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To pay for its national health care system, Japan spends 10.2% of its GDP on health care Papanicolas, (2018). This is less than France, Canada, or the United States, and Japan enjoys the longest life expectancy of all 83.98 years as of 2016 (World Bank, 2018). The government regulates close to all aspects of health care in Japan. The Universal Statutory Health Insurance System (SHIS) requires by law that the national and local governments provide efficient, quality medical care Papanicolas, (2018). Citizens are mandated to enroll in one of the SHIS plans based on age, employment status, or place of residence. Non‐citizens, immigrants, and visitors are not covered. The majority of the Japan has some form of private health insurance, only as a supplementary or complementary role.

All SHIS plans provide the same benefits package that is decided by the government. The package covers hospital, primary, specialty, and mental health care, approved prescription drugs, home care services by medical institutions, hospice care, physiotherapy, and most dental care Papanicolas, (2018). Plan participants have to pay a 30% coinsurance for services and goods received and there are zero deductibles. In 2013, out‐of‐pocket payments for cost‐sharing accounted for 13% of current health expenditures Papanicolas, (2018).

The Japanese health care system provides comprehensive care and is one of the most advanced in the world. Physicians and hospitals are predominantly run as private businesses, and costs for care are reimbursed through the national health care system. Patients' health care costs are reimbursed at a fixed amount determined by the government. Refusal of coverage by insurers is impossible, and personal medical debt is nonexistent.

Factors contributing to lower health care costs in Japan include healthier diets and lifestyles, with a lower incidence of chronic diseases. Reimbursement rates for health care services are low, but reimbursement strategies for quantity rather than quality of services erodes the advantage a healthier lifestyle might have in terms of curbing costs. Despite cost containment efforts, health care expenses are increasing, especially with the earthquakes of 2011. A shortage of physicians also means the wait time to access the health system is an issue. With an aging population and shrinking workforce, concerns as to how access, affordability, and quality will continue in the future are being voiced (National Coalition Health Care, 2008; Reid, 2009).