Revisiting the classification of the Japanese welfare state and healthcare system

Lin, Hongyi ORCID: 0009-0003-9637-8314 (2025). Revisiting the classification of the Japanese welfare state and healthcare system. University of Birmingham. Ph.D.

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Abstract

The study of the patterns of welfare states initiated by Esping-Andersen’s path-breaking typology has become popular among academia since the 1990s. In Esping-Andersen’s welfare regime typology, Japan was the only welfare state outside the Western world. Using the three types of welfare regimes proposed by Esping-Andersen, Japan was classified as liberal, conservative, or a hybrid by researchers. However, the classification of the only non-Western case triggered debate. Following this ongoing welfare modelling business, various classifications of the Japanese welfare state have been developed in addition to Esping-Andersen’s framework: a fourth familialism world, a member of the East Asian welfare model, or a unique welfare state. In addition to this unsolved puzzle of classifying the Japanese welfare state, Esping-Andersen mainly focused on income maintenance without paying sufficient attention to healthcare in his welfare regime typology. Analysts of comparative healthcare systems developed another trend of typologies concentrating on healthcare systems. Although there was an absence of a framework for classifying the healthcare system, Japan tended to be classified as a Bismarckian healthcare system (i.e., the social insurance model). There was less attention given to Japan in healthcare system typologies as it was in welfare regime studies. This thesis aims to provide an up-to-date classification of the Japanese welfare state and healthcare system by using hierarchical cluster analysis and fuzzy cluster analysis. The combination of two types of cluster analysis not only established the classification of Japan but also revealed the membership degree of Japan, which was particularly useful to analyse a hybrid case. The results showed that the Japanese welfare state seemed to be a hybrid with a weak tendency to be grouped with other conservative welfare regimes, while the healthcare system was closer to other Bismarckian healthcare systems. Furthermore, welfare regime typologies and healthcare system typologies were developed separately. This thesis attempted to connect the literature on welfare regime typologies and healthcare system typologies by applying the concept of elective affinity. Bridging these two streams of classification also contributes to the consistency issue between different policy sectors within the broader welfare state. The results of cluster analysis showed that the welfare regime and the healthcare system were relatively consistent in Japan.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):