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Health Care in Japan
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Examines the Japanese health care system to determine its structure, costs, & success in reaching a wide population.... More...
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Paper Abstract:
Examines the Japanese health care system to determine its structure, costs, & success in reaching a wide population.
Paper Introduction:
INTRODUCTION
The health care system in modern Japan has long been supported by government and private companies which have offered assistance for the ill or otherwise disabled and for the old. Beginning in the 1920s, the government enacted a series of welfare programs that were based primarily on European models and that provided medical care and financial support to those in need. The insurance systems in Japan are complex and involve a mixture of public and private funding. The health care system in Japan will be examined to determine its structure, its costs, and its success at reaching the widest population.
OVERVIEW
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(1992). Both in-patient andout-patient care are provided. A fund was established in 1988 to providefinancial compensation for AIDS patients, and it is underwritten bypharmaceutical companies that distributed imported blood products (Dolan &Worden, pp. Medical insurance, healthcare for the elderly, and public health expenses constituted about 6 percent of social welfare and security costs in 1975, while governmentpensions account for the other 2 percent. Rubinstein (1989) notes that the U.S. Beginning in the 192 s, thegovernment enacted a series of welfare programs that were based primarilyon European models and that provided medical care and financial support tothose in need. By 198 , pensions accounted fornearly 5 percent because people were living longer after retirement. It has been noted that daily hygienic behavior and the conceptsunderlying it, as perceived and expressed in terms of biomedical germtheory, are in fact tied to the basic Japanese symbolic structure. does not have the excessivehospital capacity that has been claimed and that our bed-per-populationfigure is less than half that of Japan, while total admissions as apercentage of population, or the admission rate, is nearly three times thatof Japan (p. Ikegami (1992) further notes that equity is achieved in the system bynot allowing providers or insurers the freedom to negotiate for morefavorable arrangements regarding costs or quality. There are inequitiesinherent in copayment rates that are largely mitigated by the providingthat any out-of-pocket copayment faced by a patient in a given month over acertain amount is reimbursed regardless of the plan. There are alsomore than 2 , people licensed to practice massage, acupuncture,moxibustion, and other East Asian therapeutic methods. Another 29 percent of cases werehomosexual, and the remaining 13 percent were infected through heterosexualintercourse. The present level of equity, says Ikegami, was achieved through aslow process that started by extending the population insured and then byleveling the inequities between the plans. L. Thesystem has an especially highly developed screening process, and today theJapan Society of School Health performs mass screening for heart diseasessuch as congenital heart diseases, acquired heart diseases, andarrhythmias; respiratory diseases such as tuberculosis and asthma; andrenal diseases such as hephritis and nephrosis. 11.Shulkin, D. Japanese health professionals, like health professionals all over theworld, have been concerned by the AIDS epidemic, though the number of casesin Japan remains small by international standards. In spite ofthe fee-for-service form of payment, the costs of the system have beencontained through the use of a nationally uniform fee schedule that ismandatory to all providers. The main components of this system are health education andhealth services, as well as health aspects of the school environment. It providesrelative equality of access, with fees set by a government committee.People who do not have insurance through their employers could participatein a national health insurance program administered by the localgovernments. Health insurance was first madeavailable in Japan in 1927 for manual workers employed in large companies.This was done by the establishment of the Insurance Societies. This pays for all health care costs incurredby the elderly, regardless of the plan. The practice of biomedicinewas influenced as well by Japanese social organization and culturalexpectations concerning education, the organization of the workplace, andsocial relations of status and dependency, decision-making styles, andideas about the human body, causes of illness, gender, individualism, andprivacy. For those employed in small enterprises and day labor,the insurer is again the central government, which also provides a subsidyamounting to 14 percent of total expenditure. (1989, September). Japan also has a social welfare system that is connected to thehealth care system, and both have been shaped for the 199 s and beyond bythe growth in the size of the aging population. 123-124). As the population ages, the healthcare system will be more and more tested. Officials anticipated a fourfold increase by the end of 1992.Japanese statistics on the transmission of the disease differ from those ofother countries to a significant degree. The system supported by the health insurance plan includes more than1, mental hospitals, 8,7 general hospitals, and 1, comprehensivehospitals with a total capacity of 1.5 million beds. Most Japanese were unconcerned with the danger of contractingthe disease themselves, though they were frightened of the disease andsympathetic to the plight of the hemophiliacs who had contracted it.Various levels of government responded to the introduction of AIDS into theheterosexual population by establishing government committees, mandatingAIDS education, and advising testing for the general public withouttargeting special groups. Japan: Perspectives in school health. 124). Japan's health care: Cradle, grave and no frills. Japanese policymakers and administrators also were considering ways of unifying thevarious insurance systems to control costs (Dolan & Worden, p. Japanesephysicians indeed see controls on their activities as something abhorrent(pp. (1992, December 28). The Japanese system can thus be seen as offering health care from thecradle to the grave. Japan's gross national health indices arethe best in the world: the infant mortality rate is .46 percent of livebirths and the life expectancy at birth is 75.9 for males and 81.8 forfemales. 11). The system has produced one ofthe healthiest societies in the world as well, and it has managed toaccomplish this while making the financial burden on corporationsrelatively light - Japanese companies pay about one-fifth of what Americancompanies pay for employee health insurance. Thissituation will only increase - it is expected that the portion of thepopulation 65 or older will double, from the present 12 percent to 25percent of the population, within another 3 years. The system, also has more than191,4 physicians, 66,8 dentists, and 333, nurses. The most expensive component of the health care system is geriatriccare and is paid for by contributions to the pooling fund created by theGeriatric Health Act in 1982. Chinese-styleherbalists have been required to be licensed medical doctors since about19 , and training was professionalized and, except for East Asian healers,was based on a biomedical model of disease. The problems include issues ofquality of care which may be difficult to address in the Japanese contextbut are more easily addressed in the American. This means that emulating thoseaspects of the Japanese system that we may admire will be more difficultfor us than it was for the Japanese, who spread the pain over a longerperiod of time. 614-615).OUTLOOK Anderson (1991) cites the Japanese health care system as one of thosethat are undergoing reevaluation and change as a result of changedcircumstances in society. Mostphysicians and hospitals sell medicine directly to patients, but there arealso over 36, pharmacies providing patients with the opportunity topurchase synthetic or herbal medication. 125).CONCLUSION The Japanese system may offer lessons for any American health caresystem we devise to try to achieve the same ends - universal health care.The system shows that one of the basic concerns in such a system is that itwill be affected by its own success. The present system is 3 years old, and it is now facing a challenge because of the rapid growth inthe number of retirees healthy enough to peddle a bicycle to the hospitalbut old enough to need large doses of expensive medical care. Two systems in change: Japan and the Netherlands. The health care system in Japanwill be examined to determine its structure, its costs, and its success atreaching the widest population.OVERVIEW Most postwar Japanese have relied on personal savings and the supportof the family for health care, but as noted, the government and privatecompanies do provide assistance as needed. Japan: A country study. 34-35). The health of nations. 22). Fifty-eight percent of reportedcases were hemophiliacs, tainted with the disease by imported bloodproducts that had the virus in them. It is seen as one of the most comprehensive andefficient health care systems in the world. However, it was rapidly rebuilt after the war by anew commitment to establish a welfare state. Payment for personal medical serviceshas been offered through a universal medical insurance system. American Medical News, 34, 22.Sterngold, J. J. The first confirmedcase of AIDS in Japan was reported in 1985, but by August 1989 there were1 8 confirmed cases and between 1, and 2,5 others infected with thevirus. To this pooling fund, each plansubmits a sum that would have been paid for the health spending of theelderly insured in their plan. Washington, D.C.: Federal Research Division, Library of Congress.Grunbaum, J., & Labarthe, D. The person who becomes ill inJapan faces several options, including a variety of religious-based andfolk remedies; traditional healers such as herbalists, masseurs, andacupuncturists; and Western biomedicine, the latter of which has dominatedJapanese medical care in the postwar period. 124-125).FINANCES Shulkin (1991) points out that the Japanese system of health caredelivery is not as good as the American system, where technology is better,treatment more comprehensive, and health education of a higher caliber.One area where the Japanese are clearly ahead is in financing the system,and the Japanese have found a way to provide universal health care atsignificantly less expense than the United States. Journal of School Health, 6 , 33 -337.Ikegami, N. Hospitals, 65, 34-36.Dolan, R. The New York Times, A1, A8.----------------------- 11 The Japanese have addressed their system's economics to a highdegree, and by broad measures of performance the system has been seen tohave achieved a great success. National Health Insurance is the insurer for the self-employed and pensioners who tend to be most at risk and have the lowestlevel of income, and in this plan the local government acts as the insurerwhile the central government provides a direct subsidy amounting to half oftotal expenditures. (1991, May 2 ). Out-of-pocketexpenses for copayments therefore amount to only 12 percent of the totalhealth care expenditure provided under social insurance. Screening for heart diseases includeselectrocardiography (ECG) and phonocardiography (PCG) (Grunbaum &Labarthe, 199 , p. The Economics of Health Care in Japan," Science, 258, 614-618.Rubinstein, E. Bythe next century, it is projected that there will be a fourfold increase inworkers' individual contributions (Dolan & Worden, p. (1991, March 11). (199 , September). Thereare imbalances that need to be addressed - the nation has too manyhospitals, and patients stay for extended periods because of a lack of long-term care facilities. The system balancesuniversal coverage at reasonable cost, and the government has taken on theresponsibility of acting as insurer and subsidizer of health care spendingfor the employees of small enterprises and the self-employed. All elderly persons have been covered by government-sponsoredinsurance since 1973. Government officials today are considering everyconceivable type of reform to improve the system and cut costs. ReferencesAnderson, H. A school health system had been established in Japan under nationallegislation as part of a tradition extending back to the nineteenthcentury. Funding is a greaterproblem in the American system, and the Japanese system developed over aperiod of decades and did not try to provide universal health care all atonce as we seem to be trying to do. R. Inresponse to these problems, government and professional circles in the late198 s were considering changing the system so that primary, secondary, andtertiary levels of care would be clearly distinguished within eachgeographical region. A 1988 Tokyosurvey shows that neither the utilization rate nor the health careexpenditure per person was affected by an individual's level of income.Equity in this system is achieved primarily through the fact that thegovernment takes on the responsibility by providing subsidies and managingthese plans. National Review, p. (1992, October 23). The portion of totalmedical costs that go for the aged population is expected to rise from 17.8percent in 198 to 37 percent in the year 2 and 41 percent in 2 1 (Sterngold, 1992, A1, A8). Another problem emerging in the late 198 s was an unevendistribution of health personnel, with cities favored over rural areas. National health expenditures in Japan rose from one trillion yen in1965 to over 18 trillion yen in 1987, or from slightly more than fivepercent to almost seven percent of the national income of Japan. There is little regulation of the quality of careprovided by physicians, and this is an area of growing concern. Japan indeed, at afraction of national revenues, spends less on medical care than any Westerncountry, and with few restrictions and a fee-for-service system, Japanesepatients have three times as many physician encounters at one-third thecost (p. Facilities would then be designated by level of care,with referrals required to obtain more complex care. The systemdeveloped to a considerable degree by 194 , but it was nearly destroyed bydefeat in World War II. There are also 79, clinics offeringprimarily out-patient care, and there are 48, dental clinics. Let's clean up medicine's act before the Japanese do. Recently, though, the increasingly affluentand aging population has made new demands on the system, and these can onlybe met by major restructuring. E., & Worden, R. This amount has been standardized so thatthe plan's ratio of the elderly would become equivalent to the ratio of thewhole country. The system offers universal coverage with virtually unlimitedaccess to all health care facilities in the country. Still, the system has much to offer in the way of lessonsabout how to achieve the desired goal. Mass screening for heartdisease tries to offer accurate diagnosis and systematic control of heartdisease in the school population. Under these plans, patients could choose thephysicians or facilities of their choice (Dolan & Worden, 1992, pp. INTRODUCTION The health care system in modern Japan has long been supported bygovernment and private companies which have offered assistance for the illor otherwise disabled and for the old. Thesystem has encountered cost control problems and has also been troubledwith excessive paperwork, long waits to see physicians, assembly-line carefor out-patients (because few facilities make appointments),overmedication, and abuse of the system because of low out-of-pocket coststo patients. No plan is penalized or rewarded by the ratio of theelderly it has insured, leading to equitable distribution of the burden.The central and local governments contribute 2 percent and 1 percent,respectively, of the pooling fund's total expenditure. Japan has public healthservices such as free screening examinations for particular diseases,prenatal care, and infectious disease control, and these are paid for bythe national and local governments. Someanalysts believe there will be a greater move toward managed care. J. The insurance systems in Japan are complex and involve amixture of public and private funding. 33 ). Under Article 25 of the newconstitution of 1947, the government had the responsibility to provide anadequate minimum for realizing a healthy and culturally enriching life.Universal coverage came in 1961 through a combination of governmentsubsidies and legislation, and in the years since there has been greaterequality among the plans (Ikegami, pp.
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