The Pathos of Politics (121-3) Japan


Via compulsory insurance, Japan adopted universal health care in 1947. Though the system is nationwide, it is managed at the regional and local government levels.

Patients are free to select their physicians and are never denied care. The Japanese get good basic care, and never have to worry about huge medical bills. Surgery and treatment outcomes generally equal or surpass those in the US.

Patients pay 10–30% of the fee. The government picks up the rest. Fees are waived for the poor and homeless.

Japan has one of the lowest per-capita costs for health care in the industrialized world. The Japanese have the longest life expectancy, and one of the lowest infant mortality rates.

The government controls medical fees. This keeps costs low, which is not an altogether unalloyed good.

Emergency care is often poor. One reason for this is that there are too many small clinics and not enough hospitals. Doctors prefer this because they can work less and earn more.

Some doctors see as many as 150 patients a day. Patients can nearly always see a doctor within a day. Waiting for an hour or more for an appointment is common.

Because their salaries are low, doctors tend to overprescribe tests and drugs. Clinics commonly have their own pharmacies. Prescription pill popping by the Japanese is excessive.

Japan has too few doctors – 1/3rd less than the rich-world average – because of state quotas. The shortage is severe in rural areas, and in certain specialties.

Hospital stays are 4 times as long in Japan as in the US. Japanese hospitals do not prioritize patents, so there can be a crowding-out effect for emergency care or more patients.

Patients are treated too equally. Beds are occupied by less-urgent cases, and there are no penalties for those who over-use the system. ~ Japanese health care analyst Naohiro Yashiro

Hospital doctors are often overworked, and so lack the time to hone life-saving specialized skills. Japanese are much less likely to have a heart attack than Americans, but when they do, they are twice as likely to die.