John Creighton Campbell – författare

The Japanese health care system provides universal coverage to a healthy but aging population. Its costs are among the lowest in the world and have remained nearly constant as a share of the economy for more than a decade. Americans concerned about runaway medical spending need to know about the successes that Japan has experienced and the problems the country has encountered in its effort to control costs while maintaining quality of care.

Offered here is an analysis of the key issues of cost-containment by specialists followed by reactions from some of America''s best-known experts on health care delivery and finance. Topics include the macro-and microeconomics of health care, technology and costs, institutions and costs, attitudinal and behavioral aspects, and the politics of health care.

This collection provides an authoritative study of successful cost-containment in the Japanese health care system---a chronicle of success that is neither a statistical illusion nor a result of sociocultural factors. Detailed here is information on the key mechanism of cost constraint: a fee schedule that covers virtually all medical services and rewards inexpensive services while making expensive services unprofitable. This system has resulted in the provision of quality health care to the entire population at roughly half the cost of American health care. Is it a single-payer system? Would the United States have to introduce a dramatically altered health care structure to benefit from the Japanese experience? No. Japan relies mainly on fee-for-service medicine financed by multiple insurers---a system familiar to Americans and one from which many lessons may be learned.

Based on conferences held in Washington, D.C., and Izu, Japan, this volume collects original chapters on the overall cost structure, how the negotiated mandatory fee schedule works, specific mechanisms for cost control, the politics of health care financing, and the impact of cost cutting on quality, among other topics. These pathbreaking studies will be a significant resource for policymakers and scholars interested in comparative health care systems as well as those interested in health care reform in the United States.

Japan is aging rapidly, and its government has been groping with the implications of this profound social change. In a pioneering study of postwar Japanese social policy, John Creighton Campbell traces the growth from small beginnings to an elaborate and expensive set of pension, health care, employment, and social service programs for older people. He argues that an understanding of policy change requires a careful disentangling of social problems and how they come to be perceived, the invention (or borrowing) of policy solutions, and conflicts and coalitions among bureaucrats, politicians, interest groups, and the general public. The key to policy change has often been the strategies adopted by policy entrepreneurs to generate or channel political energy. To make sense of all these complex processes, the author employs a new theory of four "modes" of decision-making--cognitive, political, artifactual, and inertial. Campbell refutes the claim that there is a unique "Japanese-style welfare state." Despite the big differences in cultural values, social arrangements, economic priorities, and political control, government responsibility for the "aging-society problem" is broadly similar to that in advanced Western nations. However, Campbell''s account of how Japan has taken on that responsibility raises new issues for our understanding of both Japanese politics and theories of the welfare state.Originally published in 1992.The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.