Notes about Japan's health care system:
1. No waiting, no gatekeeper, no rationing, and a very high level of patient choice
2. Prices are low as a result of a rigid cost-containment system that benefits the patient at the expense of the doctors and hospitals
2. Prices are low as a result of a rigid cost-containment system that benefits the patient at the expense of the doctors and hospitals
3. Even the best, most prestigious doctors are accessible at virtually no cost to the patient.
4. Japan's system is largely private.
5. Competition between doctors, clinics, and hospitals is fierce. Everybody claims their treatments or procedures are more effective. There are billboards and ads (this one a cure for sweaty hands) everywhere in the cities.
6. The Japanese use more medical care than any other country. They average 14.5 hospital visits per year, three times the U.S. average.
7. Nearly all Japanese physicians make house calls.
8. The Japanese gets twice as many cat scans per year as Americans, 3x as many MRI scans.
9. Patients enjoy twice as many hospital beds per capita as American patients.
10. The Japanese spend 36 nights per hospital visit as compared to 6 nights in the U.S.
11. Japanese women spend 8-10 nights in the hospital after giving birth, compare this to 1-3 days for American women.
12. Japanese are much less likely to take advantage of invasive surgeries. Physicians don't recommend it anyways because it's so expensive, and they receive high compensation. The Japanese also have cultural hesitations about going through surgery, they prefer to take advantage of less drastic options.
13. Drugs are usually preferred to surgery. The Japanese pop twice as many pills as Americans.
14. Despite incredibly cheap access to patients, the Japanese actually require less medical care than Americans. There is less obesity, lower rates of blood-borne diseases, and less illicit drug use.
15. Health care costs are steady or even declining.
16. Medical providers' income is much lower than in most developed countries.
17. Patients are required to pay 30% of their medical bills as a co-payment, insurance picks up the remaining 70%. Co-pay is lower for children and senior citizens. There is a monthly limit on co-payment; nobody has to pay more than $650 per month.
18. Insurance plans cannot refuse coverage, regardless of preexisting conditions, and they cannot deny a claim.
19. Insurance companies are nonprofit entities; providers are private.
20. Japan has over 3500 different insurance plans to chose from. Three major categories: 1) plans set up by large companies to cover their employees, premium split 55:45 employer:employee, no government subsidies, companies subsidize premiums for pensioners, some companies (e.g. Honda, Toyota) even maintain their own hospitals; 2) in smaller companies, employer/employee split premium but with help from government subsidies; 3) Citizens Health Insurance plan, which covers retirees and the self-employed; individual and local government split the premium
21. Everybody is required to buy into health insurance. If you don't choose one, you'll be assigned one by local government. If you don't pay your premiums, you'll be hounded by collection agencies. If you get sick, you're required to pay up on all past over-due premium payments before insurance will foot your bill. If you're unemployed or unable to pay your premiums, the local government pays your premiums and bills instead.
22. When a worker loses his job, the government steps in to cover the employer's share of his premium.
23. Even the richest are required to buy into insurance.
24. In Japan, you don't get to choose your insurance plan. Rather, you are given a plan by your employer or the local city government. Patient choice rests around physician, clinic, and hospital selection.
25. The Ministry of Health and Welfare negotiates all prices with providers. Prices are set for every doctor, clinic, and hospital in Japan regardless of how luxurious or rural. All fees for every procedure imagineable are published in a book called the Shinryo Tensu Hyakumihyo (Quick Reference Guide to Medical Treatment Points). Prices are renegotiated every two years.
26. Costs remain low because of extremely poor compensation to physicians and hospitals. Doctors don't get rich in Japan, they are average earners, "comfortably middle class". Being a physicians, however, gives you sky high social class.
27. Multi-payer system that works like a single-payer system because of the strict fee schedule. Hospitals and doctors compete for customers, but fees are set. This is like phone service in the U.S.
27. Doctors often drive innovation of cheaper, more efficient technology because they want to be able to make more money for the same procedures.28. Many hospitals and clinics are on the verge of bankruptcy.
29. The list of procedures and treatments that are paid for by insurance is vast. U.S. critics cite a lack of coverage for pregnancy-related care, but the government gives pregnant a maternity grant of $3000 to cover prenatal care, delivery, and postnatal care to mother and child.
30. There is a Confucian obligation for physicians to use their skills to treat people without expecting payment.
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