture, and policy and institutional path dependence.
When scholars do study the impact of war, they tend to treat it as a simple and identical
exogenous shock and do not address how variations in war experiences affect policies
and institutions. In contrast, this paper puts forward an argument about how a war’s
duration, depth of mobilization, casualties, battle sequence, and war-fighting regime
influence health policy development. Thus, this paper seeks to contribute to an
understanding of those factors that influence the formation and the consolidation of
health insurance systems in various countries by incorporating the Japanese case into
comparative study.
This paper is composed of four parts. First, I locate this argument in discussions
of welfare state development. Second part explains briefly history of medical institutions
and medical professionals in Japan before the 1930s. The third part shows how the
Japanese war experience from 1931 to 1945 affected the development of health insurance
policy. The concluding part will present the hypotheses and compare the Japanese case
with the American case.
The Japanese Case in Discussions of Welfare State Development
Scholars have studied welfare state development by focusing on industrialization, labor
power, and culture. In addition, recent works encouraged by the rise of historical
institutionalism argue that policy and institutional path dependence are important
variables. As this section will show, the Japanese case challenges all of the existing
theories or approaches to understand welfare state development.
First, the theory of industrialization shows that governmental social expenditure
correlates with industrialization because industrialization brings more people to urban
areas and causes new social problems. Gregory Kasza indicates that the development of
the Japanese welfare state, including national health insurance, did not fit this theory
because it expanded welfare programs not when industrialization caught up with
Convention