Scaling up community health insurance: Japan's experience with the 19th century Jyorei scheme.

Interest in community health insurance has grown rapidly in many developing countries, usually as a result of the weak capacity of governments to raise sufficient tax revenues and then to secure an adequate share for health care. There are many pitfalls, however, and only under specific conditions do community health insurance schemes appear to succeed in effectively improving access to care and enhancing financial protection against health care costs. In this paper, we focus on the initial experience with community health insurance in 19th century Japan, called 'Jyorei'. Whereas Jyorei began in 1835 in one village in Fukuoka Prefecture, it gradually expanded and the basic ideas came under government stewardship. It was scaled up as the core model of the National Citizen's Health Insurance Fund, one of the pillars of the Japanese social health insurance system. Several Jyorei success points are relevant today for developing countries wishing to support community health insurance. One of the key characteristics was social cohesion and the acceptance of equity goals with transfers between the rich and the poor.