老龄化背景下日本医保体系与卫生体系的协同变革与启示

少子老龄化是我国学术界和政策制定者共同关注的问题，少子老龄化带来的健康需求、疾病谱的变化以及代际失衡问题，对医疗保险筹资和服务提供模式提出了新的要求和挑战。20世纪90年代以来，日本面临少子老龄化和经济低迷的双重挑战，一直在进行卫生服务提供和社会保障制度改革，本文将系统梳理日本医疗保障应对老龄化的改革历程，根据世界卫生组织的卫生系统框架和协同理论，从政府治理、多层次保障、筹资与支付、基金预算与卫生资源、整合型服务等方面总结日本医疗保障和卫生体系的变革给我国带来的启示，为我国完善卫生服务和医疗保障体系，走向健康老龄化提供参考。

Studying the synergized reform of health insurance system and healthcare system in Japan under the society background of lower birth rate and aging and its inspirations

Lower birth rate and aging is a common concern of the academic society and policymakers in China. The changes in healthcare demands and disease spectrum caused by lower birth rate and aging, as well as the intergenerational imbalance problem, have stimulated the generation of new requirements and challenges to the current health insurance financing mechanism and mode of healthcare service provision. Since the 1990s, while facing the dual challenges of lower birth rate and aging as well as economic slump, Japan has been constantly conducting reforms in healthcare services and in the social security system. This article systematically reviewed the reform pathway of Japan''s healthcare security system in dealing with population aging. Furthermore, based on WHO''s healthcare system framework and the synergy governance theory, this article summarized the inspirations derived from Japan''s reform in the health insurance system and healthcare system, from aspects including governance, multi-level guarantee, financing and payment, fund budget and health resources, as well as integrated services, which should provide references for helping China improve its own healthcare service system and medical security system, allowing China to work towards the goal of healthy aging.