Wednesday, September 9, 2009

More on Japan's Health Care System

. Wednesday, September 9, 2009

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.


Anonymous said...

Honestly I'd be really keen to see statistics on the NHI program. In the 4 years I've lived in Japan I've know hundreds of people in my age range (18-35) most of whom were forced into the NHI because they could only find part or temp work that frequently changes. In those situations you would have to close and then reopen with the new insurance scheme at your next job. Out of all the young people I have known on NHI, I've only known a handful that actually PAID their premiums. It seems to me that the Japanese societal structures such as the extreme seniority pay system and the recent movement towards part/temp hiring in the last 2 decades not only are there less in each generation but they are also much less stable financially.

As far as crowding goes. I've never been in a Japanese hospital that had "no beds" ever in my time here. Although finding a single staff member can be a challenge.

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