Table of Contents

5   EXECUTIVE SUMMARY
5   Healthcare expenditure
5   Healthcare system issues
5   Pricing and reimbursement issues
7   HEALTHCARE EXPENDITURE
7   Japan has a lower than average healthcare spend per capita, but higher pharmaceutical spend
10 Japan’s economic growth has been stagnant but healthcare costs are expanding
11 Rising healthcare costs for the elderly population are increasing national medical expenditure
12 Bibliography
13 HEALTHCARE INSURANCE SYSTEM
13 Public health insurance
15 Private health insurance system
16 Trends in primary vs secondary care
19 Cost-containment measures in the Japanese healthcare system
22 Bibliography
25 PRICING AND REIMBURSEMENT OVERVIEW
25 Pricing and reimbursement tools
26 Key bodies influencing pricing and reimbursement
27 Bibliography
28 PRICING
28 Price determination process
38 Biennial price cuts are a key cost-containment mechanism
45 The government has been discouraging prescribers from dispensing drugs
46 Bibliography
49 REIMBURSEMENT
49 Reimbursement of medical fees
50 Medicines reimbursement
51 Generics use
54 Bibliography

LIST OF FIGURES

7 Figure 1: Japan – Health expenditure indicators, 2011
10 Figure 2: Japan – GDP per capita vs total expenditure on health, 2005–10
13 Figure 3: Japan – Structure of the public health insurance system
14 Figure 4: Japan – Flow of funds within the healthcare system
16 Figure 5: Japan – Types of medical institutions in the healthcare system
17 Figure 6: Japan – Number of hospitals, by type and number of beds, 2010
26 Figure 7: Japan – Key bodies influencing pricing and reimbursement of drugs
28 Figure 8: Japan – New drug pricing process, 2012
29 Figure 9: Japan – Price calculation method for new drugs
33 Figure 10: Japan – Number of drugs receiving price premium and the rates of premium,
2009–12
39 Figure 11: Japan – Biennial price revisions
49 Figure 12: Japan – Reimbursement for service providers under the DPC
52 Figure 13: Japan – Market share of generics in Japan, by volume and value, 2005–11

LIST OF TABLES

8 Table 1: Japan – Health expenditure indicators, 2007–11
16 Table 2: Japan – Comparison of clinics and hospitals
18 Table 3: Japan – Key healthcare resources, 2006–12
20 Table 4: Japan – Cost-containment measures adopted by the government
25 Table 5: Japan – Pricing and reimbursement tools, 2012
30 Table 6: Japan – Price premiums are given to drugs that can demonstrate a level of innovation
35 Table 7: Japan – Price premium awards, by type, 2009–12
35 Table 8: Japan – Average price premium awarded, by therapy area, 2009–12
39 Table 9: Japan – Special rules applied for NHI drug listings
43 Table 10: Japan – Pricing ratio for generic drugs, 2012
45 Table 11: Japan – Price reductions for long-listed products in the 2014 NHI price cuts
50 Table 12: Japan – Reimbursement for drugs under different care settings
50 Table 13: Japan – Insurance co-payment charges for different age groups
53 Table 14: Japan – Comparison of generics penetration versus other pharmaceutical markets
54 Table 15: Japan – Government measures to increase generics uptake