Japanese Health Care: No Utopia
Blaine Harden had an article in the Washington Post yesterday, which focuses on health care in Japan. It is an attempt to be balanced, but I feel that it relies a little too much on anecdotes, and misses some very significant points. The story finishes with a perplexed, ordinary Japanese woman who proclaims her bewilderment as to why the US can’t have a health care system like Japan’s. But this is a vastly ignorant comment, which ignores many differences that not only would Americans not put up with, but Japan itself will not be able to sustain for much longer. This is a topic that I can’t cover fully today, but I will be returning to it in the weeks and months ahead.
There are at least three major problems that I have with the article, just off the top of my head and without going into detailed research (which I am still in the middle of). The first is the downplaying of quality issues. Harden does mention the issue of quality in passing, while mentioning some ‘irritating’ aspects of the treatment of patients. And he again touches on the subject tangentially when he mentions that the ‘everyday doctor’ he quotes sees 150 patients a day, for about 3 minutes each. Its hard not to ignore everything else that is said in the article, because this is a big point in and of itself! No doctor can adequately serve his patients if he only sees them for 3 minutes each!
While Japanese people have been conditioned by their government and health care professionals to put up with waits of up to 3-4 hours or more (yes, I’ve waited that long in major hospitals in Japan), only to spend 3 minutes with the doctor and be rushed out of the door in the middle of a question (again, personal experience, and a well known feature of the Japanese system), this is not something that most Americans (or Australian’s, for that matter…) would put up with. If we want to go all ‘anecdotal’, I could fill pages here with my own stories of the dozens of doctors that I have seen, and how very few of them were interested in anything more than a perfunctory consultation. I have met very few Japanese doctors that are willing and eager to give information about their treatments, or that will take the time to answer all of your questions and reassure you about your course of treatment. Of course, this is anecdotal, but I have no doubt that any major survey would uncover the same results in hospitals across Japan.
Another aspect of quality, in addition to the lack of information and the inability of doctors to treat their patients like clients or customers (or even, at times, humans….), is the fact that most doctors in Japan are trained almost exclusively in one specialty area. While it is common for doctors in Australia, for example, to study as a GP before branching into their area of specialization, doctors in Japan typically pick their specialties much earlier, and are thus unwilling and unable to look at the full picture in diagnosis and treatment. Again, from an anecdotal perspective, family members have been turned away from major hospitals in the middle of asthma attacks, because the ‘asthma doctor’ wasn’t in – apparently at this hospital asthma attacks had to be reserved for Wednesdays or Fridays…!! This is the kind of incompetence that anyone who has experienced a foreign medical system sees on a routine basis in Japan. It just happens that the statistics have not yet quite caught up with the realities…. Indeed, a recent story highlighted this as a national phenomenon when a young man died as an ambulance attempted to negotiate with 14 different hospitals that all refused to take him. In 2007, more than 14,000 emergency patients were rejected at least 3 times before finding a hospital that would treat them, with as many as 1,000 or more of these cases actually dying.
A second major difference between the US and Japanese medical systems is the court system. This may sound irrelevant, but those who most loudly tout systems such as Japan for a universal system for the US are also those that are most loudly against tort reform. Legal and related insurance costs for doctors in the US are far greater than those in Japan, where law suits are far less common, and far less lucrative. In the article, Harden admits that Doctors like the ‘typical specimen’ he has quoted pay about $1,000 per year for malpractice insurance in Japan. In the US, malpractice insurance can average as much as $70,000 for a surgeon in DC, or as much as $140,000 per year for a neurosurgeon. That’s quite a difference from the average doctor in Japan…
After quality and legal issues, a third major difference with the Japanese system as opposed to the US system is the issue of innovation and drug availability. US drug companies are responsible for far more innovative drugs and treatments than are available in Japan, and regulations are so tight, and pricing mechanisms so closely controlled by the government that patients in Japan simply don’t have access to the same drugs and treatments that are available in the US. For new drugs to be approved in Japan after they have passed US FDA approval processes, they are required to undergo further extensive testing on Japanese patients under Japanese conditions, and are then required to meet costing restrictions placed by the government before they can be used in Japan. This makes it a very long process for new drugs (that are inherently more expensive) to become available in Japan. This is also the case for treatments. Indeed, until just a few months ago it was still illegal to conduct child organ transplant surgeries in Japan! This truly startled me when I heard it for the first time. Organ transplants, and other treatments that have been common place in the US and Australia for decades are still relative novelties in Japan, thanks to restrictive government policies which give doctors no incentive to train in such techniques, and no access to the latest drugs.
The Japanese system also has a number of pending problems. Not least of which is its fast aging society. Estimates are that while the Japanese system currently costs half that of the US, within just 15 years this will double, without fixing any of the problems listed above, plus a whole range of others. Not only is the Japanese population aging, but they are also becoming less and less healthy, with vast changes to diet and activity over the last two or three decades. Proponents of the Japanese health system often love to quote the life expectancy in Japan to ‘prove’ that the Japanese system is a sound one. But this completely ignores the fact that all of the people dying in their 70s and 80s today were born before the war, and have lived relatively active lives with great diets. This is certainly not the case for those in the middle ages and younger today, and for true comparisons of life expectancy we will need to wait until the children of the 60s and 70s in Japan reach the end of their lives…
But maybe this is all just too much common sense….
Related posts:
- H1N1 Flu-Vaccine Trials Underline Trouble Getting Drugs into Japan
- Celebrating Japan’s Centenarians…
Tags: Aging Society, Doctors, Drugs and Medicines, Health Care, Hospitals, Life Expectancy, Malpractice Insurance, Organ Transplants
Well done, Guyjin. I agree with your thoughts. I’ve only been to a Japanese hospital once and a clinic one other time, but my experiences were similar – long wait, only a couple minutes with the doctor, hardly any explanation, and then they basically just threw cheap drugs at me and I left.
My J-A mom had to see a doctor during a visit to Japan 15 years ago and the overworked doc was very curious about the U.S. system. He was frustrated by having so many patients, many who had really minor things wrong and many elderly with nothing wrong that just seemed to want to get out of the house and visit (his interpretation) – why not, it’s free.
I would like to absolutely disagree with the some of the conclusions drawn above, the maximum I have waited at any hospital is 20 minutes to see a specialist and I have never been allotted 3 minutes to see the doctor. My experience which is quite extensive is that the are very multidisciplinary. My experience in the US to the contrary was waiting hours, high co-pays and pressure on the doctors to prescribe expensive medication that did not and worst of all was the amount of time spent haggling and submitting requests for treatment and then being denied coverage because the treatment was “experimental”. I would never trade the Japanese system for the US system. The US is absolutely without a doubt to a magnitude more appalling than some of the health care systems I have used in other countries.
Have experienced the systems in England, Japan and the US, my last expression would be identical to the woman in the W.P. article, the US has a third world medical system in a supposedly first world country.
Some of the medications are not available in Japan but there are usually alternatives.
Some of the medications are not available in Japan but there are usually alternatives.
The average of age death should be evidence enough of how much more superior the system here is.
You are of course entitled to disagree. But your arguments are even more anecdotal than what I have based my article on. I’m happy that you haven’t had to wait long for doctors in Japan, but you are the first American that I have ever met that has had such glowing things to say about the Japanese system. Yes, the US may have some experimental treatments that get denied at times. But you miss the point that I was trying to make re the Japanese system. That is that these requests for new medications don’t even get to the patient, or the doctor, for that matter. These decisions are made by government in Japan, and the public don’t even learn about them, let alone get a chance to have them denied…. And as I mentioned in my article, placing the average life expectancy on such a high pedestal as some kind of ultimate proof of a great health care system is incomplete and naive.
Having said all of that, I appreciate your comments, and hope you will come back. I appreciate debate, and while you may disagree with my conclusions, I am always open to having them challenged. Unfortunately the anecdotal experiences of one person that I don’t know from Adam are not going to be sufficient to change my mind on the subject. I need a lot more evidence than that.
By the way, DontbashJapan, I am not a Japan basher. I love Japan, which is why I have devoted so much of my life to this country, and have lived here for more than 15 years… I simply call things as I see them. Every country has strong and weak points.
I’m going to be the second person to disagree with many of the conclusions reached above. While I agree that the Japanese health care system is no Utopia (what health care system is) and needs fixing and revision in several key area (many of which are touched on here), in general I find that my experiences with Japanese the Japanese health care system have been nothing but positive.
I’ve been living in Japan for over four years now, usually go to see the doctor for something or other between two and five times a year, and have never had a particularly bad experience. I have had to wait for hours in the waiting room before, but that was when I showed up with no appointment on the day that I wanted to be seen. Each time I’ve actually had an appointment I haven’t had to wait longer than 15 minutes. My visits to the doctor are unconscionably cheap, the doctors are always nice enough (though it’s true they don’t spend a lot of time with pleasantries), and they’ve listened to and addressed my questions. Whenever I’ve had medicine prescribed it’s been cheap and done the trick. When friends from abroad have come to visit they’ve had similar experiences (including being amazed at the incredibly cheap doctor bills).
But don’t just trust my anecdotal evidence — check out the Americans Abroad Know About National Health Care site, a site that collects stories about the positive health care experiences of Americans living abroad. This site was started by a person living in Japan, so a majority of the stories that are told here are stories about the Japanese health care system. Dozens and dozens of anecdotes, and all of them positive.
http://healthcareforamerica.blogspot.com/
Finally — and once again I agree with you that there are problems with the health care system that need to be addressed — there’s no doubt that statistically the Japanese health care system outperforms the U.S. health care system when it comes to raw, un-anecdotal statistics:
http://streetlightblog.blogspot.com/2007/03/some-statistics-on-health-care.html
It’s true that there may be many discomforts, problems, etc. when it comes to specific areas of Japanese health care — and it’s also true that the U.S. may excel when it comes to drug and treatment innovation — but as far as general care is concerned (the type that most people get and need) there’s a reason that the World Health Organization (in 2000) ranked Japan 10th and the U.S. 37th in the world when it comes to health care.
Thanks for your response troutfactory. I appreciate the time you’ve taken to make these points. You are obvious very passionate about your views. I would like to respond to some of your points, but they deserve a little more than just a passing comment in the comments section. I will be returning to this subject in the next few weeks, and I will take your points into account when I do. I hope you have the chance to come back again from time to time, and please feel free to contribute any time – even when you disagree with me….
Hi Guyjin — I look forward to hearing your reply. Again, I don’t really disagree with your criticisms of the Japanese health system when directed solely at the Japanese health system in isolation (yes! let’s make it better!), but I do think there are many ways in which it is a better system than the one that doesn’t really exist in the U.S. currently.
Like you I think that the Japanese medical system is grounded in its own particular social/cultural/economic/political matrix and it would be a mistake simply to imagine a wholesale transposition of the Japanese system onto the United States. That much said, I think there are so many positives than can be taken from the Japanese system that it would be a horrible mistake to simply dismiss what’s been able to be accomplished here despite the fact that the system may in fact be “no Utopia.”
I’ve written a much, much longer post about this at my own blog, and at the risk of seeming like a lowdown self-promoter, I’ll provide a link here:
Hmm. The link didn’t seem to post. I’ll just provide the raw URL:
http://troutfactory.wordpress.com/2009/09/16/japans-health-care-system-and-the-american-debate-about-national-care/