Channels of Stabilization in a System of Local Public Health Insurance: The Case of the National Health Insurance in Japan

Abstract

There are more than 1,700 municipalities serving as insurers in Japan’s system of National Health Insurance (NHI). The NHI has several institutional routes to buffer local premiums from abrupt changes in regional health demands that destabilize the NHI benefit expenditures. After briefly introducing the system of public health care in Japan, this study elaborates on the methods for quantifying the degree of stabilization of local public health care expenditures by critically evaluating the methods that have been utilized in the related literature and proposes a modified method appropriate for this study. It then quantifies the channels and degrees of stabilization using municipal NHI data in the 2000s.