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March 22nd, 2025 KIP Forum "The burden of medical expenses in an aging society with a declining birthrate"
Lecturer: Mr. Hiroyuki Shimazu, Wellness Business Unit, MITSUI & CO., LTD.
Profile: After graduating in 2021 with a degree in International Economics and Management (BIEM) from Keio University and Bocconi University, he joined Mitsui & Co. He was seconded to an affiliated company focused on domestic disease prevention and corporate health management, where he spent three years developing and promoting services for health insurance societies and insurance companies. He is currently involved in investment projects related to healthcare at Mitsui & Co. During his student years, he was an active member of KIP, participating in both committee work and the Intergenerational Exchange Project.
【Speech and Q&A】
Mr.Shimazu explained Japan’s health insurance system with three main points; first, the current situation of health insurance associations run by large corporations; second, survey results on how different generations perceive the health insurance system; and third, measures taken by the government. Initially, health insurance associations were designed to be self-sustained within companies. However, due to economic downturns and other factors, many have been running deficits, leading to a shift toward the government-supported Kyokai Kenpo (Japan Health Insurance Association). Since 1973, Japan has been moving toward a system of lower medical expenses for individuals, which has further strained the finances of these insurance associations. One major contributing factor to their financial burden is that a portion of the money collected by these associations must be paid to the government. This situation has led to discussions about increasing the medical expenses borne by elderly patients. Data show that elderly people feel the least burdened by medical costs, although it cannot be ignored there is a significant wealth disparity among them. As a government initiative, all health insurance associations are now required to formulate a Data Health Plan to promote health maintenance among their members. Mr. Shimazu also introduced examples from the United States, where medical costs are significantly higher, and the healthcare system is largely privatized. The Q&A session broadened the discussion, incorporating insights from retired physicians and touching on issues such as hospitals being used as social hubs.
【Ground discussion】
The debate question was “To reduce the financial burden on the working-age population, should medical expenses for the elderly be increased?”. In the group discussions, participants agreed that merely raising medical costs for the elderly would not be sufficient. Instead, a long-term approach was needed to ensure sustainability. Some proposed a tiered system for raising medical fees while also addressing the issue of hospitals being used as social hubs by enhancing alternative community spaces for the elderly. Others pointed out that high-cost treatments should be the primary concern. The general discussion was highly active with many creative ideas. One interesting proposal was to adjust corporate tax rates based on how well companies implement health and wellness programs for employees. Another suggestion was to introduce criteria beyond just age when determining healthcare cost burdens. Overall, the discussion centered on how to ensure that medical resources are directed toward those who truly need them. Mr. Shimazu emphasized that this is an ethical problem as a review comment. He encouraged us to be aware of the perspectives we adopt and to consider the issue from multiple viewpoints.
【Personal Opinion】
Through both the discussion and the process of writing this article, I was able to think about how to bring about realistic social change. I initially believed that simply creating spaces where elderly people could connect with others and stay active would naturally lead to better health and reduce unnecessary medical treatments. However, I realized that my perspective was too idealistic—I had not considered which specific stakeholders would need to take action, what measures they could implement, and what level of effectiveness could be expected.This experience made me more aware of the importance of clearly presenting concrete proposals to drive deeper discussions. The perspectives on corporate involvement and the structure for determining their cost burden were eye-opening, as they were ideas I would not have reached on my own. Additionally, I gained new insights into the healthcare cost-sharing system, making this forum a valuable learning opportunity.
Maiko Nakamura, Kyoto University, Integrated Human Studies, 3rd year