Scaling up community health insurance: Japan's experience with the 19th century Jyorei scheme

Abstract

Interest in community health insurance has grown rapidly in many developing countries, usually as a result of the weak capacity of governments to raise sufficient tax revenues and then to secure an adequate share for health care. There are many pitfalls, however, and only under specific conditions do community health insurance schemes appear to succeed in effectively improving access to care and enhancing financial protection against health care costs. In this paper, we focus on the initial experience with community health insurance in 19th century Japan, called 'Jyorei'. Whereas Jyorei began in 1835 in one village in Fukuoka Prefecture, it gradually expanded and the basic ideas came under government stewardship. It was scaled up as the core model of the National Citizen's Health Insurance Fund, one of the pillars of the Japanese social health insurance system. Several Jyorei success points are relevant today for developing countries wishing to support community health insurance. One of the key characteristics was social cohesion and the acceptance of equity goals with transfers between the rich and the poor.

A Conceptual Framework for Community-Based Health Insurance in Low-Income Countries: Social Capital and Economic Development

“…It has three main features: prepayment for health care by the community members; community control; and voluntary membership (Hsiao, 2001) i . The policy link between CBHI and universal coverage is implicitly determined by the historical experience of mutual health insurance in Europe (Criel and Van Dormael, 1999, Barnighausen and Sauerborn, 2002, Cordery, 2003 and Japan (Ogawa et al, 2003) in the 19 th century. Membership of 19 th century mutual schemes grew and eventually they merged to form various types of national health insurance.…”

The impact of filipino micro health-insurance units on income-related equality of access to healthcare

“…These schemes are often started because there are no alternative health insurance schemes, or as substitutes to other systems that fail to attract the population [7][8][9]. Recalling the claim of Ogawa et al [10] that improved equality and solidarity are important predictors for the success of community-based schemes (a conclusion based on the experience of similar schemes founded in the 19th and 20th century in Japan and elsewhere), we seek to examine how MIUs, affiliating a wide range of income groups on a voluntary basis, perform on this count today.…”

From the Editor-In-Chief

“…Community-based insurance schemes played an important role in the evolution of universal coverage in Europe and Japan (Ogawa et al, 2003), as well as in Thailand, and are currently important in China and some African (Carrin et al, 2005) and transitional countries (Balabanova, 2007). Although such schemes may offer financial protection benefits to some among…”