bodied population for producing munitions. The changes in the war largely contributed to
the policy developments toward a comprehensive reform in health insurance.
The period after the establishment of the NHI in April 1938 helped the
government prepare for radical reform. In July 1938, the government set up an
Investigating Committee of Medicine headed by the Minister of Health and Welfare to
study further reform of the health care system.
The report in October 1940 suggested
that the JMA serve a public purpose, that all doctors join in the medical association, and
that the cabinet appoint the president of the JMA.
In the meantime, the JMA was under
public attack. In 1939, an editorial in the Asahi Shimbun stated, “The reform in the
medical system requires the regeneration of liberal principles or professional ethics.
Medicine belongs not to doctors but to the public. Doctors should work for the nation as
semi-public servants.”
The events in the preceding period allowed radical reform to be
implemented in the subsequent period of the war.
As mobilization rapidly increased, the government faced a serious problem to fill
the demand of manpower.
In October 1941, Koizumi declared that Japan would have
national health insurance associations in all municipalities in three years. He carried the
banner for the slogan “all people should have insurance [kokumin kaihoken],” which was
adapted from the wartime slogan “all people are soldiers [kokumin kaihei].”
1942, Akira Hirai, head of the Insurance Bureau, stated that, “We have no goals other
than winning the war…The ultimate goal of national health insurance programs is to
produce ‘healthy soldiers, healthy people.’”
The Health Insurance Law, which was established in 1922 and offered limited
coverage for manual workers, was amended in February 1942. It extended benefits from
workers who worked in firms with more than ten employees to ones with more than five
employees, and it also stipulated that the HI cover the beneficiaries’ dependents. It also
incorporated White-Collar Workers Health Insurance of 1939. The amendment passed
because “the necessity to strengthen the war mobilization led the government to expand
the national health insurance system in order to have ‘healthy soldiers, healthy people.’”
The NHI was also radically amended in February 1942 by making it a compulsory
program. When the NHI was established as a voluntary program in 1938, the MHW had a
ten-year plan for the gradual expansion of the NHI. But the achieved number of insured
did not go much beyond the projected number until 1940. In May 1942, the government
issued an amendment to the NHI to make the establishment of national health insurance
associations mandatory and to require almost all people not covered by other health
insurance programs to participate in the NHI. After 1941, the achieved number far
24
Gunji Takei, Kōseishō shōshi: watashi no zaikinroku kara [A Short History of the Ministry of Health and
Welfare] (Tokyo: Kōseishō mondai kenkyūkai, 1952), 91; Kōseishō Gojūnenshi Henshū Iinkai, Kōseishō
gojūnenshi: kijutsu hen, 422.
25
Kawakami, Gendai nihon iryō shi, 449-51. In 1929, the number of the doctorless villages was 2,909. In
1939 the number increased to 3,243 and in 1939 to 3,600 (one-third of all municipalities).
26
As quoted in Kawakami, Gendai nihon iryō shi, 452.
27
Yoko Katō, Chōheisei to kindai nihon [The Conscription System and Modern Japan] (Tokyo: Yoshikawa
kōbunsha, 1996), 240.
28
Gregory J. Kasza, “War and Welfare Policy in Japan,” The Journal of Asian Studies 61 No. 2 (2002):
424.
29
Akira Hirai, “Nento no ji [New Year’s Greeting],” Kenkō hoken jihō 17-8 No.1 (1942): 2-3.
30
Kōseishō Gojūnenshi Henshū Iinkai, Kōseishō gojūnenshi: kijutsu hen, 361. Part of the HI amendment of
1942 was implemented on April 1, 1942 and January 1, 1943, and it was implemented entirely on April 1,
1943.
9
Convention