Healthcare in Japan

The health care system in Japan provides different types of services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered by a universal health care insurance system that provides relative equality of access, with fees set by a government committee. All residents of Japan are required by the law to have health insurance coverage. People without insurance from employers can participate in a national health insurance program, administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profits and be managed by physicians.

Medical fees are strictly regulated by the government to keep them affordable. Depending on the family's income and the age of the insured, patients are responsible for paying 10%, 20%, or 30% of medical fees, with the government paying the remaining fee. Also, monthly thresholds are set for each household, again depending on income and age, and medical fees exceeding the threshold are waived or reimbursed by the government. Uninsured patients are responsible for paying 100% of their medical fees, but fees are waived for low-income households receiving a government subsidy.

Provision

People in Japan have the longest life expectancy at birth of those in any country in the world. This was achieved in a fairly short time through a rapid reduction in mortality rates secondary to communicable diseases from the 1950s to the early 1960s, followed by a large reduction in stroke mortality rates after the mid-60s.

Staffing per bed is very low. There are four times more MRI scanners per head, and six times the number of CT scanners, compared with the average European provision. The average patient visits a doctor 13 times a year - more than double the average for OECD countries.

Physicians and nurses are licensed for life with no requirement for license renewal, continuing medical or nursing education, and no peer or utilization review. Unlike many countries, Japanese citizens do not usually have one dedicated family physician as you might find in Canada or the United States. The closest one would be internal medicine physicians clinic but they normally don’t deal with surgery cases. There are comparatively very few general practitioners since most physicians have a sub-specialty. You go directly to the specialist you need for your illness.

Many other countries have an urban-rural divide wherein physicians flock to the cities and prefer working in urban areas over rural locations. But in Japan, the opposite can be observed. There is an uneven distribution of physicians benefiting rural areas over urban ones. Physicians prefer being assigned to rural areas, saying they experience a higher quality of life outside of metropolitan areas and a less stressful work environment.

Quality

Japanese outcomes for high-level medical treatment of physical health are generally competitive with those of the US. Japan excels in the five-year survival rates of colon cancer, lung cancer, pancreatic cancer and liver cancer based on the comparison of a report by the American Association of Oncology and another report by the Japan Foundation for the Promotion of Cancer Research. The same comparison shows that the US excels in the five-year survival of rectal cancer, breast cancer, prostate cancer and malignant lymphoma. Surgical outcomes tend to be better in Japan for most cancers while overall survival tends to be longer in the US due to the more aggressive use of chemotherapy in late-stage cancers.

In contrast to physical health care, the quality of mental health care in Japan is relatively low compared to most other developed countries. Despite reforms, Japan's psychiatric hospitals continue to largely rely on outdated methods of patient control, with their rates of compulsory medication, isolation (solitary confinement) and physical restraints (tying patients to beds) much higher than in other countries.

The cost of medical appointments and hospital visits is determined by a government committee that includes physicians among its members. Every two years, fees are adjusted based on the committee’s recommendations. This allows the government to respond appropriately to changes in the economy to ensure healthcare remains affordable.

Japan’s 47 regions are responsible for implementing the rules, regulations, and fees schedule. They also have the flexibility to establish their local budget to reflect and respond to regional health concerns. One problem with the quality of Japanese medical care is the lack of transparency when medical errors occur. In 2015 Japan introduced a law to require hospitals to conduct reviews of patient care for any unexpected deaths and to provide the reports to the next of kin and a third party organization. However, it is up to the hospital to decide whether the death was unexpected.

It is important to have efficiency in sending patients to the correct medical location because there is an understaffing problem. Around 92% of hospitals in Japan have an insufficient number of doctors while having sufficient nurses. While only 10% of hospitals have a sufficient number of doctors and an insufficient number of nurses. 

Access

In Japan, services are provided either through regional/national public hospitals or through private hospitals/clinics, and patients have universal access to any facility, though hospitals tend to charge more to those patients without a referral. As mentioned above, costs in Japan tend to be quite low compared to those in other developed countries, but utilization rates are much higher.

Most one-doctor clinics do not require reservations and same-day appointments are the rule rather than the exception. Japanese patients favour medical technology such as CT scans and MRIs, and they receive MRIs at a per capita rate 8 times higher than the British and twice as high as Americans. In most cases, CT scans, MRIs and many other tests do not require waiting periods. Japan has about three times as many hospitals per capita as the US and, on average, Japanese people visit the hospital more than four times as often as the average American.

Access to medical facilities is sometimes abused. Some patients with mild illnesses tend to go straight to the hospital emergency departments rather than accessing more appropriate primary care services. This causes a delay in helping people who have more urgent and severe conditions who need to be treated in the hospital environment. There is also a problem with misuse of ambulance services, with many people taking ambulances to hospitals with minor issues not requiring an ambulance. In turn, this causes delays for ambulances arriving for serious emergencies. Nearly 50% of the ambulance rides in 2014 were minor conditions where citizens could have taken a taxi instead of an ambulance to get treated.

Due to the issue of large numbers of people visiting hospitals for relatively minor problems, a shortage of medical resources can be an issue in some regions. The so-called "tarai mawashi" (ambulances being rejected by multiple hospitals before an emergency patient is admitted) has been attributed to several factors such as medical reimbursements set so low that hospitals need to maintain very high occupancy rates to stay solvent, hospital stays being cheaper for the patient than low-cost hotels, the shortage of specialist doctors and low-risk patients with minimal need for treatment flooding the system.

Insurance

Health insurance is, in principle, mandatory for residents of Japan, but there is no penalty for the 10% of individuals who choose not to comply, making it optional in practice. Apart from conventional Western medicine and healthcare, Japanese insurance also covers traditional health therapies like acupuncture and health massages, etc., from licensed therapists. There is a total of eight health insurance systems in Japan, with around 3,500 health insurers. According to Mark Britnell, it is widely recognised that there are too many small insurers. They can be divided into two categories, Employees' Health Insurance (健康保険, Kenkō-Hoken) and National Health Insurance (国民健康保険, Kokumin-Kenkō-Hoken). Employees’ Health Insurance is broken down into the following systems:

• Union Managed Health Insurance
• Government Managed Health Insurance
• Seaman's Insurance
• National Public Workers Mutual Aid Association Insurance
• Local Public Workers Mutual Aid Association Insurance
• Private School Teachers’ and Employees’ Mutual Aid Association Insurance

National Health Insurance is generally reserved for self-employed people and students, and social insurance is normally for corporate employees. National Health Insurance has two categories:

• National Health Insurance for each city, town or village
• National Health Insurance Union

Public health insurance covers most citizens/residents and the system pays 70% or more of medical and prescription drug costs with the remainder being covered by the patient (upper limits apply). The monthly insurance premium is paid per household and scaled to annual income. Supplementary private health insurance is available only to cover the co-payments or non-covered costs and has a fixed payment per day in hospital or per surgery performed, rather than per actual expenditure.

There is a separate system of insurance (Kaigo Hoken) for long-term care, run by the municipal governments. People over 40 have contributions of around 2% of their income.

Insurance for individuals is paid for by both employees and employers. This ends up accounting for 95% of the coverage for individuals. Patients in Japan must pay 30% of medical costs. If there is a need to pay a much higher cost, they get reimbursed up to 80-90%. Seniors who are covered by SHSS ( Senior insurance) only pay 10% out of pocket. As of 2016, healthcare providers spend billions on inpatient care and outpatient care. 152 billion is spent on inpatient care while 147 billion is spent on outpatient care. As far as the long term goes, 41 billion is spent.

Today, Japan has the severe problem of paying for rising medical costs, benefits that are not equal from one person to another and even burdens on each of the nation's health insurance programs. One of the ways Japan has improved its healthcare more recently is bypassing the Industrial Competitiveness Enhancement Action Plan. The goal is to help prevent diseases so people live longer. If preventable diseases are prevented, Japan will not have to spend as much on other costs. The action plan also provides a higher quality of medical and health care.

Source:

https://en.wikipedia.org/wiki/Health_care_system_in_Japan

https://www.internationalinsurance.com/health/systems/japan.php