The Health Care Systems of the US and Japan - Report Example

Executive Summary This paper is an analytical and comparative discussion on the healthcare systems of the United s and Japan in order to highlight the advantages and limitations of both the systems so that recommendations could be made to improve the healthcare system of the United States to provide a better coverage of health to its citizens. Both the healthcare systems incorporate government as well as private organizations and operations in their structure, and depend upon contributions from both the insurers and the citizens in order to meet the expenses of health care. The U.S. healthcare includes the organizations of Medicare and Medicaid, while the Japanese system is based on a three-pronged framework to provide insurance to the public, including an extensive insurance policy for the elderly. The Japanese system enjoys universal coverage, low healthcare costs, high performance, and the highest utilization of medical technologies. Both systems are highly dependent on external factors in their effectiveness and organization, and suffer from substantial expenditure on preventable diseases. The United States healthcare system could incorporate the structure of and take inspiration from the Japanese healthcare system to improve its healthcare services to the citizens. Harris Kamran Health Sciences Comparative Paper 21 August 2011 A comparison of the health care systems of the U.S. and Japan The health care system of any country is one of the fundamental factors that determines the progress and development of that country, and the degree of satisfaction and productivity of its citizens. It is often viewed as an index for the economic and social stability of that country, and a hallmark of its progress. This paper purports to compare the health care systems of the United States and Japan in order to highlight the limitations of and gaps in the U.S. health care system so that recommendations about improvement of the system could be provided. Population and health status: this section compares the population statistics of the two countries. According to the U.S. Census Bureau (2011) census of 2010, the population of the U.S. reached around three hundred and nine million, showing an increase of around ten percent from the population statistics of 2000 (U.S. Census Bureau, 2011), when it was around two hundred and eighty million (U.S. Census Bureau, 2011). The population growth rate is about one percent per year (U.S. Demographics, 2011). The birth rate according to the 2001 census came to be fourteen births per thousand of population (U.S. Demographics, 2011), and the death rate in general was estimated at eight per thousand of population (U.S. Demographics, 2011). The infant mortality rate in particular was estimated at 6.75 death per thousand of population (CDC, 2011). The leading cause of death in the U.S. is heart disease, followed by cancer_ of all categories_ and stroke (CDC, 2011). The quality of life is dependent on many variables, but the crucial indices for the estimation of the standard of society could be the life expectancy and the educational statistics. The life expectancy is estimated at seventy eight years (CDC, 2011). The literacy is defined as those of age fifteen and over who ‘can read and write’ (U.S. Demographics, 2011). In this context, the literacy rate for both males and females is 99% according to the 2003 estimate (U.S. Demographics, 2011), and in 2007, 5.5% of GDP was expended on education (U.S. Demographics, 2011). According to the 2011 estimate, the population of Japan came to be a hundred and twenty six million (Japan Demographics, 2011). The population growth rate in general has decreased by 0.3% by the year 2011 (Japan Demographics, 2011), so that the growth in population is expected to decline in the subsequent years. The birth rate is estimated at seven births per thousand of population (Japan Demographics, 2011), and the death rate at ten deaths per thousand of population (Japan Demographics, 2011). The infant mortality rate in particular is at three deaths per thousand live births (Japan Demographics, 2011). According to the 2002 estimates, the leading cause of deaths in Japan is stroke or cerebrovascular disease, followed by ischemic heart disease and respiratory infections (WHO, 2006). When analyzing the quality of life, the life expectancy is estimated at eighty two years (Japan Demographics, 2011). The literacy rate for both males and females is 99% (Japan Demographics, 2011), whereas the expenditure of GDP was calculated at 3.5% (Japan Demographics, 2011). Availability of heath services: this section discusses the organization and nature of health care systems in the two countries. The American healthcare system is best described as a combination of many government and public agencies and operations working together to bring about a policy of health insurance for about more than half of the American population (Cutler, 2008). Much of how the system works is determined by the insurance companies and other bureaucracies (Cutler, 2008), so that the over all system is often viewed as flawed and inappropriately structured (Cutler, 2008). As already mentioned, it covers more than half of the population (Cutler, 2008), leaving the rest to seek medical aid and assistance on their own through direct payment to the hospitals and doctors. The two main components of the system that are governed by the federal government in an attempt to reduce the over all spending on health by the public are the Medicaid and Medicare programs (Cutler, 2008). These programs are structured so that the citizens under insurance pay a monthly or yearly compulsory fraction of the cost (CMS, 2010), set by the government in accordance with the needs, expenditure, patient load, and requirement of the medical machines by the hospitals, and the complicacy and cost of the procedures that the patients usually require in those hospitals (CMS, 2010). Apart from that set cost, the patient has to pay again a fraction of money on the actual visit of the hospital, the rest being covered by the government (CMS, 2010). The exact figures of expenditure by the government and the citizens on the U.S. healthcare system would be discussed in the subsequent section. The issues related to the system are with regard to the incomplete coverage of the system; the dependency on manual work and filing instead of the incorporation of information technology in the system, that would require another couple of billion dollars (Cutler, 2008) and five years for its functioning (Cutler, 2008); the neglect of the system with regard to the prevention and treatment of the chronic illnesses (Cutler, 2008) and the prevention of the most common illnesses the complications of which could be easily prevented, like diabetes(Cutler, 2008); and the lack of an analysis and calculation of the effectiveness and the efficiency of the different components of the system, like the new policies, new drugs (Cutler, 2008), and new methods of patient care against the old polices, drugs, and methods respectively, in order to determine the worth of these new introductions (Cutler, 2008) so that they can be accurately and adequately customized and molded. The Japanese healthcare system is a combination of private and public insurers who cater to the task of providing healthcare insurance coverage to the complete population (KFF, 2009). The majority of the funding of the health system comes from the government; however, this funding is applied to the system through a network of private hospitals and clinics, so that the system is essentially operated by private companies and health managers (KFF, 2009). The Japanese system is a network of five thousand health insurers (KFF, 2009), which divide the insurance procedure into three categories, depending on the sector or nature of the demographics that they are serving. These categories include the ‘employer-based insurance, national insurance, and insurance for the elderly’ (KFF, 2009). Through these sectors of insurers, the citizens are free to choose their own private and federal physicians, specialists (KFF, 2009), and hospitals or clinics for procedural purposes. The system, while providing coverage to the whole population, and making it mandatory fro everyone to sign up for health insurance (KFF, 2009), however, does not include maternity care under its insurance, as maternity care is provided for by the public health system (KFF, 2009). The maternity care is catered to by providing monetary checks to the expecting mothers to cover the costs of labor and birth (KFF, 2009). The system also does not involve funding on prevention of diseases (KFF, 2009), so that preventative care management if left to autonomous and independent private companies, or is not covered at all (KFF, 2009). The health system depends on the contribution from both the government and the citizens to meet the expenses of the services (KFF, 2009); however, those living below on the poverty line or those on the welfare system are not expected to pay (KFF, 2009). The elderly, especially those over sixty five years of age, are provided with long term care services in the form of home care or institutional care (KFF, 2009). Expenditures: this section discusses the financial statistics related to each healthcare system. In the American healthcare system, the cost of providing health insurance to a family of four is estimated to be $12,000 (Cutler, 2008). Therefore, the complete population is not covered by health insurance_ the government insures 80.3 million people (Cutler, 2008), and 201.7 million are insured privately (Cutler, 2008), so that in 2006, 15.8% of the population remained uninsured (Cutler, 2008). This percentage showed an increase from the 14.2% uninsured individuals of 2000 (Cutler, 2008). The government, both federal and state combined, meets ‘44.7% of the total expenditure on health’ (Cutler, 2008), so that 18.9% of the government budget is spent on the provision of the healthcare system (Cutler, 2008). According to the 2007 estimate, the government of Japan spends 17.9% of the GDP on healthcare service (KFF, 2009), with the GDP per capita amounting to $34,200 in 2008 (KFF, 2009). The fess paid by the government to the healthcare officials is highly regulated nationwide by the program of Medical Fee Table (KFF, 2009), and the costs of drugs is determined by the National Health Insurance Price List (KFF, 2009). This means that the overall cost of healthcare in Japan is tightly controlled by government agencies, and is markedly reduced as compared to the other countries (KFF, 2009). This gives Japan dual benefits of spending less on the health sector than ‘other developed countries’ (KFF, 2009), and providing the latest in medical technology, like MRI, to its citizens at a per capita rate that is often twice of that of the American system (KFF, 2009). The monthly coinsurance that the citizens have to pay for healthcare usually does not exceed $720 (KFF, 2009). Macro-environmental influences on the health care system: this section discusses the external factors that regulate the design and workings of the two healthcare systems. The organization, management, and working of the healthcare systems of both the U.S. and Japan are heavily influenced by macro-environmental factors like political, socioeconomic, cultural, and technological variables. The most obvious of these determinants is the population statistics of the two countries. The population of the U.S. is substantially more than that of Japan (U.S. Demographics, 2011). This means that the government has to spend far more in the U.S. to provide a universal coverage of healthcare than the government of Japan; this is one major reason of the affordability of the universal coverage in Japan (KFF, 2009). The cultural and social framework and lifestyle in the U.S. has resulted in the prevalence of the prevalent disease of diabetes (Cutler, 2008) and in the condition of obesity which is a harbinger of many preventable yet common diseases (Cutler, 2008). This means that the healthcare system in the U.S. has to spend millions on diseases that could easily be prevented and the money saved to provide a wider insurance coverage (Cutler, 2008) only if the public were to bring appropriate changes in their lifestyle. Similarly, in Japan, the prevalence of smoking means that the diseases associated with the habit have to be catered to by the government while they could be easily prevented. The third major cause of death in Japan is respiratory illnesses (WHO, 2006), while there are 500,000 ‘cigarette vending machines in the country’ (KFF, 2009). To augment the problem, the anti-smoking policies and campaigns by the government are ineffective and weak (KFF, 2009), and the government has not provided adequate smoking-free places, even in public areas (KFF, 2009). This has made smoking the most potent cause of death in Japan (KFF, 2009). The high cost of healthcare in the U.S. means that the healthcare system cannot afford to spend much on the information technology and medical technology provisions to its citizens (KFF, 2009). In Japan, the low cost of healthcare has resulted in the highest utilization of latest medical technology than any other developed country (KFF, 2009), with 70% of the hospitals having CT scanners (KFF, 2009), and 30% having MRI scanners (KFF, 2009), the highest in any OECD country (KFF, 2009). Summary and comments: this section summarizes the findings of this paper, drawing comparisons between the two healthcare systems, and concluding with regard to the healthcare system of the United States. The paper has discussed various components of the healthcare systems of the U.S. and Japan, the effectiveness and the efficiency of the two healthcare systems, their financial statistics, and the external factors that serve as variables to determine the organization and workings of these systems. It is obvious that the United States government spends much more on its healthcare system_ around a trillion dollars (Culter, 2008)_ than the Japanese government (KFF, 2009), but still fails to provide a universal coverage to its citizens regarding health insurance. The individuals have to pay much more monthly and on visits to the hospital (CMS, 2010) than the Japanese citizens, whose monthly expenditure on health is limited by their income, the monthly payment premiums, and their paying capabilities (KFF, 2009). In both the countries, the expenditure of the government on preventable diseases takes up the majority of the portion of the government spending on healthcare, the cut down of which would enable the government to further improve its healthcare services, and to decrease the cost of healthcare in the country. The money thus saved cab especially enable the United States government to lessen the insurance premiums, and to widen the insurance coverage_ it is estimated that savings in the expenditure can reduce the cost of providing insurance to a family of four from $12,000 to $10,000 (Cutler, 2008). The low cost and the low population demographics of Japan means that it can enjoy the highest ratio of 15.8 inpatient beds per thousand individuals in any OECD country (KFF, 2009), and the best medical technology most widely available (KFF, 2009). The huge patient turn over in the U.S. and the increased number of inpatients requiring beds in the hospitals mean that the average stay in the hospitals in the U.S. is just six nights as compared to thirty six nights in Japan (KFF, 2009). Evidently, the United States healthcare system needs to incorporate much improvements in its organization, structure, and management in order to cater to the majority of the U.S. citizens, and to provide better healthcare facilities. It can learn from and take inspiration from the Japanese healthcare system in this regard. References CDC. (2010, May 5). Deaths and mortality. Retrieved from http://www.cdc.gov/nchs/fastats/deaths.htm Center for Medicare & Medicaid services. (2010). Quick facts about payment for outpatient services for people with Medicare Part B. Retrieved from http://www.medicare.gov/publications/pubs/pdf/02118.pdf Cutler, D. M. (2008). The American healthcare system. Retrieved from http://www.economics.harvard.edu/faculty/cutler/files/The%20American%20Healthcare%20System.pdf Japan demographics profile 2011. (2011, July 12). Index Mundi. Retrieved from http://www.indexmundi.com/japan/demographics_profile.html The Kaiser family foundation. (2009). International health systems. Retrieved from http://www.kaiseredu.org/Issue-Modules/International-Health-Systems/Japan.aspx United States demographics profile 2011. (2011, July 12). Index Mundi. Retrieved from http://www.indexmundi.com/united_states/demographics_profile.html U.S. census bureau. (2011, 3 June). State and country quickfacts. Retrieved from http://quickfacts.census.gov/qfd/states/00000.html World health organization. (2006). Mortality country fact sheet 2006. Retrieved from http://www.who.int/whosis/mort/profiles/mort_wpro_jpn_japan.pdf Read More