The triple goals of Universal Health Coverage (UHC) are to cover the whole population, to reduce patients' costs, and to expand coverage to all effective services, equitably available to all. This paper analyses the experience of Japan in achieving these goals, focusing on the central role played by the payment system. The payment system, or fee schedule, sets the price of services and pharmaceuticals, as well as the conditions that providers must comply with in order to receive payment. The fee schedule was first introduced following the enactment of social health insurance (SHI) in 1922. Initially, the SHI program covered only manual workers, who comprised a mere 3% of the population. However, the fee schedule of the largest SHI plan was subsequently adopted by all other SHI plans. From 1958, there has been only one fee schedule. Population coverage was achieved in 1961 by mandating all residing in Japan to enroll in SHI, thereby making everyone entitled to all the services and pharmaceuticals listed in the fee schedule. Next, co-insurance was capped to an affordable level by the introduction of catastrophic coverage in 1973. Lastly, extra billing and balance billing were explicitly restricted in 1984. The key to achieving and sustaining UHC goals in Japan lies in being able to contain costs and reallocate resources by revising the fee schedule.

中文翻译：

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日本：通过规范付款实现超高附加值。

全民医疗保险（UHC）的三重目标是覆盖全体人口，降低患者的费用，并将覆盖范围扩大到所有人人平等享有的所有有效服务。本文分析了日本在实现这些目标方面的经验，重点介绍了支付系统所发挥的核心作用。付款系统或费用表确定服务和药品的价格，以及提供者必须遵守的条件才能接收付款。费用表是在1922年制定社会健康保险（SHI）后首次引入的。最初，SHI计划仅覆盖体力劳动者，仅占总人口的3％。但是，其他所有SHI计划随后都采用了最大的SHI计划的费用表。从1958年开始，只有一个收费表。1961年，通过强制所有在日本居住的人加入SHI，实现了人口覆盖，从而使每个人都有资格获得费用表中列出的所有服务和药品。接下来，1973年引入灾难性保险，共同保险被限制在可负担的水平。最后，1984年明确限制了额外的计费和余额计费。在日本实现和维持UHC目标的关键在于能够控制成本并通过修改费用表重新分配资源。