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Delivering public health services is a complex business. It requires different interactions: between medical professionals and administrative organizations at local levels; between central bodies and local agents; and between the public health system(PHS) and the health care system(HCS). They share common objectives of improving health and resources in part, but have quite different administrative structures.
With development of preventive services for individuals, boundaries between the PHS and the HCS have been changing. This also raises questions as to changes in responsibilities of delivering preventive services for individuals, mechanisms for achieving more efficient and equitable delivery, mechanisms for involvement of local people and agencies.
This paper aims to consider those issues by analyzing recent Japanese health system reform. Japan, where health care is funded mainly through social health insurance, enacted the Health Care Reform Act in 2006, which transferred responsibilities of screening tests for common chronic diseases, except cancer, from municipalities to public health insurers. By reviewing literatures, the paper analyses policy goals, mechanisms for implementation, and policy outcomes so far.
Results
The aims of the reform, in terms of public health delivery, can be summarized as: integrating responsibilities of delivering clinical health services and preventive services in insures; enhancing local responsibilities and involvement in delivering health services; establishing national standards for preventive services for individuals across diversified sites of services, including worksites and communities; developing national systems for gathering and analyzing individual’s health information. Both regulations and economic incentives are introduced to achieving the policy goals. Information on preventive services is more clearly gathered and published. Insures are regarded to “compete” to increase rates of insured members who use preventive services. Although how local coordination and involvement works are yet to be examined, insures now have critical roles of delivering public health services.
297 Words
Learning Objectives: 1. Describe possible combination of responsibilities of governments and insurers for delivering public health services in countries with social health insurance. 2. Discuss pros and cons of different allocation of responsibilities between governments and insures.