The research question for this paper is: What is the significance of universal health insurance in Japan? My hypothesis is that universal health insurance is a quasi-public welfare system. Low-income people did not fit in with insurance, but high economic growth and egalitarianism postponed the resolution of the contradiction of insuring poor people who could not afford to pay the appropriate premiums.
There is a great deal of accumulated research on the Japanese medical insurance system. Saguchi (Citation1957), Sugaya (Citation1976, Citation1977), Yoshihara and Wada (Citation2001) and other works detail the policy and legislative process, focusing on the long-term evolution of the healthcare system. The emphasis is on elaborate factual descriptions rather than interpretations. About the medical care system, the issue of the national treasury’s burden is controversial and touches on the question of the role of the state and the significance of social insurance. Kawakami (Citation1965), Matsunaga (Citation1967), Asakura (Citation1983), Niki (Citation1992, Citation1994) and other workers demand an increase in the national government’s subsidies, advocating that the state should play a greater role to protect the people’s right to life guaranteed in the Constitution. On the other hand, Niwata (Citation1973, Citation1975), Shakai Hosho Kenkyujo (Citation1975), Ono (Citation1991) and others suggest that even social insurance must follow insurance principles as much as possible, that the amount of the contributory burden of social insurance premiums should be kept to a minimum, and have questioned the increase in the national treasury’s share. In an eclectic mix of these interpretations, Ikegami and Campbell (Citation1996) argue that the foundation of the Japanese healthcare system is state control and the very unique sense of balance within Japanese society, such as public medical treatment fees and universal coverage. The continuity and discontinuity of the Japanese medical insurance system before and after World War II has also been a major point of contention. Sugiyama (Citation1995) emphasizes the intermittency of the Japanese social security system as newly started after the war, while Zhong (Citation1998) as well as Yokoyama and Tada (Citation1991) attach much importance to continuity between the prewar and postwar periods.
