A healthcare system refers to the organization of people, resources and institutions that provides medical support services for people, and meeting their specific needs. Healthcare quality varies from country to country, and it is dependent upon its economic, social, and political situation. Japan and the Philippines, both island countries, differ drastically in the quality of their healthcare systems. Japan is a developed country well known for its comprehensive and solid healthcare system. The Philippines’ healthcare system, on the other hand, is falling behind the global community, as it was ranked 87^th out of 190 countries in 2019, according to the World Health Organization (WHO). Understanding the difference in healthcare quality between Japan and the Philippines, as well as the reason why the Philippines’ healthcare is falling behind, is important for its improvement and the improvement of countries with stark healthcare inequality. International cooperation and collaboration between well-resourced and under-resourced countries are significant because the former can provide aid and insight for under-resourced countries to reinforce their efforts to fight against current and future healthcare crises, as well as potentially changing policies around the issue. Having a strong healthcare system is important in many countries, and for developing countries, they might not be able to address their problems without international assistance.

Stark Differences in Healthcare Quality Between Two Island Countries
The Japanese government spends about 8.2 percent of its GDP on healthcare, the highest proportion in the world. Thus, the country has a high ratio of doctors to its population–for every 1000 people, there are approximately 2.5 doctors in Japan. Its healthcare system performance is ranked to be 10th in the world. Japan’s government provides high quality health insurance for its residents, and workers and their families are expected to be protected by insurance,. Furthermore, the life expectancy in Japan is the highest in the world, and this is not only achieved by mortality reduction and disease reduction, but also the actions taken by the government to improve healthcare support. Since 2000, the Japanese government has invested in a number of acute care beds in hospitals, increasing the ratio to 13 acute beds per 1000 people in 2018, much higher than many Organization for Economic Cooperation and Development (OECD) countries. Insurance in Japan is mandatory for all citizens in the country, and everyone is requested to enroll in the national public medical insurance and pay their insurance premiums. What’s more, Japan established Health Insurance Societies, which are able to offer additional benefits depending on the circumstances of each society. Compared to most countries, healthcare costs in Japan are very low, just around US $200 every month. This is credited to the government’s strong subsidies for insurance coverage for Japanese residents. The Japanese government is also praised to be highly responsive to COVID-19 because they proactively acted to address the significant increase in COVID-19 in the country.

Healthcare in the Philippines varies across its 2000 inhabited islands, meaning healthcare inequality is an issue in the country. Northern areas, such as the capital Manila, are well-equipped with staff and healthcare facilities, while more remote parts of the country have low levels of resources and weak access to healthcare. Furthermore, the country has a low ratio of doctors to its population with only 0.6 doctors per every 1000 people. Even though there is a wide range of healthcare services provided, the costs of such services, especially medicine, are expensive. The country only spends 4.7 percent of its GDP on its healthcare sector, with a portion of the funds going towards the Philippine Health Insurance Corporation, also known as “PhilHealth.” The investments and the actions taken by the Philippines are insufficient, especially when facing important public health issues. Even though 90 percent of the population is registered for free healthcare under the national insurance program, the geographic barriers of the Philippines make it difficult to provide healthcare for all people across its 2000 inhabited islands. It’s necessary for the Philippines to address the problem of uneven distribution of healthcare resources and ensure that people are able to have enough access to healthcare resources, no matter what region they’re from.

Japan’s Assistance to the Philippines During the COVID-19 Pandemic
The weak healthcare system in the Philippines was also reflected in the country’s ineffective response to COVID-19. The Philippines fell to the last place in COVID-19 ranking of best and worst places to be in a pandemic. The government was criticized for its lack of urgency to address COVID-19 problems and implementing mass testing and contact tracing. Furthermore, the country had a lack of medical facilities, vaccines, and quarantine beds to address the national healthcare crisis during the pandemic. As a result of its disconnected islands and isolated location, quarantine facilities received insufficient support. Local governments alsodid not respond to the federal government requests to import medical and healthcare facilities to meet the needs of the entire population. The Japan International Cooperation Agency (JICA) provided financial support for the Philippines to bolster its response and management of COVID-19. JICA built partnerships with local hospitals in the Philippines to improve their capability in treatment, management, and detection of COVID-19 cases. The Philippines’ healthcare system tells us that the lack of resources as well as inadequate international support and aid can be especially harmful for developing countries that need to strengthen their healthcare sector. If the Philippines did not receive timely support from neighboring countries such as Japan, it would have had even greater difficulty addressing the issue of COVID-19 domestically. This suggests that international relations are important for most countries—assistance from more developed countries can help developing countries to tide over difficulties in their hardest time.

Other Japanese Support and Inspiration for the Philippines’ Healthcare Sector
The healthcare system of the Philippines has received support from other countries like China and Russia, and the international healthcare support is regarded to be one important approach for countries to build relationships and demonstrate their social responsibility. In February 2022, the Japanese government and the Asian Development Bank announced that they would provide a US $2 million technical aid package to support the healthcare system reforms in the Philippines. This aimed to build a universal healthcare program in the Philippines. Before this project, the Japanese government led Resilient Asia and the Pacific Funding to provide US $600 million to the Philippines to improve its healthcare system. Besides the financial fundings, this project would provide technical assistance to support the Philippines’ healthcare reformation. For instance, this program would register all Filipinos into “PhilHealth.” Furthermore, the Philippines’ government could learn from Japan to mobilize the revenue gained from charging tax from sweetened beverages, tobacco, and vapor products. This allows the government to have more funding to spend on healthcare initiatives, such as supporting students studying for careers in the medical field, which is a good way to increase the country’s low doctor to patient ratio. Learning from what Japan has done well in the healthcare sector can make up for the deficiencies in the Philippines’ policies and make the Philippines’ healthcare system better.

While countries have high healthcare coverage, the health care inequalities in the Philippines is an issue because the country does not provide equal access to healthcare across the country. Japan is a leading country with a large amount of government funding to support its healthcare system, whereas the Philippine country does not have a comparable financial situation. The close relationship between Japan and the Philippines can produce fruitful collaborations, especially with Japan taking the lead on sending monetary and technical assistance to the Philippines. The collaboration between the two nations shows how countries can cooperate to achieve win-win results and embrace a better future for all. For Japan, it needs to demonstrate its social responsibility as a big country. For the Philippines, it needs to gain cooperation from big countries to address its healthcare weaknesses and learn from what these big countries have done well to make up for its own shortcomings.