Reconsidering Japan's path to universal health insurance: Pre-war origins and the complementarity of occupational and community-based schemes

Japan's health security system began with the enactment of the Health Insurance Act in 1922, which was occupational health insurance intended for workers in large factories and mines. The scope of this social health insurance was subsequently expanded, but the issues of insurance coverage for agricultural workers and the self-employed remained. To address these issues, the Citizens' Health Insurance Act, a community-based health insurance system, was legislated in 1938. Japan's health security collapsed with the end of the Pacific War (World War II) in 1945, but during postwar reconstruction, legislation was conducted in 1958 and universal health insurance was achieved in 1961. Japan's universal health insurance system cannot be considered a purely postwar product. It began to be established before the war in response to the industrialization of society, and it was completed during the period of postwar economic growth, overcoming the interruption caused by the end of the war.