HEALTH care in any nation is a complex system, one that has been shaped over the years by social, cultural, and economic factors as well as by historical accidents. We try to explain these factors and their interactions later in the book. Our main focus is nonetheless governmental health policy, not because it is necessarily the most important aspect of the healthcare system but because it is where deliberate decisions make the most difference, in Japan as in the United States.

HEALTH-CARE POLITICS IN JAPAN AND THE UNITED STATES

Before analyzing the substance of Japanese health policy and its impact on the health-care system, we need a sense of how it is devised. We begin therefore by asking: Who makes health policy in Japan? Where do they get together (and under what rules)? What do they talk about? A quick comparison with the United States indicates that Japan is different in terms of these three key aspects of governmental decision making. We then go into a bit more detail on the Japanese decision-making system, in general and as it operates in the health-care policy area.

Actors

When we begin to describe a decision-making system, we start with the individuals and (more often) organizations that have both enough interest in health care and enough political power to participate and have an impact.