Japan started a public LTCI program in 2000. (File photo)

Japan created a universal public acute health care system in 1961 and a public long-term care insurance (LTCI) system in 2000.

Overall health care spending is close to the rich-country average, but it’s eating up more of the country’s gross domestic product (GDP).

Japanese economists write in a report for the International Monetary Fund that two-thirds of the spending increase is the result of an aging population, and one-third from excess cost growth. The economists say one problem is that, when Japan tries to put limits on the cost of long-term care (LTC) services, the LTC services providers get around the controls by providing more services or steering patients toward higher-cost services.

The authors suggest that the Japanese government should consider adding gatekeepers, to control access to services, and to encourage more use of generic drugs.

—Allison Bell