In this Series in The Lancet, we review the past 50 years of Japan’s universal health coverage, identify the major challenges of today, and propose paths for the future, within the context of long-term population aging and the devastating crises triggered by the March 11 earthquake. Japan is recognised internationally for its outstanding achievements during the second half of the 20th century, in both improving the population’s health status and developing a strong health system. At the end of World War 2, in Japan, life expectancy at birth was 50 years for men and 54 years for women; by the late 1970s, Japan overtook Sweden as the world’s leader for longest life expectancy at birth. Japanese women have remained in the number one slot for 25 years, reaching a life expectancy of 86.4 years in 2009 (while Japanese men slipped to fifth longest living that year, at 79.6 years).
In 2011, Japan celebrates 50 years of kaihoken: health insurance for all. Universal health insurance was achieved in 1961, assuring access to a wide array of health services for the whole population. Since then, benefits have become more egalitarian while health expenditures have remained comparatively low: 8.5% of the gross domestic product and 20th out of countries in the Organisation for Economic Co-operation and Development in 2008. This achievement is all the more remarkable because the percentage of the population aged 65 years or older has increased nearly four-fold (from 6% to 23%) over the past 50 years.
This book applies an established analytical framework for health sector reform (Getting Health Reform Right, Oxford, 2004) to the performance problems of the pharmaceutical sector. The book is divided into three sections. The first section presents the basic ideas for analysis. It begins by insisting that reform start with a clear understanding of the performance deficiencies of the current system. Like all priority setting in the public sector, this 'definition of the problem' involves both ethical choices and political processes. Early chapters explain the foundations of these ideas and apply them to the pharmaceutical sector. The relationship of ultimate outcomes (like health status or risk protection) to classic health systems concepts like efficiency, access and quality is also explored. The last chapter in the first part is devoted to 'diagnosis'—explaining how to move from the definition of a problem to an understanding of how the functioning of the system produces the undesirable outcomes in question.
The second part of the book devotes one chapter to each of five 'control knobs': finance, payment, organization, regulation and persuasion. These are sets of potential interventions that governments can use to improve pharmaceutical sector performance. Each chapter presents basic concepts and discusses examples of reform options. Throughout we provide 'conditional guidance'—avoiding the approach of a 'one size fits all' model of 'best practices' in these five arenas for reform. Instead we stress the need for local knowledge of political systems, administrative capacities, community values and market conditions in order to design pharmaceutical sector policies appropriate to a country’s particular circumstances.
The last part of the book is a set of teaching cases. Each is preceded by questions and is followed by a brief note on the lessons to be learned. The goal is to help readers develop the skills they need to deal effectively with pharmaceutical sector reform problems in their own countries.
The 2008 G8 summit in Toyako, Japan, produced a strong commitment for collective action to strengthen health
systems in developing countries, indicating Japan’s leadership on, and the G8’s increasing engagement with, global health policy. This paper describes the context for the G8’s role in global health architecture and analyses three key components—financing, information, and the health workforce—that affect the performance of health systems. We propose recommendations for actions by G8 leaders to strengthen health systems by making the most effective use of existing resources and increasing available resources. We recommend increased attention by G8 leaders to country capacity and country ownership in policy making and implementation. The G8 should also implement a yearly review
for actions in this area, so that changes in health-system performance can be monitored and better understood.
Many people in developing countries lack access to health technologies, even basic ones. Why do these problems in access persist? What can be done to improve access to good health technologies, especially for poor people in poor countries?
This book answers those questions by developing a comprehensive analytical framework for access and examining six case studies. Access to health technologies in poor countries is shaped by social, economic, political, and cultural processes. To understand those processes, the authors develop an analytic framework based on four A's—Architecture, Availability, Affordability, and Adoption.
The book applies this approach to explain why some health technologies achieved more access than others. The technologies include praziquantel (for the treatment of schistosomiasis), hepatitis B vaccine, malaria rapid diagnostic tests, vaccine vial monitors for temperature exposure, the Norplant implant contraceptive, and female condoms. The book is based on research studies commissioned by the Bill & Melinda Gates Foundation.
The book is available in its entirety for download at Access.
The G8 summit in Toyako offers Japan, as the host government, a special opportunity to influence collective action on global health. At the last G8 summit held in Japan, the Japanese government launched an effort to address critical infectious diseases, from which a series of disease-specific programmes emerged. This year’s summit provides another chance to catalyse global action on health, this time with a focus on health systems.
Global efforts to improve health conditions in poor countries have embraced two different strategies in recent decades, one focusing on health systems, the other on specific diseases. The interactions of these two strategies have shaped where we stand today.
Objective. To review original research studies published
between 1990 and 2004 on the access and use of medicines in
Mexico to assess the knowledge base for reforming Mexico’s
pharmaceutical policy. Material and Methods. A literature
review using electronic databases was conducted of original
studies published in the last 15 years about access and use
of medicines in Mexico. In addition, a manual search of six
relevant journals was performed. Excluded were publications
on herbal, complementary and alternative medicines. Results.Were identified 108 original articles as being relevant,
out of 2 289 titles reviewed, highlighting four policy-related
problems: irrational prescribing, harmful self-medication, inequitable
access, and frequent drug stock shortage in public
health centers. Conclusions. This review identified two
priorities for Mexico’s pharmaceutical policy and strategies:
tackling the irrational use of medicines and the inadequate
access of medicines. These are critical priorities for a new
national pharmaceutical policy.
In the last 20 years, orphan drug legislation (ODL) has been adopted in several countries
around the world (USA, Japan, Australia, and the European Union) and has successfully
promoted R&D investments to develop new pharmaceutical products for the treatment of rare
diseases. Without these incentives, many life-saving new drugs would have not been
developed and produced.
For economic reasons, the development of medicines for the treatment of diseases prevalent
in the developing world (or tropical diseases) is lagging behind. Among several factors, the
low average per-capita income makes pharmaceutical markets in developing countries appear
relatively unprofitable and therefore unattractive for R&D-oriented companies.
The case of ODL may offer some useful insights and perspectives for the fight against
neglected tropical diseases. First, the measures used in ODL may also be effective in boosting
R&D for neglected tropical diseases, if appropriately adapted to this market. Second,
small-sized companies, which have played a successful role in the development of orphan
drugs for rare diseases, may also represent a good business strategy for the case of tropical
Road traffic injuries are a major cause of death and disability globally, with a disproportionate number occurring in developing countries. Road traffic injuries are currently ranked ninth globally among the leading causes of disability adjusted life years lost, and the ranking is projected to rise to third by 2020. In 1998, developing countries accounted for more than 85% of all deaths due to road traffic crashes globally and for 96% of all children killed. Moreover, about 90% of the disability adjusted life years lost worldwide due to road traffic injuries occur in developing countries. The problem is increasing at a fast rate in developing countries due to rapid motorisation and other factors. However, public policy responses to this epidemic have been muted at national and international levels. Policy makers need to recognise this growing problem as a public health crisis and design appropriate policy responses.