The financial burden of a long-term illness such as cancer can
be devastating, with as much as 66% of the costs of cancer being
nonmedical. These financial concerns are leading some Americans
to buy insurance policies that, upon diagnosis of cancer, assist
them in paying for their care.
Several companies now offer disease-specific insurance policies
for cancer, with the industry leader being American Family Life
Assurance Company (AFLAC).
AFLAC built this program by selling cancer insurance to the Japanese,
starting in 1974 when they became the second foreign company licensed
in Japan. AFLAC currently has a monopoly in Japan, insuring 20%
of the Japanese. The $7.2 billion company receives 85% of its
revenues from Japanese operations.
Understanding the factors that made cancer insurance successful
in Japan may assist policy makers in eval-uating strategies for
cancer insurance policies in America. However, cultural considerations
clearly differ between the two countries.
The Japanese population is one of the healthiest in the world.
Japan provides universal access for its 127 million citizens and
has the highest life expectancy of any industrialized nation (76.1
years for males and 82.1 years for females), as well as the lowest
infant mortality rate (0.5%)[3,4].
These statistics, however, overshadow trends for cancer. Cancer-related
deaths in Japan have risen sharply over the past 50 years, and
in 1992, 188 of every 100,000 Japanese died of cancer, making
it Japan's number one cause of death.
Cancer Care in Japan
1. Cancer Facts & Figures--1996. Atlanta, Ga, American Cancer
2. Annual report for AFLAC Inc., 1995.
3. Iglehart JK: Japan's medical care system: Part 1. N Engl
J Med 319:807-812, 1988.
4. Okimoto DI, Yoshikawa A: Japan's Health System: Efficiency
and Effectiveness in Universal Care. Washington DC, Faulkner
& Gray, Inc., 1993, pp 85,88.
5. Statistics and Information Department, Minister's Secretariat,
Minister of Health and Welfare, Japan, 1992.
6. Ohnuki-Tierney E: Illness and Culture in Contemporary Japan:
An Anthropological View. New York, Cambridge University
Press, 1984, pp 62-66.
7. Lohr S: Under the wing of Japan Inc., a fledgling enterprise
soared. The New York Times, January 15, 1992, section A,
8. Iglehart JK: Japan's medical care system: Part 2. N Engl
J Med 319:1166-1172, 1988.
9. Cancer Insurance: Exploiting Fear for Profit. Report by the
Select Committee on Aging, House of Representatives, 97th Congress,
1st session. US Government Printing Office, Washington DC, Oct.
1981, 2nd ed, p 11.
10. Annual Report for United American Insurance Company, 1994.
11. Boroson W: Stock only Mammon could love. The Record,
May 10, 1995, p BOI.
12. Limited benefit insurance: Palliative or panacea? Chicago
Tribune, February 25, 1996, business section, p 3.
13. Weinstein GW: The Lifetime Book of Money Management.
New York, New American Library, rev ed, 1987, p 455.
14. Weil H (ed): Health insurance to avoid. Retire with Money,
15. Covinsky KE, Goldman L, Cook EF, et al: The impact of serious
illness on patients, families. JAMA 272:1839-1844, 1994.