Health Care in Japan

The Health care system in Japan provides healthcare services, including screening examinations for particular diseases where the patient pays 30% of the cost of, prenatal care, and infectious disease control while the government pays the remaining 70%. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through 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-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals.

Overview

Japanese Super Ambulance, Tokyo Fire Department

It is compulsory to be enrolled in one of Japanese insurance programs if you are a resident of Japan.^[1] Although with the downturn in the Japanese economy many Japanese companies refuse or cannot afford to provide insurance payments to their employees thus millions fall through the cracks or fall behind on their payments. Foreigners in Japan live within a grey zone where government officials recommend joining the national health scheme but do not force them. There are a total of eight health insurance systems in Japan. They can then be divided into two categories. The two main categories of health insurance are referred to as Kenkō-Hoken 健康保険 ([Employee's] health insurance) and Kokumin-Kenkō-Hoken 国民健康保険 (national health insurance). Employees’ Health Insurance is broken down to 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, whereas social insurance is normally for corporate employees. National health insurance can be broken down into:

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

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 higher for those without a referral. Compared to the United States, Japan has about three times as many hospitals per capita as the United States does. Also compared to the United States, Japanese visit the hospital 14 times a year, more than four times as often as Americans. Due to large numbers of people visiting hospitals and doctors for relativity minor problems space can be an issue in some regions. More than 14,000 emergency patients were rejected at least three times by Japanese hospitals before getting treatment in 2007, according to the government survey for that year. In some of the more publicized cases an elderly man was turned away by 14 hospitals before dying 90 minutes after being finally admitted. In another case a pregnant woman complaining of a severe headache was refused admission to seven Tokyo hospitals. She later died of an undiagnosed brain hemorrhage after giving birth.

Interior of standard ambulance

Public health insurance covers most citizens/residents and the system pays 70% or more of the medical or drugs 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 usually makes a fixed payment per days in hospital or per surgery performed, rather than per actual expenditure. In 2005, Japan spent 8.2% of GDP on health care, or US$2,908 per capita. Of that, approximately 83% was government expenditure

History

The beginning of the Japanese Health care system happened in 1927 when the first Employee Health Insurance plan was created.

In the 1980s, health care spending was rapidly increasing as was the case with many industrialized nations. While some countries like the United States allowed costs to rise Japan instead tightly regulated the health industry to rein in costs. So while in the U.S. a MRI scan of the neck region costs about $US 1,500; in Japan, the identical scan costs $US 98. Since 1983 all elderly persons have been covered by government-sponsored insurance.
By the early 1990s, there were more than 1,000 mental hospitals, 8,700 general hospitals, and 1,000 comprehensive hospitals with a total capacity of 1.5 million beds. Hospitals provided both out-patient and in-patient care. In addition, 79,000 clinics offered primarily out-patient services, and there were 48,000 dental clinics. Most physicians and hospitals sold medication directly to patients, but there were 36,000 pharmacies where patients could purchase synthetic or herbal medication.
National health expenditures rose from about 1 trillion yen in 1965 to nearly 20 trillion yen in 1989, or from slightly more than 5% to more than 6% of Japan's national income. The system has been troubled with excessive paperwork, assembly-line care for out-patients (because few facilities made appointments), over medication, and abuse of the system because of apparent low out-of-pocket expenses to patients.  Another problem is an uneven distribution of health personnel, with rural areas favored over cities.