Sick Around Japan

I was talking with Jen the other day about a variety of things and she had mentioned that her husband watched a TV program by Frontline, called “Sick around the World” on the “social” healthcare systems in five countries that “worked” compared with the USA system. He was interested to know what Jen’s “friends in Japan” thought about the discussion so he forwarded her a link to the program after it came online. She sent it to me asking if I had any thoughts on the topic. Rather than watching the actual interviews, and the program, I thought that the more important thing would be for me to read the transcript of the interview with the Japanese Healthcare Economics specialist. And so I did. It was a good read, and it reaffirmed pretty much what I experience in real life and have always thought about the healthcare system here in Japan. Of course it isn’t perfect, but it does work extremely well, and the most important thing is that nobody is “left to rot”.

I agree with everything the specialist Naoki Ikegami is saying in the transcript of the interview in Japan. There is nothing incorrect here in the interview that does not correspond with “in the street” or “real life experience” as so often happens when “global reviews” take place. A good example of this “gap” is what happens in Europe when countries switch to the Euro; the governments say that things become more expensive by only a few single digit percentage points, but in reality, (in Italy and other countries where I have real friends), they say that their cost of living expenses have gone up by 30- 50% since their currency has been dropped for the Euro. These are real-life results as opposed to “government statistics” and you always have to be careful when you look at things like this, to go to the street as well.

I will include the comments that I believe are, to me, of the most value in the interview, although I recommend reading the entire interview through to get a good overall picture of the differences between the Japanese and American systems. Before I do so, I would just like to give my own thoughts on this overall system with a few short examples of when I needed major care in the hospital (cut my fingertip off and had emergency appendectomy).

I love this system, and have never found my "copays" to be overly expensive.

When I cut my fingertip off it cost me about JPY 3,000 I think for the initial visit. Then I went back every day for two weeks and they changed the bandages. The cost per visit then was just a few hundred yen a time and the amount of time I was in front of a doctor was like he says in the interview, just a few minutes. I would say that I didn’t pay any more than JPY 15,000 in total when all was said and done, and that includes medication, antibiotics, and all the follow-up visits. The wait time was less than 30 minutes. It was no problem at all.

One of the reasons why we have “3X then number of visits to hospitals compared with Americans” that the interviewer mentions is that the doctors have us come back regularly to continually inspect, change bandages, and watch the healing process. I don’t think it is like this in the USA, as far as I know, and once the initial procedure is done (unless of course it is a major procedure), you are on your to take care of it properly.

When I had my emergency appendectomy, the entire thing, including 10 days in the hospital didn't cost me any more than $300 to the hospital. That was it. Of course there was the national healthcare I pay which varies every year depending on how much money I make in the year. If I make very little money, I pay very little. When I made a fair deal two years ago, I ended up paying about $2,000 for the entire year. That's about $166 per month. It’s peanuts, really.

There are two kinds of coverage; one is funded over 50% by employer. Mayu was in that when she was working. The other one is national health care and I have opted for that. It revolves around your salary, and the copay used to be more than the employer based, but now it's the same: 30%. I did my calculations years ago to decide which one to go for and chose National because I don't get sick much at all.

Also the company-related one includes deductions for pension, etc. and since I don't pay pension here I chose not to, even though it is mandatory and instead invest overseas my monthly pension contribution for my future. The reason I chose not to is that in order to get pension I have to be working in Japan for minimum of 20 years. At the time I did not know if I would be here in Japan that long and chose not to invest in something with "iffy" returns. Now, 20 years later I look back and am still glad I invested on my own because the pension plan system in Japan is collapsing and the government has made a mess of it (they "lost" the pension payments of 500,000 people. It's a debacle).

Also the number of elderly and retiring baby boomers is skyrocketing, and we are at critical mass plus the numbers of young not working, and not paying pension is at an all time high, a very bad situation. This is a separate problem, and not really directly related to healthcare, but related to the amount of money the elderly who get sick more often have to use on healthcare, so it indirectly affects the situation.

It works very smoothly indeed, and because the government is involved, it can be considered "social medicine" but it is in no way anything like it is portrayed as in the USA "socialized (communistic) medicine".

Please be sure to read the interview and then you will understand my next comments: I can see doctors in the USA screaming "government control!!" over this system because the Japanese government does control the amount of money they can make and how much can be billed; it is highly regulated.

I believe that "the business of healthcare" should NOT be treated in the same way as “the business of products and services”. In the latter you provide basic commodities, luxuries and services to people at a price, and try to make as much money from it as possible. That’s business. The people who can afford the product at the highest profit margin, will pay it, and those who cannot will go elsewhere to find a lower level, lower quality basic product that suites their needs. If they can afford it, they will purchase, but if they can't they learn to do without.

In healthcare, if you can't afford the product you have a good chance of becoming extremely ill, or even of dying. It isn’t a matter of “doing without” if you’ve cut your fingertip off, or just finding some “discount 100 yen shop” to run in for an appendectomy. It doesn’t work that way. And it shouldn’t, in my opinion. I feel there is a fundamental difference in these “businesses” and only those who understand this difference should be in "the business of saving lives". Healthcare should not be about making the highest profit margin that the market will support. It is not the same.

I think this pretty much covers my experience here in the Japanese system that runs very smoothly. It will be interesting to see how it works over the next 10 years as the baby boomers, retirees all age and our aging silvers are more than the paying and working population. There will likely be a big stress on the system. It may get more expensive and they may find way to shift taxes around, and the working population may have to pay more in taxes to cover the retired, but it won't break us; we won’t be put out on the street wandering around confused, and drugged because we don’t have the funds to pay grossly over-inflated prices. The country will most likely continue to provide medical care to everyone who needs it, without making them go broke. - Cam

Here are the key points that I believe hit home in this interview:

So here we are in a country with the longest life expectancy, good health results, low costs -- sounds like paradise. Are there problems in paradise?

I think it's a mirror image of the United States in that we [underspend] on health care. For example, in the year 2006, health expenditures only increased by 0.1 percent, whereas the nominal GDP increased by ... 1.5 percent.

Health care went up 1/10 of 1 percent?

Right, and the reason why the government has this tight control over all prices is because the national government funds one-quarter of health expenditures, ... and the Japanese government now has a huge deficit amounting to 1.5 percent [of] GDP, and the debt is still increasing as a result of having to make tax cuts and investing in public works during the 10 years of deficit.

So in order to [start] paying back, they are making every effort to cut expenditures. This is across-the-board cost containment, and health expenditures are under that umbrella.

And remember that this is happening at the time when Japan is having a very rapid growth for the elderly. According to my calculations, just aging within the population should contribute a 2 percent increase, so the fact that there has been only a 0.1 percent [increase] means that real ... expenditures did decrease. ...

I think what you're getting at here is that they've got a system that makes sure people don't go broke paying medical bills.

Right. I think the main goal of a public health insurance system is to prevent people [from] going broke.

How many people in Japan go bankrupt because of medical bills?

None, or at least there should be none, because first of all, they should be covered, and if they're not covered, then they can get covered by paying back one year's premiums. And if they can't pay back the one year's premium, then they will be on public assistance.

If somebody in Japan loses [her] job, does she lose her health insurance, too?

She loses the employment-based insurance, but then there's the community-based insurance, which is mandated for her to enroll and for the local government to enroll that person.

Can they turn her down if she has heart disease or something?

That is forbidden. ... Neither can the employer deny in hiring someone because of health conditions.

So if lose my job I don't lose my health insurance; in fact, I'm required to buy it, but from the city instead of an employer?

Yeah. ... It's more like taxes rather than having something that you want to pay or must pay. ...

These health care plans covering basic health care for a worker and his family, do they make a profit?

No, because they are not allowed to make a profit. And anything left over is carried over to the next year, and if there's a lot carried over, then the premium rate would go down.

Do you think the Japanese people feel that everyone in this country should all have a basic package of medical coverage?

According to opinion polls, I would not only say basic but egalitarian coverage [for] all. Over 70 percent of the Japanese, when they're asked that question, say they're not only in favor of basic coverage; they are in favor of egalitarian coverage.

Notes:

Link to Interview Transcript:

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html

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