As the U.S. debates health care reform, I've been interested in comparative looks at other systems. A few weeks ago I wrote about Japan's health care system, which is very inexpensive and also has very good outcomes, and one way that they keep costs low: they pay doctors very little relative to the U.S. Toward the end of that post I mentioned that even with low doctor salaries demographic shifts will make it difficult for Japan to hold down expenses over the medium run. A recent WaPo article highlighted the same thing:
Half a world away from the U.S. health-care debate, Japan has a system that costs half as much and often achieves better medical outcomes than its American counterpart. It does so by banning insurance company profits, limiting doctor fees and accepting shortcomings in care that many well-insured Americans would find intolerable.
The Japanese visit a doctor nearly 14 times a year, more than four times as often as Americans. They can choose any primary care physician or specialist they want, and surveys show they are almost always seen on the day they want. All that medical care helps keep the Japanese alive longer than any other people on Earth while fostering one of the world's lowest infant mortality rates.
Health care in Japan -- a hybrid system funded by job-based insurance premiums and taxes -- is universal and mandatory, and consumes about 8 percent of the nation's gross domestic product, half as much as in the United States. Unlike in the U.S. system, no one is denied coverage because of a preexisting condition or goes bankrupt because a family member gets sick.
But many health-care economists say Japan's low-cost system is probably not sustainable without significant change. Japan already has the world's oldest population; by 2050, 40 percent will be 65 or older. The disease mix is becoming more expensive to treat, as rates of cancer, stroke and Alzheimer's disease steadily increase. Demand for medical care will triple in the next 25 years, according to a recent analysis by McKinsey & Co., a consulting firm.
If current trends hold, Japan's health care costs will be equal to the U.S.'s within a decade, and that's even if they keep doctor's salaries down. But shortages of doctors are getting worse, particularly for specialists, and average wait times are getting longer. Quality of service is declining as costs are increasing. It's not a good mix, and the Japanese system is beginning to look as unsustainable as the U.S.'s system.
The whole article is worth reading.