Japan needs to shift to a more structured health system, promoting differentiation of functions (primary care, acute care and long-term care, for example) while assuring mutual collaboration to ensure that peoples’ needs can be met by the most appropriate service, in a co-ordinated manner if needed. As this differentiation occurs, the infrastructure to monitor and improve the quality of care must simultaneously deepen and become embedded at every level of governance -institutionally, regionally and nationally. As well as long life expectancy, some indicators of the quality of health care are amongst the best in the OECD. Five-year relative survival estimates after a diagnosis of breast, cervical or colorectal cancer are all high, for example, and 30-day case fatality after an ischaemic stroke is the lowest in the OECD, at 3%.