Tuesday, September 6, 2011

The pain, oh the pain--

Admit it! You've been to a hospital at least once in your life. Don't lie to me! Although... you probably haven't been to a Japanese hospital before. The fundamentals are the same--make people feel better, cure diseases, etc--so it's really the finer points that make the sharp contrast between Japanese health care and American health care.

As a resident of Japan, I was required to enroll in the Japanese health care system. Everyone living in Japan must have health insurance. Of course, that's just the law. In reality, many people cannot afford health insurance and enforcement is lax. Japanese citizens visit the hospital nearly four times as often as Americans. I recall my time spent as a foreign exchange student in Tokyo; whenever any of us would get even remotely ill, all of our friends would advise us to visit a doctor.

I had occassion to visit the hospital this week. Let me assure you, it was nothing serious. While there, I was not particularly shocked by anything I saw, except for the large population of elderly people visiting at the same time. This may be due to the rising median age in Japan. I did a short report on the diminishment of the Japanese population back in 2009. The gist of it was that if Japan doesn't start having more babies or bring in some foreign labor, the youth of Japan will not be able to shoulder the burden of the expanding elderly population. By 2050, 40 percent of Japanese citizens will be over 65 years old!

But that's neither here nor there. Public health insurance pays around 70% of my medical expenses, and I make up the rest out-of-pocket. This comes down to a very reasonable amount, at least when compared to the soaring costs of medical care in the United States. Here's a real zinger for you: in the USA, an MRI scan costs $1,500. An equivalent MRI in Japan costs roughly $100. Since Japan is a cash-based society, the hospital doesn't send you a bill. They prefer you to pay in cash, at the counter, on your way out the door.

I'm not going to pretend it's a perfect system, though. It is easy to get an appointment with a doctor because there are three times as many hospitals per capita in Japan than in America. However, these hospitals still suffer from a "crowding-out" effect where serious patients suffer due to an influx of people going to the hospital for routine or non-serious treatment. The system also suffers from over-medication and excessive paperwork.

I'll always remember a story my friend (a fellow ALT) told me about her experience with Japanese hospitals. She cut her hand with a knife while cutting vegetables and had to be taken to the local clinic. The doctors held her from treatment until they could determine which name or title would be most appropriate to use when addressing her. Finally, they sent her home with medication so powerful that it caused her to black out. I'm paraphrasing, of course, but my point is that every health care system has its flaws. I can imagine, though, that from an American's perspective low co-pays, short waiting times and an abundance of readily-available clinics would be seen as a godsend.

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