Japan
An ageing high-income system with universal insurance that built specialist palliative services through cancer-control law while therapeutic opioid use stayed low.
9 domains reviewed · 9 high-confidence · 0 dated estimates · 9 material gaps
WHO region: Western Pacific. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 24
- Newest source 2026
Lessons from Japan
- A rising share of patients on opioids can hide doses that stay too low. Track dose adequacy, not only prescription prevalence.200,201
- Cancer-control law and a national education program built hospital palliative teams, but community hospitals lagged. They need to be targeted directly.203,206
- A new fee for team-based palliative care changed nothing when few providers used it. Payment incentives need uptake support.204
- Japanese clinicians report preferring tramadol because it sits outside the licensing, training and storage rules that apply to narcotic opioids.270,272
- Admission rules that require diagnosis disclosure or agreement to a do-not-resuscitate policy can act as barriers to inpatient hospice.346
- Individualized letters or cards from palliative care staff are a low-cost form of bereavement care that families value.676
Palliative care
Is morphine available in Japan?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
The share of terminally ill cancer patients prescribed opioids rose over the decade to 2019, yet availability is described as extremely low, below the WHO adequacy measure in the early 2010s and varying by prefecture. Lower opioid doses were linked to more severe pain.200,201,202
How does national consumption after 2021 compare with the WHO adequacy measure?
Help answer it:Search PubMedHow does Japan regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
Narcotic opioids fall under the Narcotics and Psychotropics Control Act, and both the prescribing physician and the facility need a narcotics license. Tramadol and buprenorphine sit outside these rules, and clinicians report preferring tramadol for that reason. Pharmacies need a separate license to transfer narcotics between them; fewer than half of surveyed community cooperation pharmacies held one.270,271,272
What limits apply to prescription duration for narcotic opioids, and when did the rules last change?
Help answer it:Search PubMedWho can prescribe morphine in Japan?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
Only physicians may prescribe opioids, and a narcotics license is needed for narcotic opioids. Before 2016, physicians could bill the insurance fee for basic palliative care with opioid prescribing whether or not they had palliative training. Lack of professional training is named as the main barrier to opioid availability.201,270
How does palliative care reach patients in Japan?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
The Cancer Control Act has promoted palliative services nationwide. Specialist care runs through palliative care wards, hospital teams, outpatient clinics and home care, with designated cancer hospitals ahead of community hospitals.203,167
How large and widespread is specialist home palliative care today?
Help answer it:Search PubMedWho pays for palliative care in Japan?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
A 2018 insurance incentive for team-based palliative care in heart failure was rarely adopted and did not change end-of-life care. Palliative unit leaders report that non-cancer admissions are not covered on equal terms with cancer.204,205
How does insurance pay for home palliative care and hospital consultations outside cancer?
Help answer it:Search PubMedHow are palliative care clinicians trained in Japan?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Palliative care is not an independent specialty; the Japanese Society for Palliative Medicine awards an add-on certification after accredited training, restructured into three tiers in 2023. A nationwide workshop program trains non-specialist physicians.167,206
Will the tiered certification gain government specialty recognition?
Help answer it:Search PubMedHow does Japan prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Japan has good formulary availability of opioids for cancer pain, but prescribing stays low by international standards: 2.7% of the population received an opioid in 2015, the lowest of 19 jurisdictions. Among people who died of cancer, opioid prescription before death rose only from 60.8% to 65.9% between 2010 and 2019.200,674,675
Do Japan's narcotics licensing and prescriber rules, or clinician attitudes, explain why about one in three people dying of cancer receive no strong opioid, and what access exists to methadone or buprenorphine treatment and take-home naloxone for people with opioid use disorder?
Help answer it:Search PubMedHow do children get palliative care in Japan?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
An estimated 12% of children with cancer in Japan used hospital palliative care teams in 2015, and few teams had experience with children with non-cancer conditions. Care for non-cancer conditions is less developed, and most of these children die in hospital under intensive care. Families' wishes tend to come before the child's in decisions.678,679
How many children with non-cancer life-limiting conditions receive palliative care, and what is actual pediatric strong-opioid use now that national open data suppress most pediatric counts?
Help answer it:Search PubMedHospice care in Japan
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in Japan?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Japanese research uses "hospice" and "palliative care unit" (PCU) together, as in "inpatient hospice/palliative care units", so the terms are largely interchangeable. National evaluations cover hospital-based PCUs and separate home hospice services, and most participating institutions reported no religious affiliation.345,346
When were the first hospice/PCU wards opened and when did national insurance begin paying for them, according to peer-reviewed sources?
Help answer it:Search PubMedWho can get hospice care in Japan?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
In a 2014 survey of all 251 PCUs, the most common admission condition (86%) was that the patient or family knows the diagnosis, and 71% required the patient or a family member to agree to a do-not-resuscitate policy. Units prioritized people who had waited a long time after applying, pointing to waiting lists.346
Are PCU admissions formally restricted to cancer (and AIDS), and how many days before death do patients typically arrive?
Help answer it:Search PubMedWho pays for hospice care in Japan?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
PCU care is paid through public health insurance at a national per-day rate, reported as JPY 51350 per day for Days 1-30 and JPY 45820 per day for Days 31-60. Hospitals must meet facility criteria to bill PCU inpatient charges, and some services such as disease rehabilitation are not separately reimbursable there.347,348
What share of hospice costs, such as room charges, fall on patients out of pocket?
Help answer it:Search PubMedHow many people reach hospice in Japan?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
A 2025 nationwide survey identified 462 hospitals meeting the facility criteria for PCU inpatient charges. In a national bereavement survey, patients with hematological malignancies were less likely to die in PCUs than those with solid tumors.348,349
What share of all deaths, and of non-cancer deaths, occur in PCUs or with home hospice support?
Help answer it:Search PubMedWhat fills the gap in Japan
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
In a nationwide survey of 532 bereaved families who used home care services, 60% of family caregivers had sleeplessness and 35% depressed mood in the last month of the patient's life. Being the patient's spouse was linked to caregiver psychological symptoms.502
National evidence- Faith communities
Rinsho-shukyo-shi, Japanese interfaith chaplains, provide religious and spiritual care in some settings. In one university hospital palliative care unit, 10 of 15 patients interviewed said the chaplain's role was necessary for end-of-life care.503
Single-site evidence
Sources cited here
- 200Takahashi R, Miyashita M, Murakami Y, et al.
Trends in strong opioid prescription for cancer patients in Japan from 2010 to 2019: an analysis with large medical claims data. Japanese Journal of Clinical Oncology 2022;52(11):1297-1302. Opioid prescription prevalence for terminally ill cancer patients rose; oxycodone grew most. Abstract read.
- 201Hasegawa-Moriyama M, Morioka Y, Hiroi S, et al.
High prevalence of severe pain is associated with low opioid availability in patients with advanced cancer: Combined database study and nationwide questionnaire survey in Japan. Neuropsychopharmacology Reports 2024;44(3):502-511. Availability extremely low, below the WHO adequacy measure in the early 2010s; prefectural variation; training named as the main barrier; insurance fee for basic palliative care before 2016. Abstract and full text read. Industry-affiliated authors.
- 202Shoji T, Akazawa M, Nakagomi N, et al.
Trends of Strong and Weak Opioid Prescriptions in Japan: A Cross-Sectional Study Based on Open Data from the National Database and Hospital Claims Data from Fiscal Years 2015 to 2021. Biological and Pharmaceutical Bulletin 2025;48(3):279-285. Inpatient use fell, outpatient use rose, tramadol grew. Abstract read.
- 270Smith Cavalcante J, Kunisawa S, Fushimi K, et al.
Opioid use in postoperative pain management of pediatric appendectomy patients in Japan. Journal of Anesthesia 2025;39(5):741-749. Discussion describes narcotic licensing for physicians and facilities under the Narcotics and Psychotropics Control Act. Full text read; regulatory description is secondary to the study.
- 271Nagatani K, Nakahara M, Omotani S, Myotoku M
Questionnaire on the current status and awareness of palliative medicine by community cooperation pharmacies. Pharmacy (Basel) 2024;12(4). Kinki region survey; 2021 pharmacy certification requires a narcotics dispensing system; transfer licenses held by a minority. Full text read.
- 272Dowd LA, Hamada S, Hattori Y, et al.
A mixed-methods study on the pharmacological management of pain in Australian and Japanese nursing homes. Age and Ageing 2024;53(2). Japanese clinicians describe prescriber training, registration and storage rules as opioid barriers; tramadol preferred. Focus group perceptions. Full text read.
- 203Nakazawa Y, Kato M, Miyashita M, et al.
Growth and Challenges in Hospital Palliative Cancer Care Services: An Analysis of Nationwide Surveys Over a Decade in Japan. Journal of Pain and Symptom Management 2021;61(6):1155-1164. Cancer Control Act has promoted services nationwide; designated cancer hospitals developed, community hospitals lag. Abstract read.
- 167Oh SN, Kim SH, Lee MA, et al.
The Hospice and Palliative Medicine Physicians Certification Programs across Countries/Regions. Journal of Hospice and Palliative Care 2025;28(2):31-39. Review of certification in the United States, United Kingdom, Australia, Japan, Taiwan, Hong Kong and South Korea. Abstract and full text read.
- 204Morita K, Miyamoto Y, Mizuno A, et al.
Impact of a financial incentive scheme for team-based palliative care in patients with heart failure in Japan: A nationwide database study. International Journal of Cardiology 2023;387:131145. April 2018 incentive rarely adopted and not associated with changes in end-of-life care. Abstract read.
- 205Hamano J, Shima Y, Kizawa Y.
Current situation and support need for non-cancer patients' admission to inpatient hospices/palliative care units in Japan: a nationwide multicenter survey. Annals of Palliative Medicine 2023;12(1):81-89. Unit leaders call for non-cancer coverage equal to cancer. Abstract read.
- 206Inoue A, Yamaguchi T, Tanaka K, et al.
Benefits of a Nationwide Palliative Care Education Program on Lung Cancer Physicians. Internal Medicine 2019;58(10):1399-1403. The national PEACE program improved knowledge and practice. Abstract read.
- 674Chan AYL, Bahmanyar S, Beyene K, et al.
International Trends in Opioid Prescribing by Age and Sex from 2001 to 2019: An Observational Study Using Population-Based Databases from 18 Countries and One Special Administrative Region. CNS Drugs 2025;39(11):1173-1185. Multinational database study; 2015 opioid prescribing prevalence was lowest in Japan (2.7%) and South Korea had the largest annual rise; indications were not captured. Abstract read.
- 675Cleary J, Radbruch L, Torode J, et al.
Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Asia: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2013;24 Suppl 11:xi24-32. 20-country survey of opioid formularies and regulation in Asia; notes Japan and South Korea as exceptions to low availability; produced by an access-advocacy initiative. Abstract read.
- 676Sakai Y, Kitae M, Masukawa K, et al.
The Desirable Approach to Sending Letters and Cards and Holding Memorial Services: Recommendations for Bereavement Care in Hospice and Palliative Care Unit Settings. Am J Hosp Palliat Care 2026. Nationwide J-HOPE4 bereaved-family survey (563 respondents) on letters, cards and memorial services from palliative care units. Abstract read.
- 677Fujisawa D, Ito M, Nakajima S, et al.
Associations between grief, depression, and productivity loss among the bereaved families of individuals with cancer. PCN Rep 2025;4(4):e70266. Nationwide J-HOPE-4 survey of 902 bereaved families from palliative care units measuring prolonged grief and depression. Abstract read.
- 678Yotani N, Kizawa Y
Specialist Palliative Care Service for Children With Life-Threatening Conditions: A Nationwide Survey of Availability and Utilization. J Pain Symptom Manage 2018;56(4):582-587. National survey of cancer centers, children's cancer centers and palliative care units estimating use of specialist palliative care by children in 2015. Abstract read.
- 679Yotani N
Current status of pediatric palliative care and decision making in Japan. Curr Probl Pediatr Adolesc Health Care 2024;54(1):101557. Single-author narrative review of pediatric palliative care and decision making in Japan. Abstract read.
- 345Aoyama M, Morita T, Kizawa Y, et al.
The Japan HOspice and Palliative Care Evaluation Study 3: Study Design, Characteristics of Participants and Participating Institutions, and Response Rates. Am J Hosp Palliat Care 2016;34(7):654-664. Design paper of a nationwide bereaved-family survey covering 20 acute hospitals, 133 inpatient hospice/palliative care units and 22 home hospice services in Japan (2014); describes institutional characteristics including religious affiliation. Abstract read.
- 346Kizawa Y, Yamaguchi T, Yagi Y, et al.
Conditions, possibility and priority for admission into inpatient hospice/palliative care units in Japan: a nationwide survey. Jpn J Clin Oncol 2021;51(9):1437-1443. Nationwide survey of responsible physicians at all 251 PCUs in Japan (2014; 76% response) on admission conditions including diagnosis disclosure and DNR agreement. Abstract read.
- 347Sasahara T, Ogasawara T, Hamano J, et al.
Public insurance costs of end-of-life care in hospice residential facilities in Japan: an exploratory comparison with palliative care units. Jpn J Clin Oncol 2026. Exploratory cost estimate for eight cancer patients in hospice residential facilities compared with national per-day reimbursement rates for palliative care units; very small sample; co-authors affiliated with private companies in the hospice and palliative care sector (Family Hospice Inc., Palliative Care Partners Co.), a potential industry conflict. Abstract read.
- 348Fukushima T, Tsuji T, Takashima K, et al.
The current status of cancer rehabilitation provided by palliative care units in Japan: a nationwide survey. BMC Cancer 2025;25(1):451. Nationwide survey of the 462 hospitals meeting the facility criteria for PCU inpatient charges in Japan (58.0% response), documenting fee-schedule limits on rehabilitation. Abstract read.
- 349Ikeda S, Hiratsuka Y, Nakazawa Y, et al.
Comparing the quality of dying for patients with hematological malignancy and solid tumors: A bereavement study in Japan. Cancer 2026;132(9):e70438. Secondary analysis of a nationwide bereaved-family mortality survey (2017-2018) finding patients with hematological malignancies were less likely to die in palliative care units than those with solid tumors. Abstract read.
- 502Kobayakawa M, Ogawa A, Konno M, et al.
Psychological and psychiatric symptoms of terminally ill patients with cancer and their family caregivers in the home-care setting: A nation-wide survey from the perspective of bereaved family members in Japan. J Psychosom Res 2017;103:127-132. Nationwide bereaved-family survey (J-HOPE3), 532 families using home care services. Abstract read.
- 503Hiratsuka Y, Aoyama M, Kaneta T, et al.
Impressions of Interfaith Chaplain's Activities among Patients in a Palliative Care Unit: A Semi-Structured Interview-Based Qualitative Study. Tohoku J Exp Med 2020;251(2):91-96. Interviews with 15 advanced cancer patients in one palliative care unit at Tohoku University Hospital. Abstract read.