JAPAN MEDICAL ASSOCIATION*1

Yoshitake YOKOKURA1

Japan attained the goal of establishing the uni-

versal health insurance system in 1961. In recent

years, the Long-term Care Insurance System and

Medical Insurance System for the Elderly aged

75 or over were established in 2000 and 2008,

respectively to maintain national health in the

aging society.

Seeing the historical changes of the popula-

tion ratio of those over 65 years old in Japan, we

can estimate that the ratio will be rising from

23% in 2010 to 39.9% in 2060. Thus, Japan will

be aging at an unprecedentedly rapid pace.

As Japan approaches a super-aged society,

what is required is to establish the stronger com-

munity health provision system focusing care of

the elderly, to improve and strengthen the roles

of family physicians in the comprehensive com-

munity health care system, and to build a sus-

tainable health care system which meets the

needs of the people in communities.

To achieve this goal, the JMA requested the

national government to bear the fi nancial bur-

den, which led to the General Security Fund for

Community Medicine and Long-term Care with

7.5 billion US$ for medicine and 60 billion US$

for long-term care in 2014. Using this fund, we

will do our best in supporting any effort by local

medical associations that aim to realize effective

and quality medical and long-term care.

In Japan, we have health check-up systems

which totally provide us with a health check-up

covering a whole life from infant to the old-old

stage of elderly. However, these systems are pro-

vided individually and there is no integrated sys-

tem to manage the personal life-long health

information by connecting these individual sys-

tems. The JMA proposes the government to

incorporate these in to the plan of “Life-long

Health Services.” To manage the personal whole-

life health information in an integrated way

helps to reduce the gaps between average life

expectancy and healthy life expectancy. Having

many more healthy elderly in a society may also

keep the medical costs lower.

The JMA is also endeavoring to increase

healthy longevity by incorporating the health

check-up programduring the period from child-

hood, working years to old age in the plan of

“Life-long Health Services.”

For disaster preparedness by the medical

profession, the JMA was appointed as a desig-

nated public organization in August 2014 which

reviews the government’s Basic Disaster Provi-

sion Plan. Dr. Yoshitake Yokokura, President of

the JMA was also appointed a member of the

Central Disaster Prevention Council in June

2015 which consists of the cabinet ministers with

Prime Minister as chair.

In the areas of overseas medical assistance,

the JMA extended medical support to Nepal

which was severely damaged by the great earth-

quake in April 2015. As requested mainly by the

Taiwan Medical Association, the JMA also dis-

patched six Japanese specialists to Taiwan to

provide medical assistance to many patients with

a severe burn injury by the accident of dust

explosion which occurred in June of this year.

The case of Taiwan was carried out based on the

iJMAT program which the JMA has been

promoting.

236 JMAJ, December 2015—Vol.58, No.4

Special Feature: Th e 30th CMAAO General Assembly & 51st Council Meeting

Country Report

*1 This article is base on a presentation made as the Report of Activities by each NMA at the 30th CMAAO General Assembly and 51st Coun-

cil Meeting, Yangon, Myanmar, on September 23-25, 2015.

1 President, Japan Medical Association, Tokyo, Japan (jmaintl@po.med.or.jp).

CMAAO Myanmar General Assembly

September 24, 2015

Yoshitake Yokokura, M.D. President

Japan Medical Association

Country Report Social Security System of Japan

Oct 1950 Social Security Advisory Council presented Social Security System Recommendations – Recommended that all citizens should be eligible

for national health insurance policy

Mar 1956 Eligibility status of public health insurance – Approx. 30 million people were still NOT eligible

About 30% of the population were NOT insured

Apr 1961 Universal Health Insurance System was established

Apr 2000 Long-term Care Insurance System was implemented

Apr 2008 Medical Insurance System For the Elderly Aged 75 Or Over was implemented

23.0%

39.9%

16.8%

20.4%

30.1%

16.6%

25.1%

18.2%

26.2%

11.1%

33.6%

13.1%

21.9%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060

Source : United Nations, World Population Prospects 2010, Ministry of Internal Affairs and Communications, Japan

Transition of the Population of age 65 or over

2

Sweden

United States

United Kingdom

France Germany

Japan

Korea

Country % of population 65 y/o doubling period

(years) 7 14 7 14

Japan 1970 1994 24 Japaan Germany

19770 1932

19994 1972

244 40 Germanymanny

U.K. 193321929

197721976

400 47 U.KKK.

U.S. 192291942

197762015

477 73 U.SS.

Sweden 194421887

201151972

733 85 Swedeeen

France 18887 1864

19772 1979

855 5 115

Korea 1999 2017 18 Koreea Brazil

1999992011

20117 2032

118 21 Brazzill

Thailand 20111112003

20332 2025

221 22 Thailannnd

Tunisia 20003 2009

20225 2032

222 23 Tunisisiia

China 200092001

20332 2026

223 25

Ageing speed: International Comparison

3

A man fell at home and was

transported by an ambulance

htratrat

Emergency care in an acute ward

Rehabilitation in a convalescent ward Recuperation

in chronic ward

Moves to home care

Community Medicine Plan (Vision) will help differentiate medical functions and secure

human resources

Community support projects will support the collaboration of medical

and long-term care

The Fund (medicine) will support functional

differentiation and secure human

resources training

The Fund (medicine)

will support home care

Community-based Comprehensive Care

System Approach

<Home Care>

<Long-Term Care Health Facilities>

Toward Comprehensive Medical and Long-term Care

The Fund (long-term care) will support

long-term care system and train nursing staff

4

Promotion of Community-based Comprehensive Care System

The General Security Fund for Community Medicine and Long-term Care was established by request from JMA. In 2014,

752 million USD or 90.4 billion yen for medicine 602 million USD or 72.4 billion yen for long-term care

*JPY-USD exchange rate is as of Sept. 11, 2015.

5

JAPAN MEDICAL ASSOCIATION

JMAJ, December 2015—Vol.58, No.4 237

To Extend Healthy Life Expectancy

Health checkups for employees Industrial Safety and Health Act MHLW Labour Standards Bureau

Age 0

Infant checkups Maternal and Child Health Act MHLW Equal Employment, Children and Families Bureau

School checkups School Health and Safety Act MEXT Sports and Youth Bureau

Health checkups for the elderly aged 75+ Assurance of Medical Care for Elderly People Act MHLW Health and Welfare Bureau for the Elderly & Health Insurance Bureau

Average Life Expectancy

Healthy Life Expectancy

Specific checkups Health insurance Insurers (mandated) MHLW Health Insurance Bureau & Health Service Bureau

6 22 M 70.4 F 73.6

75 40 M 79.6 F 86.3

[Infancy] [School Age] [Work Age] [Elderly]

18

Systemize as “Life-long Health Services”

Need to shorten

6

Disaster Victims Health Support Liaison Council

Japan Medical Association (JMA)

Japan Dental Association

Cabinet Office

Japan Pharmaceutical Association

Japanese Nursing Association

Japan Hospital Association

Ministry of Health, Labour

and Welfare

Reconstruction Agency

Ministry of Education,

Culture, Sports, Science

and Technology

Association of Japanese Medical Colleges

The Japan Dietetic Association

Rehabilitation support organizations (consisting of 10 rehabilitation and long-term care related organizations)

Conference to Promote Team Medicine (consisting of 16 professional organizations)

Japanese Paramedics Association

Japan Red Cross Society

All Japan Hospital Association

Association of Japanese Healthcare Corporations

Japan Psychiatric Hospitals Association

The Japan Association of Radiological Technologists

Japanese Society of Hospital Pharmacists

Secretary General

Chair & Secretary

General

Japanese Society of Certified Clinical Psychologists

Japan Association of Medical and Care Facilities

JMA’s Roles Counterpart of the government Keystone in multidisciplinary collaboration

Japan Association of Geriatric Health Services Facilities

After the 311 Disaster in 2011, the Disaster Victims Health Support Liaison Council was established to support the health of disaster victims.

7

JMA’s Position in the National Disaster Management

(Aug. 1, 2014) Prime Minister Abe appointed JMA as a Designated Public Organization according to the Basic Act on Disaster Control Measures

(June 9, 2015) Prime Minster Abe appointed the JMA President as a member of the Central Disaster Prevention Council

JMA dispatched 1393 teams of 6054 JMAT (Japan Medical Association Team) staff in total in the 311 Disaster. Additional medical teams were also continually sent for months.

8 Japan Medical Association

AMDA: The Association of Medical Doctors of Asia

The joint reconstruction project of JMA and AMDA after the Central Java Earthquake hit the island on May 27, 2006.

Construction of the Banguntapan Third Health Center in Yogyakarata

May 2006 Central Java Earthquake

International Relief Activities for Disaster Medicine-

9

Japan Medical Association

The average number of patients is about 88 daily. (24,000/year)

The center plays an important role in the local healthcare infrastructure.

May 2006 Central Java Earthquake

International Relief Activities for Disaster Medicine-

10 Japan Medical Association

Old LMS building located near the sea and was damaged by the Typhoon Yolanda.

New LMS building located in a hill side was constructed by donations from the JMA and its members. Open ceremony was held on March 8th, 2015.

Nov. 2013 Philippines Typhoon Yolanda International Relief Activities for Disaster Medicine-

Leyte Medical Society (LMS)

11

Yokokura Y

238 JMAJ, December 2015—Vol.58, No.4

Japan Medical Association

Opening ceremony, March 8th 2015

Maternity Day Event, March 2015

Plate for appreciation

Leyte Medical Society (LMs) Nov. 2013 Philippines Typhoon Yolanda

International Relief Activities for Disaster Medicine-

12 Japan Medical Association

Dr. Saroj Prasad Ojha Dr. Anjani Kumar Jha Dr. Shigeru Suganami (AMDA) Vice President of NMA, President of NMA

After a major earthquake hit Nepal on April 25, 2015, the JMA assisted in disaster relief through AMDA and started a mental health project for schools and communities by the donations from the JMA and its members.

International Relief Activities for Disaster Medicine- April 2015 Nepal Earthquake

Dr. Suganami, Representative of AMDA visited the Nepal Medical Association requested by the JMA on May 3. Dr. Ojha is a Vice President of the Nepal Medical Association and also the representative of AMDA Nepal.

13

Japan Medical Association

The Agreement between the Japan Medical Association and the Taiwan Medical Association concerning Mutual Consent on Dispatching Physicians and Assistance Systems for Medical Relief Assistance in Disaster Situations iJMAT Agreement) .

Conclusion of iJMAT Agreement

Dr. Yoshitake Yokokura (JMA) Dr. Chung-Chuan Su (TMA)

Dr. Yoshitake Yokokura (JMA) Dr. Chi-Chun Liu (Taiwan Root Medical Peace Corps)

14 Japan Medical Association

Dispatching of the JMA Burn Care Support Team to Taiwan

When the dust explosion accident occurred in Taiwan in June of this year, many suffered severe burns. Under the concept of the iJMAT agreement, JMA accepted the request for emergency medical support and sent 6 burn specialists.

June 2015 Dust Explosion Accident

15

Demonstration Experiment simulating the Great Nankai Trough Earthquake -Disaster prevention training-

HD Video Images Transmission

Kochi MA

Miyazaki MA

Mie MA Shizuoka MA

JMA

Other Prefectural Medical Associations

JAXA Tsukuba Space Center

Internet connection Information sharing by Cloud Type Web conference system

Kizuna

16

Thank you for your attention!

17

JAPAN MEDICAL ASSOCIATION

JMAJ, December 2015—Vol.58, No.4 239