Lessons from Japan’s Medical Insurance System under the Background of Population Aging

doi:10.14156/j.cnki.rbwtyj.2025.02.006

Abstract

Abstract: With the rapid progression of population aging in China, there is an urgent need to improve the medical insurance system to adapt to demographic changes and strengthen healthcare protection for the elderly. Based on a comparative analysis of international trends in population aging and medical expenditure, this study finds that Japans medical insurance system demonstrates advanced practices and effective outcomes, achieving the highest life expectancy with relatively moderate per capita medical expenditure. The study systematically summarizes Japans key reforms in response to aging, particularly the establishment of the medical insurance system for the elderly and the long-term care insurance system, as well as the construction of age-differentiated insurance structures and care frameworks, which has reference significance for Chinas medical insurance system reform. Drawing on the experience of Japans medical insurance system and combining it with the contradiction between Chinas current medical insurance system and aging population, this paper proposes suggestions for the “aging-friendly” reform of Chinas medical insurance system.

Key words: population aging, Japan, medical insurance, long-term care insurance, aying-friendly, reform

CLC Number:

C913
F840

QIN Cheng, WANG Xueyi. Lessons from Japan’s Medical Insurance System under the Background of Population Aging[J]. Japanese Research, 2025, 39(2): 67-80.

References

[1] FISHER C R. Differences by Age Groups in Health Care Spending[J]. Health Care Financ Rev, 1980, 1(4): 65-90.
[2] HOLLY A, GARDIOL L, DOMENIGHETTI G, et al. An Econometric Model of Health Care Utilization and Health Insurance in Switzerland[J]. Eur Econ Rev, 1998, 42(3/4/5): 513-522.
[3] 仇雨临.人口老龄化对医疗保险制度的挑战及对策思考[J].北京科技大学学报(社会科学版), 2005, 21(1): 27-29.
[4] 李乐乐,杜天天. 人口年龄变化、医疗需求行为与医疗费用增长:基于医疗保险结算数据的实证研究[J].当代经济管理, 2021, 43(4): 72-80.
[5] 朱波,周卓儒.人口老龄化与医疗保险制度:中国的经验与教训[J].保险研究, 2010(1): 27-35.
[6] 郭佩.整合照料视角下日本特色 “医养结合” 的实现路径及启示[J].日本问题研究, 2021, 35(6): 64-72.
[7] 赵明,赵正堂,佘佐萱,等.长期护理保险、临终医疗费用与价值医疗效应[J].保险研究,2025(1):68-80.
[8] 薛伟玲,陆杰华. 基于医疗保险视角的老年人医疗费用研究[J].人口学刊, 2012, 34(1): 61-67.
[9] 马颖颖,申曙光.老年医疗保障制度探析[J].中国社会保障, 2014(9): 28-29.
[10] 储怡菲,吴方卫.从机会公平到结果公平:城乡居民基本医疗保险制度的演进逻辑[J].农业经济问题, 2025, 46(1): 119-131.
[11] 陈起风.基本医疗保障促进老年人口健康:医疗与保健的双路径分析[J].社会保障研究, 2020(5): 63-69.
[12] 王琬.退休人员医疗保险政策:缘起、困境与应对[J].学术研究, 2020(4): 95-102.
[13] 代宝珍,周绿林,余悦.基于农村医疗保障制度的老年居民慢性病管理理论框架构建[J].西北人口, 2013, 34(4): 83-89.
[14] 王佳林.长期护理保险制度构建:国际经验及对我国的启示[J].南方金融, 2019(11): 3-10.
[15] 赵斌,陈曼莉.社会长期护理保险制度:国际经验和中国模式[J].四川理工学院学报(社会科学版), 2017, 32(5): 1-22.
[16] 华颖.中国居民医保制度:现实问题与改革出路[J].学术研究, 2023(9): 87-95.
[17] 唐金成,李莹莹.长期护理保险赋能农村养老问题研究[J].南方金融, 2022(3): 63-76.
[18] 陈诚诚.长期护理保险与医疗卫生服务:两体系的边界辨析与发展路向[J].社会保障评论, 2025, 9(1): 84-97.
[19] 张思锋,滕晶.中国老龄人口医疗保障体系发展:从治病为中心到健康为中心[J]. 北京工业大学学报(社会科学版), 2022, 22(2): 10-22.
[20] 刘吉双,衣保中.日本农村社会养老保险中的政府主导作用[J].现代日本经济, 2013, 32(2): 73-80.
[21] 刘晓梅,楚廷勇.日本社会医疗保险全覆盖的经验——兼评我国的医改方案[J].探索与争鸣, 2010(7): 63-67.
[22] 杨晶鑫,王欣昱.日本医疗保险制度的改革进程及对我国的启示[J].东北亚论坛, 2010, 19(1): 115-122.
[23] 吴妮娜,高广颖,李莲花,等.老龄化背景下日本医保体系与卫生体系的协同变革与启示[J].中国卫生政策研究, 2021, 14(11): 67-74.
[24] 李莲花.医疗保障制度发展的 “东亚道路”:中日韩全民医保政策比较[J].河南师范大学学报(哲学社会科学版), 2010, 37(1): 1-7.
[25] GemMed.65歳以上高齢者、2024年は3625万人·総人口の29.3%で、過去最高の更新続く―総務省 | GemMed | データが拓く新時代医療 [EB/OL]. [2024-09-18]. https://gemmed.ghc-j.com/?p=62791.
[26] 日本厚生劳动省.第23回社会保障審議会人口部会資料[EB/OL]. [2024-03-24]. https://www.mhlw.go.jp/stf/newpage_32750.html.
[27] 宋健.银发消费是中国经济增长的得力引擎[J].人民论坛,2020(21):36-38.
[28] 国家卫生健康委、教育部、科技部等多部门.关于印发“十四五”健康老龄化规划的通知 [EB/OL]. [2024-03-24]. https://www.gov.cn/gongbao/content/2022/content_5692863.htm?utm_source=chatgpt.com.
[29] 国家卫生健康委员会.国家卫生健康委员会举行新闻发布会介绍建立完善老年健康服务体系指导意见有关情况[EB/OL]. [2024-03-24]. https://www.gov.cn/xinwen/2019-11/02/content_5448445.htm?utm_source=chatgpt.com.
[30] 国务院.国务院关于推进养老服务体系建设、加强和改进失能老年人照护工作情况的报告 [EB/OL]. [2024-03-24]. http://www.npc.gov.cn/npc/c2/c30834/202409/t20240911_439362.html.