Japanese Self-Defense Forces

Presentation to the Defense Health Board

February 10, 2020

Universal Statutory health Insurance System (SHIS) Noncompeting public, quasi-public, and employer-based insurers (age, employment status, and/or place of residence)All the citizens enroll mandatory

All SHIS plans provide the same benefits package

Fee-for-service system

Free access to any hospitals

Premiums (total 10% of salaries)Employees’ premiums are checked off from their salary (5%) Employer has to pay another 5% as employees’ benefit

Structure of Healthcare System

Co-payment75- years old 10%70-75 20%6-70 30%1-5 20%0-1 0%

High-Cost Medical Care Benefit systemMaximum co-payment : 800$+α

Ex) (30,000*0.3-800)*0.01 +800=882

$4,152Health care spending per capita

$126Out-of-pocket health care spending Per capita

TAX= about 40%

Healthcare Fee and Insurance

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Naha, OKINAWA(50)

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Sapporo, HOKKAIDO (200)*

Fuji, SHIZUOKA(50) *

Gifu, GIFU (100)

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◎ ： Central Hospital● ： Ground x 7● ： Maritime x 5● ： Air x 3★ ： NDMC

Ominato,AOMORI (30)

Misawa,AOMORI (50)

Sendai, MIYAGI(150) *

Central Hosp, TOKYO

(500)*Yokosuka, KANAGAWA

(100)*

Maizuru, KYOTO (50)

Hanshin, HYOGO(200) *

Name, PREFECTURE(# Beds)

Kure, HIROSHIMNA (50)

Fukuoka, FUKUOKA (200)*

Kumamoto, KUMAMOTO (100)

Beppu, OITA(50)

Sasebo, NAGASAKI(50)

★◎

National Defense Medical College, SAITAMA

(800)*

*8 Hospitals(underlined) are authorized to treat civilian patients.SDF Hospitals

Authorized Self Defense Personnel： 247,154 (As of Mar 31, 2018)

Women percentage: 6.9% (compared to actual total number)Target goal of 9% until FY2027

Female service member’s job limitationJust recently almost all* the positions have been open to female service members ( submarine 2018.12~)*Exception for some part of NBC Weapon Defense Unit (chemical) and Tunnel Company

Analysis/ policy over women’s healthNo analysis of unplanned/planned pregnancy rate: limited service of OBGYN in SDF hospitalsNo special policy/limitation for contraception, menstrual suppression, fertility treatment.

Policy for Maternity/ Childcare leaveMaternity leave: from 6 weeks before birth till 8 weeks after birthChildcare leave: after Maternity leave up to 3 year without salary

Recommendation for Paternal leave“7 days around birth paid leave” hasn’t been achieved 100%Paternal leave is used only 3.8% (FY2018) (government target goal is 13% by FY2021)

SDF personnel

Initial (FY2016) Target Goal (by FY2021)

Holidays/Vacation (days) 10 >15

Paternal Leave (%) 0.5 13

Male parental paid leave up to 7 days* (%) 22* 100

Women Recruit (%) 9.4 >10

Women service members number (%) 6.9 9 (〜FY2027)

Women >MAJ (%) 3.1 >3.1

Physical fitness standards are different according to gender and ages-Run (3000m), push-ups, sit-ups, pull-ups, throwing

*Leave for spouses’ childbirth (up to 2 days) 62.4%*Leave for participation in childcare (up to 5 days) 22.0%

Musculoskeletal Research

Conducted in the National Defense Academy

Total n=9143 (Male 8674, Female 739)

Average 20.4±1.5 yrs

The occurrence of stress fracture: 13.6 cases / 1000 people / year

Female cases is 3.3 times significantly high occurrence (p<0.01)

The event occurs within 3 months after admission to Academy, followed by 30 % of those had initial event within 3 months couldn’t finish the entire course of Academy.

The prevalence of the location of stress fracture is as follows;Tibia (50%)Metatarsal (20%)Pubic (10%)

Research on women’s health

Suicide cases trend in SDF

4636

43 44 50 4864 64 65

48 51 53 55 49 52 47 43 45 40

61

35

17

1716 8

15 17

16 15 19

23 16 15 1014 7 16

12 1112

11

11

12

9

14

7

13 10

14 14 9

129 12 12 15 20 13

11 95

12

11

4

3

8

5

76

6 8 8

67

6 6 8 4 6

3 88

6

5

0

10

20

30

40

50

60

70

80

90

100

110

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

civilian ASDF

MSDF GSDF

Cases downward trendMax about 100 in 2004~2006

Suicide rate comparison (/100k) SDF personnel suicide rate is higher than general adults

Suicide rate itself is higher among men (men: 70%, women: 30%)Male service personnel accounts for more than 90% in SDF.

32.3 30.9

38.1 38.3 38.3 35.2

33.1 34.2 33.2 34.5 33.8

33.3

27.9 29.4

26.5

36.4

25.1

30.7

32.630.5 30.6 30.1 31 30.1 30.7 29.4 28.4

25.8 25.423.7 22.3

20.3 19.7 19.216.9 17.7

21.7 20.7

16.4 17.8

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

SDF（１８～６０yrs）

general（２０～５９yrs）

government（１８～６０yrs）

Suicide rate comparison (/100k) No difference between SDF and general men suicide rate

43.748.3

44.7 45.6 43.2 44 43.1 45.142.6

39.836.3

35.433

31.228.7 28.3 27.1

33.9 32.1

40.6 39.3 40.9 37.2

35.4 36.3 34.3 36.2 35.9 35.8

28.3 31.4

28.3

39.1

27.0

16.919.8

24.8 23.5

18.1 20.2

0

10

20

30

40

50

60

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

general M（20～59y）

SDF M (18-60y)

Government M（１８～６０y）

Age-specific suicide rate (/100k) Young (<20) and after 50 year old age group has higher suicide rate in SDF Male service members. The cause of suicide is as follows;

working related problems ( 40%)family related problems ( 18%) health related problems ( 17%)

3.6

23.8

26.0

26.3 31.9

35.3

27.5

19.6

25.5

42.0

0.0

10.0

20.0

30.0

40.0

50.0

10- 20-29 30-39 40-49 50-

general M SDF M

Annual mental health screening (The Brief Job Stress Questionnaire including job stressors, psychological and physical stress reactions, and buffering factors, IES-R etc.)

Counseling (psychotherapist)

Appointment with psychiatrist if needed

Mental health education

Care service after suicide cases

Pre-/ Post-/ onsite mental health screening for deployment (The 30-item General Health Questionnaire)

Measures against behavioral health

Research on behavioral health 1

Research on behavioral health 2