Monday, August 17, 2009

Health Care Stories: Tokyo, Japan

Mr. Salaryman has only one thing to say to us all about Japan's health care system:

I like the Japanese health care system!

Now, in a rare moment of weakness I will actually get mildly political here, and perhaps even a little controversial. You see, I happen to actually like the Japanese health care system, and I say this both as a taxpaying individual (included in the general health insurance) and as a professional in the Japan office of a foreign-based company specialized in high-risk health care products.

This should not be read as a statement that I think the Japanese health care system is perfect, it is far from it, but I think the general policy is correct; the issues that I do have with the system are more related to the general slowness of the Japanese bureaucracy and problems in execution of a policy.

In any case, discussing my views as a professional is a bit too complex and boring for this brief text, but I can just briefly say that in general I like the Japanese system in theory and if they could just achieve better harmonization with other important foreign regulatory bodies (such as the US FDA), I believe that it would be a pretty good system. The problem that plagues Japan, and foreign companies wanting to enter the lucrative Japanese market, is that it takes longer to get new therapies and products to Japan due to regulatory requirements in terms of clinical trials, etc., sometimes leading to the most effective treatment not being available for the Japanese patient. But one should also keep in mind that in theory, this is to provide safe products and drugs to the people in Japan.

As a private individual without any severe and/or chronic diseases, I really like the Japanese health care system. I must admit that even though I was born and raised in Sweden, my knowledge as a “customer” of the Swedish health care system is a bit limited, but from the little I know of it, it’s a hassle to actually get medical care unless you are dead, dying, or somewhere in-between. When trying to book a time for any non-acute problem they will do their utmost to convince you, over the phone, to wait at least another week before you even consider bothering them again. If you would happen to be lucky enough to get a time and get a diagnosis for something that requires a medical procedure you will most likely end up waiting to get the treatment for a number of months, again, unless you happen to be dead, dying, or somewhere in-between. However, once you do enter the system, the care you get is free and of a very high standard.

In Japan, availability is the least of the troubles; with the huge number of private clinics around, everyone welcomes a new patient. No problem is too small to get checked out by a physician and then getting a significant amount of drugs prescribed to you for your little headache, fever, muscle ache, or whatever you happen to be suffering from. The problem that you can encounter in Japan is over-treatment, since the hospitals/clinics and, by extension, doctors get more money the more treatment and drugs that they can dish out to the patients.

The cost of treatment is also very reasonable, with 30% of treatment and drug costs financed by the patients themselves in a standard case (say me going to get medicine for the flu), but is also flexible enough to take into account the financial situation of the individual patient with a roof for cost ensuring that no patients in Japan will not be able to receive a critical medical treatment due to financial constraints. In short, even though there is a co-payment sum the individual has to pay, the Japanese system ensures that no individual will be denied critical medical care due to that person’s financial situation.

That a developed and leading, in so many ways, country such as the United States of America has not yet ensured the same protection for its citizen is a complete mystery to me.

Mr. Salaryman
Tokyo, Japan

Check out his blog, The Adventures of a Foreign Salaryman in Tokyo.

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mameha said...

I generally agree but I think more control/regulation is need to prevent clinics from profiteering on customers.

As you say, they over-prescribe, but a bigger problem is that they like to bring you in multiple times because they get a fee just for looking at you. So you will often be told to come several times for something that would be done in one session in a country like the UK where healthcare is free. For a busy person, this is a major hassle and I do not like challenging the ethics of my doctor/dentist every time about whether the 2nd visit is really necessary or not.

Mr. Salaryman said...

Yeah, basically I agree with you actually so not much to argue around... The big problem here in Japan is overprescription and keeping patients for way too long in the hospitals (in the US they chase the patients out with sticks after a few days, but in Japan they'd like to keep them forever if they could). I've seen comparison data on f.i. hospital stay and Japan was about three times as long.

But, and that's the core argument for me here, I'd rather have healthcare that does too much rather than too little as long as it can afford it.

Generally, I'm pretty particular in selecting doctors so I get someone I trust to not overdo shit.