The Structure and Process of Health Policy Making in Japan

Health policy making is very complex political process involving the interactions between multiple governmental agencies and pressure groups, requiring long time, and affected by socio-economical ups-and-downs and national elections. At the end of 2020, two policy issues reached conclusions under the COVID-19 calamity: the introductions of 20% patient burden into the Health Insurance System for the Late Elderly, and the increased outpatient burden without referral when visiting large hospitals. Why did these things happen? To answer why, this study did three things: the historical and institutional considerations on the strengthening of the Cabinet, the development of the governance structure of actors and conference bodies, and the process tracking of the above two issues. Findings are (1) under the parliamentary cabinet system and the stable majority of the ruling party the reform of the political system in 1994, the repositioning of the governmental agencies and conference bodies in 2001, and the gradual strengthening of the cabinet functions in later years, helped the cabinet to have more efficient consensus making mechanisms than before, and (2) appropriate measures were wisely adopted, depending on the level of political difficulties, which in turn depends on the unique features of the issue (and their effects on national election) and the level of the resistance by the opposing pressure groups. Limitations of the study were also discussed.