Learning from Japan's Health Care System
Wait times are not a problem in Japan’s universal health care system.
One could argue wait times don’t really exist at all.
Patients receive health care within days, not months or years like we so often hear about in Canada. Yes, the country that voted “instant noodles” the best invention of the 20th century also has “instant health care.”
According to a 2020 OECD report on health, Canada had wait time problems in all eight categories of health care services they studied – everything from cancer and cardiac care to diagnostic scans and primary care. Conversely, Japan didn’t have any waiting list problems in any of the categories – none.
So how do they do it?
In 2025, SecondStreet.org travelled to Japan to learn more about their health system.
This page includes our main documentary, background information and we will update it with additional content once it is ready.
As noted in our short documentary, Japan isn’t simply spending more money on health care in order to achieve greater results.
2019 OECD data suggests Japan spends about 11.0% of GDP on health care while Canada spends 10.8% (simply put, this refers to the amount of economic activity dedicated to health care). While these two figures are about the same, it’s important to note that Japan’s population is, overall, older than Canada’s. It’s a fact of life that people tend to require more health care services as they get older so one could expect Japan to spend more.
However, if you adjust for age in order to do an apples-to-apples comparison, you will find Canada‘s system spends more – see this Fraser Institute for details.
Thus, Japan’s advanced health system can’t be chalked up to spending.
After visiting the Asian country to learn more about their health system, we identified two fundamental differences with Canada:
Reason #1 : Supply, Supply, Supply!
While Canada takes a top-down approach to health care, Japan takes a bottom-up approach.
In Canada, it’s not easy for a non-profit or for-profit clinic to open up and start providing surgery, diagnostic scans and other non-primary care health services to patients. Government policies restrict supply. And because supply is restricted, waiting lists have grown by leaps and bounds.
Think of a community with one drive-through restaurant. As long as the food is good and the prices are reasonable, long wait times will eventually occur as the town grows. However, if a second drive-through restaurant opens, then wait times will likely decrease. In Canada, the government controls the supply of health care and government policies make it difficult for more providers to open up and ease waitlist pressure.
In Canada, there are many examples of partnerships between the government and non-government providers. Not only are most family doctors’ offices private, but you might have been referred to a private clinic for a blood test and didn’t even realize it wasn’t a government clinic. That’s because in both cases the government paid for the privately-provided service using tax dollars.
Establishing government partnerships with non-government clinics for blood testing, diagnostic scans, minor surgeries, etc. can be quite complex. The process can be quite political and ideology can get in the way. Unions and some union-funded activists inevitably protest when the topic of third-party delivery comes up, insisting that all health services should be delivered by government-run entities. This is one reason why governments have been slow to expand third party delivery of health care services through the public system.
Similarly, it is also difficult for non-government providers to open up in Canada and operate outside of the public health care system – i.e., a situation whereby a patient wants to pay for surgery at a non-government provider instead of waiting for the government to provide the procedure. The situation is complex, but generally speaking, with the exception of Quebec, government barriers make it difficult for patients to pay for health services in their own province. For example, this is why a Vancouverite will fly to Calgary for surgery while a Calgarian flies to Vancouver for the same surgery.
In Japan, we find the opposite approach.
The government determines the price for health services and how much it will pay. For example, the government might decide, say, the price for knee replacement surgery in the country is $10,000 and it will pay, say, $8,500 (the rest coming from patients – more on that in a moment).
Those in the non-profit, for-profit and government health care sector then know that if they help a patient with that type of procedure, they will receive $10,000. This makes it very straightforward for health providers to enter the market – the process is not political. What matters is whether or not the provider can deliver quality treatment to patients.
As noted in the video above, we heard from multiple experts that Japan actually has an oversupply of health care. This is why patients can get in right away and why Japan’s health sector is actively trying to grow their medical tourism industry.
In terms of co-payments, Japanese patients do have to pay a portion of each medical bill. For less costly health services, patients tend to pay a higher percentage – approximately 30%. Dr. Matsuda from Ritsumeikan University in Kyoto estimated that a typical cost for patients for a family doctor is about 3,000 yen (approx. $28 CDN). However, for something more significant, like a heart operation, there are caps to protect patients from facing large bills. The amount a patient spends depends on how much the patient earns and how much they’ve paid in a month. For example, this Japan Times article notes that someone, in Canadian dollars, earns approximately $36,000 to $74,000 would pay a maximum of $840 per month.
Something interesting about Japan’s co-payment system is that it might actually contribute to the next fundamental difference between Japan’s health care system and Canada’s…
Reason #2: Prevention
One cannot overlook the fact that Japanese people are, generally speaking, healthier than Canadians.
This means their health care system is going to face less stress than Canada’s due to lower rates of disease and other health conditions that arise due to unhealthy lifestyles. For example, while Canada’s obesity rate is approximately 33%, Japan’s obesity rate is under 5%. This is significant as many health conditions are correlated with obesity – heart disease, diabetes, stroke and some cancers to name a few. Obesity is also correlated with a higher demand for certain orthopaedic services and primary care.
But it’s not just that obesity rates are lower in Japan, the Japanese diet is generally healthier and citizens are generally, more active people. These factors of course have other health benefits.
Canadians might bristle at some of the examples of government policies below that are designed to encourage healthy living in Japan, but they are important to note:
Nutritionists in Schools – The public school system helps get children off to a healthy start through a number of measures, including having nutritionists in elementary schools to help teach children how to make healthy food. Schools often serve healthy meals to students as well.
It’s also common for Japanese schools to outright ban junk food in schools. This is quite different from Canada where school canteens and vending machines sell chocolate bars, chips, sodas and other junk food to students.
Radio Taiso – Pretty much everyone in Japan is aware of “radio taiso”. It’s a music jingle that people will stretch to – often in the morning – to loosen up. From schools to worksites, it’s common for people to warm up to this calisthenics program that is broadcast on radio across the country. Here’s a clip from a park in Japan where it was played – click here.
Metabo – The Japanese government requires businesses and organizations to have their employees’ waistlines measured once per year. Those deemed to have unhealthy waistlines are helped with advice on how to slim down while companies can face fines if too many of their workers are considered unhealthy. Here’s a CNN clip on the policy. This policy of course wouldn’t be acceptable in Canada, but it is an interesting difference between our two nations.
Although it’s not a government requirement, it’s worth noting that Japanese people often participate in something called “Human Dock,” also known as “Ningen Dock”. It’s essentially a comprehensive annual review of a patient’s health to identify health risks early on to prevent diseases and health conditions from developing or catch them before they grow into larger problems. The reviews vary by provider, but can include everything from an annual physical to more comprehensive tests like MRI scans, endoscopies, etc. This YouTuber chronicled his “Human Dock” in 2024.
Part of what leads Japanese people to live healthier lives might also be something we examined above – the fact Japanese patients have to pay a portion of the bill each time they receive health services (on top of what they pay in taxes). This provides a financial incentive to take greater care of their bodies. Simply put, if you live a healthy life, you can reduce the chances that you will require health services and thus, you’ll save money.
To be sure, a healthy lifestyle won’t protect everyone from requiring health services. Many patients have genetic health problems that can’t be avoided, others will be involved in unforeseen accidents and ageing will eventually catch up with all of us. But prevention can reduce the overall strain on the system.
One other preventative health care difference worth noting – and it’s related to geography – is that Japan is a country with a large number of people living in a small area of land. For perspective, Japan’s population is three times Canada’s, but they’re living in an area that’s smaller than Manitoba – and much of it is too mountainous for habitat. This density makes it financially viable for a robust transit system. And with high levels of transit usage comes a higher level of physical activity – walking or riding a bicycle to a train station, transferring from one line to another, walking to your final destination, etc. Far fewer people drive from door to door. Canadian cities generally do not have the same level of population density that you find in Japan.
Conclusion
Japan’s approach to openly welcome non-profit and for-profit companies to provide health services within its public system is a lesson worth learning for provincial governments in Canada.
Implementing this approach of course would require a shift in Canada – from our politicized, ideological model of health care delivery to one where the needs of patients are squarely at the centre. Again, under Japan’s model, it doesn’t matter if the provider is government-run or a non-government entity, all providers have the opportunity to compete to deliver care for patients. And if they do, they receive the same rate of compensation.
In terms of prevention, many of Japan’s policies likely wouldn’t work in Canada – one can only imagine how controversial it would be to suggest workplaces in Canada begin measuring peoples’ waistlines and reporting the results to the government.
However, it would be worthwhile for provincial governments to spend more time looking at prevention and identify policies from other countries that are both effective and amenable to the public. If we do, we might ease demand for health services in the first place.
If you are interested in learning more about Japan’s health care system, this post by the Commonwealth Fund provides a good summary – click here
