OBJECTIVES: Japanese health care system experienced important changes to cope with population ageing. The government passed a new Health bill in 2015 to complement the 2012 one. The objective of this research is to describe how those two reforms will impact the health care landscape in Japan. METHODS: We did a literature review and analysed health care reform acts of 2012 and 2015 RESULTS: Main directions are:
• Enhanced decentralisation with transfer of power to Prefecture (regional government). Regional governance will be established to accountably manage health plan.
• Prefectures are responsible for health care plan for cancer, stroke, acute myocardial infarction, diabetes mellitus, psychiatric disease, pediatric care. But also to develop home care delivery.
• Integrated health care are under Prefecture responsibility with case managers who coordinate health care for chronic and multimorbid patients. More than 300 diseases are eligible to case management.
• Equity in health care access is high on the agenda to ensure equitable accessibility to health services. the two markers will be: mortality and use of expensive therapies (with special focus on oncology).
• New incentives to encourage patients to use GP for hospital referral and discourage patients self-decision. At the same time large hospitals will be requested to ensure health care coordination with all community based providers to prevent admission and re-admission. Hospital ensuring post-discharge follow-up in coordination with ambulatory care providers will receive subsidies
• The unique social security and tax number will be established in 2018 to support the extension of E-health record networks currently piloted in targeted catchment area.
CONCLUSIONS: The Japanese Health care system is operating a reform toward prefecture accountability, and health care integration supported by development of unique E-Health record, incentive for information sharing, case managers, and strengthening GP’s role. This process is established smoothly but should improve health care quality and cost.