MartiniLush had asked me about healthcare in Japan and I never got the chance to give a more detail overview. I was skimming the news just now and I saw that NYT had a pretty good article on it so I thought I shared.
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Health Care Abroad: Japan
By Sarah Arnquist
John Creighton Campbell is professor emeritus of political science at the University of Michigan and a visiting researcher at the Tokyo University Institute of Gerontology. He co-authored “The Art of Balance in Health Policy: Maintaining Japan’s Low-Cost, Egalitarian System” (Cambridge University Press, 1998). Dr. Campbell spoke with the freelance writer Sarah Arnquist.
This is the second in an occasional series of posts briefly describing health care delivery in other countries. The first post discussed Canada.
BY THE NUMBERS
Japan
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- Life expectancy: 83 years
- Infant mortality: 3 per 1,000 live births
- Health spending as a percentage of GDP: 8
- Percentage of health spending that is private: 18
- Doctors per 10,000 people: 21
Source: World Health Organization. U.S. statistics.
Q.
How does the Japanese system provide health care at lower cost than the American system?
A.
Japan has about the lowest per capita health care costs among the advanced nations of the world, and its population is the healthiest. That is largely due to lifestyle factors, such as low rates of obesity and violence, but the widespread availability of high-quality health care is also important. Everyone in Japan is covered by insurance for medical and dental care and drugs. People pay premiums proportional to their income to join the insurance pool determined by their place of work or residence. Insurers do not compete, and they all cover the same services and drugs for the same price, so the paperwork is minimal. Patients freely choose their providers, and doctors freely choose the procedures, tests and medications for their patients.
Reimbursement rates to doctors and hospitals are negotiated and set every two years. The fees are quite low, often one-third to one-half of prices in the United States. Relatively speaking, primary care is more profitable than highly specialized care, so Japanese doctors face different incentives than U.S. doctors. As a result, the Japanese are three times more likely than Americans to go to the doctor, but they receive many fewer surgical operations.
Q.
What does the Japanese health system do particularly well?
A.
First, Japan is egalitarian and medical bankruptcy is unknown. An individual’s income influences the quantity and quality of medical care probably less than in any other country. Premiums and out-of-pocket costs are minor concerns for most, and low-income people and the elderly receive subsidies to afford care.
Second, the Japanese system is quite good for chronic care, particularly because it has so many older people. Along with appropriate medical care, Japan also provides long-term care to all older people who need it through a public insurance system that started in 2000.
Q.
What is your biggest criticism of it?
A.
Financial stringency and organizational rigidities have led to inadequate hospital services in some areas, particularly in emergency care, where patients in ambulances are sometimes turned away. There also are doctor shortages in some regions and specialties. Consultation times can be too short for complicated diagnoses and for psychotherapy. Specialized training and certification for physicians should be better, and cutting-edge surgical techniques should be more available.
Many of the problems are largely due to underinvestment, and the severity of the cost control has become an issue in the current election campaign.
Q.
What is the most important lesson Americans should learn from the Japanese system?
A.
In the 1980s, health care spending was increasing as quickly in Japan as in America, but the Japanese government learned how to influence medical care provision without rationing by manipulating how it paid for services. Annual spending growth has thus been quite low despite a rapidly aging population. Including everyone in a controllable system was a prerequisite. Japan is not a single-payer system, but like France and Germany, it has been able to control costs by tightly regulating multiple
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Source
Ok this article doesn't really go into the full scale of exactly how things work here. Please keep in mind that one of the reason why healthcare is so low in Japan in comparison to the US, is because the people here live a relatively healthier lifestyle . Most people still walk everywhere, catch the trains, bus, and while a good portion of the population do have cars, people generally only drive if there's an absolute need for it. Where as in the US, about 60 % of the population are medically obese, consume too much food, especially fatty food, will drive rather than walk, and diabetes and other preventable diseases are ridiculous high. So while healthcare is not perfect anywhere, I think we can learn from a system like Japan's or Singapore and if we are to truly impletement healthcare in the US. However IMO healthcare reform should start at the home.
Jaeger
Here are things I gleaned from this post:
- paperwork is minimal
- People pay premiums proportional to their income to join the insurance pool determined by their place of work or residence.
- Financial stringency and organizational rigidities have led to inadequate hospital services in some areas, particularly in emergency care, where patients in ambulances are sometimes turned away.
- Consultation times can be too short for complicated diagnoses and for psychotherapy.
- There also are doctor shortages in some regions and specialties.
- Most people still walk everywhere, catch the trains, bus, and while a good portion of the population do have cars, people generally only drive if there's an absolute need for it.
- healthcare reform should start at the home.
A big questions I have with this article is
- What is the rate of lawsuits per dollar brought in by the doctors in Japan?
- What sort of R&D do companies in the Japanese medical industry do, if any?
The Japanese people walk almost everywhere, and they can do that in a country that is that size. That doesn't work in a country the size of the U.S.A. I agree that we need to live a healthier lifestyle, and preventative medicine will help lead to smaller hospital bills, but we've got to lower the overhead for hospitals and doctors before they can reasonably lower their prices. They lower their prices, and the insurance companies can lower their premiums. Allow Insurance companies to cross state lines to increase their pools, and those premiums go down even more. Let's also look into oversight for those insurance companies. If they have a high paid CEO, there should be sound reasoning behind it.
1Dave the last part was written by me not the author of the article since I'm living Japan right now and have before when I was younger. The country is a small however only a few cities, well they're called prefectures here, are metropolitan with large populations like Osaka, Tokyo. But most cities in the US are metropolitan and people still rather take their cars to drive a short 1/2 mile than walk.
There are regions where doctors shortage are because the inhabitants population are relatively low there, so having say a general hospital in that region is not very likely and if there is one, they are usually small and wouldn't be adequate to fulling a massive load of emergency like earthquakes and typhoons which is a patient could be turned away. It's actually pretty rare for a hospital to refuse to see a patient and if they do, they will referred them to another hospital that usually will take them.
And no there aren't any medical malpractice lawsuits that's been file, for as long as I can remember. The system isn't perfect but it's works for them and has been working for a long time. And I personally do believe that healthcare reform should start in the home. We're the ones who's ultimately responsible for our healthcare. Not the government, doctors, nurses, etc. You want to be healthy and avoid preventable diseases then start live a healthier lifestyle.
2Good points unDave. I think we can glean information from many sources in order to build better healthcare here in America. A healthier life style is the answer but somehow I don't see Americans moving from french fries to rice. It would be better if they did. I can't remember the last time I had a french fry but I have rice twice a week.
3Baby steps.
Medical malpractice insurance and litigation has a huge impact on how much we pay for healthcare.
4true cheeky but there aren't any here in Japan. Not to say that doctors are freaking perfect and I'm sure it's lack of being able to afford a lawyer, but for the most part, people here are very happy with their healthcare and wouldn't change it for a more American based system, at all.
5Thanks very much for this Myst!
6This is a good article, I agree.
7The point we're trying to make is that if we reduce the amount of malpractice lawsuits, and the amount a person is able to sue for, then we reduce the malpractice insurance. Some doctors pay over $250,000 in malpractice insurance. How many patients does that doctor have to see each day to make up for that? Who ends up paying for that? His patients, and the medical center. How does the medical center cover their costs (and their own malpractice insurance)? They pass it on to the patient. The healthcare system in Japan sounds good, but ours is essentially just as good. We need to tweak several areas which will help us cut costs, but it's ridiculous to throw out a good system because a few things are messed up.
Thanks for posting this, Myst!
I think the big thing for me in this is that the health of the population plays a large role in cutting medical costs. We need to take more personal responsibility for our health here.
Dave, very good point about the malpractice insurance here - I have several friends who are doctors, and their premiums are insane! And I have a friend who is entering med school and was going to specialize in OB-GYN, until she found out what she would have to pay for malpractice insurance!
8This is one of the reasons I am moving into anesthesiology. Malpractice is astounding...and it is the ball that rolls downhill---and that hill is steep.
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