2026-07-16 東北大学
＜関連情報＞
- https://www.tohoku.ac.jp/japanese/2026/07/press20260716-01-reassurance.html
- https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(26)00124-0/fulltext
- https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(26)00125-2/fulltext
2040年に向けた日本の医療制度：構造的課題と新たな社会契約 Japan’s health system toward 2040: structural challenges and a renewed social contract
Lisa Yamasaki ∙ Haruka Sakamoto ∙ Hideki Hashimoto ∙ Naoki Kondo ∙ Osamu Kunii ∙ Yusuke Tsugawa ∙ et al.
The Lancet Regional Health – Western Pacific Published: July 15, 2026
DOI:https://doi.org/10.1016/j.lanwpc.2026.101920
Summary
Japan’s universal health coverage system has supported healthy longevity, but now confronts institutional stagnation: widely recognised structural pressures persist without reform of its core architecture. A multidisciplinary working group of 25 experts from Japan and the Western Pacific identified three interdependent structural challenges perpetuating policy inertia. These comprise a volume-driven, hospital-centric delivery model sustained by fee-for-service incentives, rigid budget allocation, and underdeveloped health technology assessment; fragmented data infrastructure and eroded public trust undermining evidence-informed governance; and institutional insularity limiting global interdependence. We propose a Vision 2040 framework with three goals: transitioning to an open, community-based ecosystem prioritising daily functioning and wellbeing; establishing trust and scientific independence as foundations of governance; and ensuring equity through circular innovation, in which Japan contributes to and learns from regional health networks by integrating global learning with domestic value assessment. Nine recommendations provide a roadmap for governance reform, data integration, reimbursement realignment with societal value, and reciprocal workforce partnerships. Reconstructing the social contract underpinning universal health coverage is central to sustainability across ageing Western Pacific societies.
西太平洋における日本のグローバルヘルスへの関与：構造的慣性の診断と人間の安全保障外交の枠組み Japan’s global health engagement in the Western Pacific: diagnosing structural inertia and a framework for human security diplomacy
Haruka Sakamoto ∙ Lisa Yamasaki ∙ Sarah Krull Abe ∙ Satoshi Ezoe ∙ Shinichi Egawa ∙ Renzo R. Guinto ∙ et al.
The Lancet Regional Health – Western Pacific Published: July 15, 2026
DOI:https://doi.org/10.1016/j.lanwpc.2026.101921
Summary
The global health architecture is under increasing strain in the context of intensifying multipolarity. Development assistance for health is declining and geopolitical fragmentation stalls collective action, leaving health sequestered within discretionary foreign aid. As Asia’s sole G7 nation and a universal health coverage pioneer, Japan navigates tensions between domestic social protection and external change. Drawing on a two-round expert consultation and literature synthesis, this analysis diagnoses three interdependent structural barriers forming a cycle of strategic inertia: a crisis of solidarity, financing, and governance in the multilateral architecture; episodic leadership driven by institutional fragmentation and misaligned incentives; and unidirectional knowledge transfer that forecloses reverse learning needed to revitalise domestic capacity and regional partnerships. We propose a framework of human security diplomacy, positioning health as a pillar of regional architecture rather than discretionary expenditure. This framework advances three goals: harmonising global contribution with domestic growth; fostering solidarity and regional public goods through catalytic leadership; and mainstreaming health into social systems for planetary resilience. Central to this strategy is circular co-evolution, in which Japanese institutional expertise and partner-country innovations reinforce one another.
