FOREWORD
by Marianne C. Fahs, Ph.D.
Associate Professor and Director
Division of Health Economics
International Leadership Center on Longevity and Society (U.S.)
Mount Sinai Medical Center
International study is gaining recognition as a useful method of inquiry into questions of how best to allocate national resources to improve health. Yet policy analysis of the Japanese system of health care remains underdeveloped.. Indeed, serious debates regarding health care reform strategies for the United States often exclude references to Japanese health care delivery and financing. This exclusion is unfortunate and obscures some outstanding successes of health policy in Japan. For instance, in only 20 years and starting from a level similar to the United States, Japan has achieved the lowest infant mortality rate in the world. The United States remains 19th among developed nations. Japan became the world's leader through a well-thought-out plan for prevention, coupled with government investment. Now, Japanese policy leaders are turning their attention to the elderly.
The United States and Japan face similar problems. Both countries face a demographic revolution in the decades ahead as the population ages. Medical expenditures, as a proportion of GNP, are increasing at similar rates. Both governments face fiercely competing demands for resource allocation among prevention, treatment and basic science interest groups. Both medical care systems face a diverse mix of patients with increasing rates of functional disability. Both systems are financed by a large number of employer-based private insurance plans in addition to public insurance for the poor and the elderly.
In this information era, we face a world hungry to know what works in health care and what it costs. One of medicine's great challenges is to inform policy-makers and the public of long-term produc tive benefits and costs to our society of preventing and postponing disability. Many initiatives in the United States will require fundamental change. The most cost effective will be those targeted with sensitivity and respect for cultural tradition to reach the myriad of groups in our pluralistic society. Enlarging our understanding of socio-cultural patterns of health behavior, disease and economic productivity and costs calls for increasing international communication and research partnerships.
Professor Rodwin and his associates provide an excellent overview of the health care system in Japan. This comprehensive and well-documented monograph will serve as an essential reference for policy leaders and researchers alike who are interested in pursuing comparative policy analysis. The Japan Society is to be commended for organizing this timely conference. Professor Rodwin, a leading expert in the comparative analysis of health systems, has taken the conference presentations and discussions and used them as a springboard for his own further investigation of political and economic aspects of Japan's health care system. In this monograph, he presents a clear and well-organized perspective on what the United States can learn from Japan. Let us hope that the challenges Professor Rodwin raises will be met in the years ahead as we pursue health care reform to achieve the goals of effectiveness, efficiency and equity.