There has been a raging debate among citizens as well as politicians in the United States about the healthcare system in place. When compared to other developed countries, the US’ healthcare system costs more but does not provide an equitable quality of services. Comparatively, Japan has a much more robust healthcare set up. Comparing the healthcare system in both these countries reveals several shortcomings in the US system while questions the stability and economical impact of the system prevalent in Japan.
Comparing the Healthcare System in Japan & the United States
Japan’s economy saw a boom about three decades ago as the country emerged as a leading manufacturer and exporter of electronic goods and technology. Measured on a purchasing power parity (PPP) basis that adjusts for price differences, Japan in 2010 stood as the third-largest economy in the world after China, which surpassed Japan in 2001[ CITATION CIA11 \l 1033 ]. The country boasts of the highest life expectancy rate in the world at 82.7 by 2008 statistics, a full 4 years more than the US’ 77.9 in 2007. The long life expectancy is generally attributed to the healthy lifestyle that the Japanese lead. However, it Japan’s preventive medicine approach towards healthcare has also been a major contributing factor. Here is a look at how Japan’s healthcare system has developed over the years till 1997:
History of Public Health Insurance in Japan
Sources: White Paper on Health and Welfare 1998 Edition; Japan International Corporation of Welfare Services (1995).
Health insurance is a mandatory for all Japanese citizens. Those who are employed are provided health insurance by their employers while the unemployed and poor are funded by the government. Even when a person loses or quits his or her employment, the health insurance continues. This focus on providing healthcare to all citizens regardless of their employment status or their financial strength enables the Japanese populace to have access to healthcare throughout their lives. Since 1973, all elderly persons have been covered by government-sponsored insurance [ CITATION Cou11 \l 1033 ].
Japan provides universal coverage to all residents through three broad categories of insurance: employer-based insurance, national insurance and insurance for the elderly [ CITATION Kai11 \l 1033 ].
Employer based insurance: Every company having over 5 and under 300 employees is required by law to provide health insurance to its staff. The premium costs are borne equally by the employer and the employee, drastically reducing an individual’s spending on healthcare. This scheme covers over 30% of Japan’s total population. Larger companies are required to form a healthcare society along with their employees in order to equally share the cost of premiums. In the case of small and medium businesses, the government foots 14% of the health insurance costs of the employees.
National Health Insurance: The national health insurance offers coverage to those not eligible for employee-based insurance, such as farmers, self-employed individuals, the unemployed, retirees, and expectant mothers, all of whom comprise about 34% of the population [ CITATION Kai11 \l 1033 ]. Since this section of the populace is not sponsored by an employer, the government pays for the employer’s portion of the health insurance premium costs.
Health Insurance for the Elderly: Considering the high life expectance and low infant mortality rates, Japan’s aged or elderly population is growing at an astounding rate. However, the government is keen to transfer the responsibility of providing healthcare for the elderly from the family to the state. This plan covers those who are over 65 years of age or are aged between 40 and 64 but have disabilities.
From the above discussion, it is clear that the Japanese government is committed towards providing quality healthcare for every citizen in the country. Another aspect if Japan’s healthcare system is the easy accessibility of services. Citizens are free to choose any physician or medical institution as the rates and charges for diagnosis, treatment and medicines are fixed. They are not even required to take prior appointments and so can walk into a doctor’s clinic whenever they need medical attention.
As a result of these measures, Japanese citizens are able to make better use of healthcare facilities and hence lead a healthier life. The Japanese go to the doctor about three times as often as Americans. Japanese patients also stay in the hospital much longer than Americans, on average. They love technology such as magnetic resonance imaging; they have nearly twice as many scans per capita as Americans do [ CITATION Rei08 \l 1033 ]. American songwriter and film maker David Chester effectively recounts his experience with the Japanese healthcare system when compared to its American counterpart: “When you apply for health insurance in Japan, you aren’t given a blood test or interrogated about your health history. This means, in essence, that even if you have cancer or are HIV-positive, you won’t be denied coverage. Once in the system, you don’t have to wait in fear to find out whether certain procedures or tests will be approved by some God-like doctors in ivory towers. Another valuable feature of national health insurance in Japan is, the less you earn, the less you pay—and you still get the same level of care and coverage. In America, insurance companies bide their time until you get older so they can raise your premium dramatically, all without the least concern for how you will pay for it [ CITATION Che10 \l 1033 ].
However, considering the fact that the Japanese government tries very hard to keep healthcare costs as low as possible, the system is driving hospitals into bankruptcy. Even the doctors that attend to health conscious Japanese citizens have to find alternate sources of income as their pay is abysmally low. Personal bankruptcy due to medical expenses is unheard of in Japan, says Professor Saito Hidero, president of the Nagoya Central Hospital. But while the patients may be healthy, the hospitals are in even worse financial shape than the doctors. "I think our system is pretty good, pretty good, but no system is perfect," he says. "But 50 percent of hospitals are in financial deficit now." While the United States probably spends too much on health care, Japan may be spending too little. In a country with $10-a-night hospital stays, prices just aren't high enough to balance the books [ CITATION Rei08 \l 1033 ].
Recommendations for a better healthcare system in the US
“The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close” [ CITATION Gaw09 \l 1033 ].
The American healthcare system lacks several aspects that make healthcare systems in countries like Japan so effective, even if they are slightly heavy on the economy. To begin with, the approach towards healthcare has to be more citizen oriented than profit oriented. This would mean reducing the cost of healthcare, including premiums for health insurance. Although this may result in the state taking on some of the healthcare expenses or passing it on to employers, it needs to be made clear that the population in a developed country like America deserves the healthcare of the best international standards.
Secondly, healthcare in America needs to be made more accessible. Citizens, regardless of their age group or financial strength, need to be provided with healthcare on demand. Waiting for a doctor to grant a specified time of appointment and then struggling to adhere to the schedule often discourages people from seeking timely medical assistance. While certain diseases take time to set in and give plenty of chances to be diagnosed, there are diseases like cancer or AIDS that require immediate attention.
Thirdly, the US health ministry needs to make a sincere effort to form regulations that control the prices and charges of treatments, doctor consultations and even medicines. The costs of lab tests and scans like the CT scan or the MRI scan in Japan is much lower than in the US. In Japan, the health ministry convenes every two years and revises a set of fixed prices that are applicable across the country. The ministry will also have to create strict laws focused on preventing malpractices such as asking patients to run unnecessary tests just to increase the bill amount. Once the rules are formed, they will need to be implemented strictly. A similar approach towards regulating healthcare charges will make services much more affordable and will go a long way in improving a citizen’s standard of living.
Finally, the United States healthcare system needs to be pro-active in promoting the latest preventive medicine treatments in order to eliminate diseases before they take hold of a person. For example, people suffering from diabetes need to be encouraged to take sugar control medication. America has the largest incidence of obesity in the world with even the younger sections of the society facing severe weight issues. A system needs to be developed that will track such illnesses from a young age and prescribe lifestyle changes as well as preventive medication in order to curb potential illnesses from developing into full blown diseases that require intensive healthcare like surgery.
The US needs to steer its healthcare system away from profiteering and start thinking of it as a system aimed at social or community service, where the prime focus is the health of the citizen and not ensuring that every transaction yields the highest amount of profits. By focusing on providing quality healthcare at the lowest expense possible will guide the US towards a far better healthcare system than the one prevalent today.
Bibliography
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CIA. CIA - The World Fact Book. 28 April 2011. 10 May 2011 <https://www.cia.gov/library/publications/the-world-factbook/geos/ja.html>.
Country Studies US. HEALTH CARE AND SOCIAL WELFARE. 10 May 2011 <http://countrystudies.us/japan/75.htm>.
Gawande, Atul. The New Yorker. 1 June 2009. 10 May 2011 <http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande>.
Kaiser Family Foundation. International health Systems - Japan. 10 May 2011 <http://www.kaiseredu.org/Issue-Modules/International-Health-Systems/Japan.aspx#footnote1>.
Reid, T.R. Japanese Pay Less for More Health Care. 14 April 2008. 10 May 2011 <http://www.npr.org/templates/story/story.php?storyId=89626309>
