The Japanese Health Care System - Essay Example

 The Japanese Health Care System Introduction There are four major kinds of health care systems globally. Single payer is one type of system, and this means that the government pays for the health care of the citizens, and the citizens pay the taxes that pay for this type of system (Docteur & Oxley, 2003). Employment based is another type of health care system, and this is the type of system that Japan, the country that is the subject of this article, utilizes. In this system, the employers provide their workers with health insurance through premiums which are taxed to the employee and this money is paid directly into the health care. The government may be involved in this type of health care system, in that the government sets the premium amount (Tanner, 2008). Managed competition is the third system. In this system, individuals are mandated to have health care in this system, and employers are also mandated to provide health care to their employees (Docteur & Oxley, 2003). In the fourth system, which is the private insurance provider model, private insurance and private providers are used, and there is not the kind of controls and mandates that are a part of the managed competition (Tanner, 2008). Wealthier countries spend more money on health care than do poor countries (Marmot, 2005). In this essay, the Japanese system will be examined in more depth. Rationale for Choosing the Japanese System The Japanese system will be the system that is the subject of this essay. The reason why the Japanese system was selected is because the system was evaluated by the Organisation for Economic Co-Operation and Development (OECD) as having one of the top health care systems of the countries that comprise the OECD (Minhat et al., 2012). Moreover, the Japanese system is somewhat unique in that its system emphasizes both wellness of the citizens and alternative medicine (Tanner, 2008). As another consideration, the population of Japan is ageing, as the average life span in that country is 81.9 years, while there is also a low birth rate (Tanner, 2008), therefore the strain of an ageing population would be especially pronounced in this country. It would therefore be interesting to ascertain how a country with a low birth rate coupled with a high average life span would be able to keep pace with the health care demands of such a population. How the Research Was Obtained The research for this project was obtained through PubMed, JStor and Google Scholar. The keywords that were used to search for articles was Japan + Health Care System. The articles which were obtained were from the years 2003 and newer, with the bulk of the articles dating from 2008 to the present. This is because health care systems are rapidly changing, therefore older articles than 2008 might not be relevant to the Japanese health care system of today. The articles which were used were articles that detailed the health care system in Japan, along with an article that focused upon health care systems around the world. In particular, since the populace of Japan is rapidly ageing, articles which focused upon the ageing of the population, and the challenges that the country faces in health because of this, were selected. Other articles that focused upon the Japanese health care system, in general, were included, as these articles often focused upon the advantages and disadvantages of the system, therefore these articles provided an understanding of what challenges the Japanese health system face, in general. Japan’s Health Care System Japan has a universal health care system that is employer-based, and has, according to Minhat et al. (2012), one of the best health care systems within the Organisation for Economic Co-Operation and Development countries. The system is employer based. The employees contribute 45% to the health care system, and the employers supply the rest. These employees are covered by the Employee Health Insurance- large companies cover their employees through Health Insurance Societies, and small employers cover their employees through Social Insurance Agencies and government officers through Mutual Aid Association. If a person is self-employed, retired, a student, or unemployed, that person has the option of enrolling in the Community Based National Health Insurance (NHI). Municipal governments run this program. Older Japanese, over the age of 75 years, are eligible for the Long Life Medical Care System. Furthermore, the Japanese citizens may also obtain private health insurance to cover costs that are not covered through the national health insurance, and the private health insurance may also be used to cover co-pays (Minhat et al., 2012). There are advantages and disadvantages inherent in this type of system. One of the advantages is that, because the Japanese system is not single payer, nor is it exclusively private, there is better patient choice than in a single payer system, and the citizens are universally covered, which gives this system the advantage over the private health systems (Joumard, 2010, p. 48). There are generous benefits in this system, which also set it apart from the single-payer system. This is not to say that the Japanese people do not shoulder a good deal of the health care costs – they not only pay into the system through payroll taxes, but they also must pay a co-pay for the benefits which are used. This co-pay may be from 10 to 30 percent, which works out to around $2,300 per year for the average Japanese family (Tanner, 2008). As noted above, Japan has the advantage over the countries that operate with private insurance, in that there is universal coverage for Japanese citizens. The country’s advantage over single-payer systems, such as Spain and France, is that Japan can afford cutting-edge technology. Japan has MRIs and CT scanners at a rate that is comparable to the United States, which operated on a private health system until recently (Tanner, 2008). At the same time, Japan has the advantages over the private health systems in that the hospitals do not have price competition. Hospitals must offer patients quality and cutting-edge technology, as they are unable to use lower prices as a way to attract patients, which makes the quality of health care in Japan top-notch (Tanner, 2008). There are also disadvantages. One major disadvantage is the way that the doctors are paid. The government sets the amount of reimbursement for these doctors, and the reimbursement is generally low. Because of this, doctors are pressured to see multitudes of patients. Two-thirds of Japanese patients only spend 10 minutes or less with their doctors. Eighteen percent of patients spend less than three minutes with their doctor, and Japanese doctors, on average, see 6,500 patients a year (Tanner, 2008). Japan has managed to keep its health care costs controlled through a variety of different mechanisms, and different countries who have more out of control health care costs may learn a lesson from this country. One way that Japan has controlled health care costs is that the country has fewer surgeries than other countries, because the cultural bias in this country is in favor of alternative medicine and against surgery. Moreover, the country has low obesity rates, low smoking rates, low drug abuse rates, low crime and accident rates, and the people in Japan tend to lead an overall healthier lifestyle than many Western countries, including the UK and the United States (Tanner, 2008). According to one study, the fact that the Japanese people, as a whole, concentrate on living healthy, would account for 25% of the difference in health care spending in Japan when compared to the health care spending in the United States (Tanner, 2008). The health habits of the populace is not a minor factor in health care spending – Preston & Ho (2009) note that the United States spends 16% of its GDP on health care, by far the highest of any country, and the reason for this is the country’s citizens have unusually poor lifestyle habits. The US has high rates of cigarette smoking and obesity, which contributes to a high disease rate in that country, which tax the health care system tremendously (Preston & Ho, 20008). Pressures on the Japanese Health System One of the major pressures on the Japanese health care system is that the country’s population is ageing, due to the long life expectancies of the people of the country, coupled with the low birth rate for the country (Hsu & Yamada, 2011). The life expectancy in the country is 81.9 years, as of 2005 (Marmot, 2005). The proportion of the elderly residents is projected to double in 26 years, which means that this problem is one that will only worsen over time (Chongsuvivatawong et al., 2011). According to Tamiya et al. (2011), the country has responded to this particular pressure by initiating mandatory public long-term care insurance (LTCI) in 2000. The LTCI provides benefits for older Japanese irrespective of the income or family situation, and the system is generous in coverage and benefits when compared to other countries, such as the United States and Germany. This system is seen as a good thing for carers who were overburdened with the needs of the elderly before the system was put into place. However, the system is overburdened, in that nursing home beds are in high demand, so appointments for these beds must be made weeks in advance, and home helper visits are scarce because of the financial and logistical concerns in providing this service. The programme is also very expensive, and the government has had a difficult time keeping the costs manageable. That said, Tamiya et al. (2011) state that the LTCI has performed reasonably well for more than a decade because the programme has been carefully prepared by the government. There is also some indication that there is pressure on the people of Japan due to the structure of the cost-sharing in the country’s health care system. As noted above, one of the features of the Japanese health system is that the health care expenses are shared by the Japanese people, in the form of co-pays, and also through the mechanism of paying for the health care through payroll taxes. Nishi et al. (2012) examined the Japanese system of health care sharing, stating that, in 2001, Japan introduced two different cost-sharing rates – 30% for adults aged less than 70 years, and 10% for adults aged 70 or over if they had a low income. For adults aged 70 and over with a higher income, the rate was 30%. Nishi et al. (2012) found that, with regards to mental health, there was a marked improvement in the population who paid the 10%, when compared to the population that paid the 30%, and the physical health of this population improved as well in comparison to the population that paid 30%. What these researchers found was that if there is higher cost sharing for the insured adults, there is less use of clinical services and more adverse health outcomes. Conclusion While no health system is perfect, the Japanese system works well comparatively. Considering that this country is ageing rapidly, with a high life expectancy and low birth rate, the fact that the country is able to deliver health care efficiently is truly remarkable. One aspect that sets it apart from many other health systems is that the populace concentrates on wellness. Obesity rates are low, as are the rates of cigarette smoking, and the accident rate is also low. This keeps health care rates down, because a citizenry that has a high rate of disease burdens a health care system, as shown in the United States. The country also emphasizes alternative medicine over traditional surgical methods, and this, too, could be a factor in keeping the Japanese health care costs under control. The country of Japan therefore should be a model to other countries which are struggling with high health care costs – namely, that these other countries should emphasize wellness programs, such as smoking cessation and obesity fighting programs. These kinds of programs might be the key to fighting the ever spiraling costs of health care. Resources Chongsuvivatwong, V., Phua, K., Yap, M., Pocock, N., Hashim, J., Chhem, R., Wilopo, S. & Lopez, A. (2011) “Health and Health-Care Systems in Southeast Asia: Diversity and Transitions,” Lancet, vol. 377, pp. 429-437. Docteur, E. and Oxley, H. (2003) “Health Care Systems: Lessons from the Reform Experience.” OECD Health Working Papers, No. 9. pp. 1-98. [Online] Retrieved 25 March 2013 from www.ideas.repec.org/p/oec/ecoaaa/374-en.html Hsu, M. & Yamada, T. (2011) “Financing Health Care in Japan: The Impact on an Ageing Population.” [Online] Retrieved 25 March 2013 from www.ideas.repec.org/p/red/sed011/717.html Joumard, I., Andre, C., & Nicq, C. “Health Care Systems: Efficiency and Institutions.” Economics Department Working Papers No. 769. [Online] Retrieved 25 March 2013 from: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1616546 Marmot, M. (2005) “Social Determinant of Health Inequalities,” Lancet, vol. 365, pp. 1099-1104. Minhat, H., Rahman, A., Fatihah, O., Saad, N. (2012) “Experiencing health care and culture in Niigata, Japan,” International Journal of Public Health, vol. 2, no. 1, pp. 122-128. Nishi, A., McWilliams, J., Noguchi, H., Hashimoto, H., Tamiya, N. & Kawachi, I. (2012) “Health Benefits of Reduced Patient Cost Sharing in Japan,” Bull World Health Organization, vol. 90, pp. 426-435A. Tamiya, N., Noguchi, H., Nishi, A., Reich, M., Ikegami, N., Hashimoto, H., Shibuya, K., Kawachi, I. & Campbell, J. (2011) “Population Ageing and Well-being: Lessons from Japan’s Long-Term Care Insurance Policy,” Lancet, vol. 378, pp. 1183-1192. Tanner, M. (2008) “The Grass is Not Always Greener: A Look at National Health Care Systems Around the World.” Policy Analysis, No. 613., pp. 49-68. [Online] Retrieved 25 March 2012 from: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1262978 Read More