Health care in Japan
Encyclopedia
The health care system in Japan provides healthcare services, including screening examinations, prenatal care
Prenatal care
Prenatal care refers to the medical and nursing care recommended for women before and during pregnancy. The aim of good prenatal care is to detect any potential problems early, to prevent them if possible , and to direct the woman to appropriate specialists, hospitals, etc...

 and infectious disease
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...

 control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered through a universal health care
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...

 insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...

 programme administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals. Clinics must be owned and operated by physicians.

Overview

Enrollment in one of Japan's health insurance programmes is compulsory for residents of Japan. There are a total of eight health insurance systems in Japan. They can then be divided into two categories, and . Employees’ Health Insurance is broken down to the following systems:
  • Union Managed Health Insurance
  • Government Managed Health Insurance
  • Seaman’s Insurance
  • National Public Workers Mutual Aid Association Insurance
  • Local Public Workers Mutual Aid Association Insurance
  • Private School Teachers’ and Employees’ Mutual Aid Association Insurance


National Health Insurance
National Health Insurance (Japan)
is one of the two major types of insurance programs available in Japan. The other is. National Health insurance is designed for people who are not eligible to be members of any employment-based health insurance program...

 is generally reserved for self-employed people and students, whereas social insurance is normally for corporate employees. National Health Insurance can be broken down into:
  • National Health Insurance for each city, town or village
  • National Health Insurance Union


In Japan, services are provided either through regional/national public hospitals or through private hospitals/clinics, and patients have universal access to any facility, though hospitals tend to charge higher for those without a referral. Cost in Japan tends to be quite low compared to other developed countries, but utilization is much higher. This is achieved principally through tight regulation of the price of every medical service. Japan has about three times as many hospitals per capita as the United States and, on average, people visit the hospital more than four times as often as the average American. Due to large numbers of people visiting hospitals and doctors for relativity minor problems, space can be an issue in some regions. The problem has become a wide concern in Japan, particularly in Tokyo. A report that more than 14,000 emergency patients were rejected at least three times by Japanese hospitals before getting treatment in 2007, according to the government survey for that year, got a lot of attention when it was released in 2009, and around this time there were several highly publicised incidents in the Tokyo area, such as an elderly man who was turned away by 14 hospitals before dying 90 minutes after being finally admitted, and a case of a pregnant woman complaining of a severe headache being refused admission to seven Tokyo hospitals and later dying of an undiagnosed brain hemorrhage after giving birth.
Public health insurance covers most citizens/residents and the system pays 70% or more of medical and prescription drug costs with the remainder being covered by the patient (upper limits apply). The monthly insurance premium is paid per household and scaled to annual income. Supplementary private health insurance is available only to cover the co-payments or non-covered costs, and usually makes a fixed payment per days in hospital or per surgery performed, rather than per actual expenditure. In 2005, Japan spent 8.2% of GDP on health care, or US$2,908 per capita. Of that, approximately 83% was government expenditure.

History

The beginning of the Japanese Health care system happened in 1927 when the first Employee Health Insurance plan was created.

In the 1980s, health care spending was rapidly increasing as was the case with many industrialized nations. While some countries like the United States allowed costs to rise Japan instead tightly regulated the health industry to rein in costs. As of 2009, an MRI scan
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...

 of the neck region costs $US 1,500, but in Japan, $US 98. Japanese patients favor medical technology such as scans, and they receive MRIs at a per captia rate 8 times higher than the British and twice the amount of Americans. Prices all for health care services are set every two years by negotiations between the health ministry and physicians. The negotiations determine the price for every medical procedure and drug, and prices are identical across the country. If doctors attempt to game the system by ordering more procedures to generate income, the government lowers at the next round of price setting. For example, the price of MRI's were lowered 35% in 2002 by the government.

Since 1983 all elderly persons have been covered by government-sponsored insurance.

By the early 1990s, there were more than 1,000 mental hospital
Mental Hospital
Mental hospital may refer to:*Psychiatric hospital*hospital in Nepal named Mental Hospital...

s, 8,700 general hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....

s, and 1,000 comprehensive hospitals with a total capacity of 1.5 million beds. Hospitals provided both out-patient and in-patient care. In addition, 79,000 clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...

s offered primarily out-patient services, and there were 48,000 dental clinics
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...

. Most physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

s and hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....

s sold medication directly to patients, but there were 36,000 pharmacies
Pharmacy
Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs...

 where patients could purchase synthetic or herbal medication.

National health expenditures rose from about 1 trillion yen in 1965 to nearly 20 trillion yen in 1989, or from slightly more than 5% to more than 6% of Japan's national income. The system has been troubled with excessive paperwork, assembly-line care for out-patients (because few facilities made appointments), over medication, and abuse of the system because of apparent low out-of-pocket expenses
Out-of-pocket expenses
Out-of-pocket expenses are direct outlays of cash which may or may not be later reimbursed.In operating a vehicle, gasoline, parking fees and tolls are considered out-of-pocket expenses for the trip...

 to patients. Another problem is an uneven distribution of health personnel, with rural areas favored over cities.
In the late 1980s, government and professional circles were considering changing the system so that primary, secondary, and tertiary levels of care would be clearly distinguished within each geographical region. Further, facilities would be designated by level of care and referrals would be required to obtain more complex care. Policy makers and administrators also recognised the need to unify the various insurance systems and to control costs.

In the early 1990s, there were nearly 191,400 physicians, 66,800 dentist
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...

s, and 333,000 nurses, plus more than 200,000 people licensed to practice massage
Massage
Massage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle"...

, acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....

, moxibustion
Moxibustion
Moxibustion is a traditional Chinese medicine therapy using moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or...

, and other East Asian therapeutic methods.

See also

  • Aging of Japan
    Aging of Japan
    The ageing of Japan outweighs all other nations with the highest proportion of elderly citizens, 21% over the age of 65. In 1989, only 11.6% of the population was 65 years or older, but projections were that 25.6% would be in that age category by 2030...

  • Erwin Bälz
    Erwin Bälz
    Erwin Bälz was a German internist, anthropologist, personal physician to the Japanese Imperial Family and cofounder of modern medicine in Japan.- Biography :...

    —an oyatoi gaikokujin and cofounder of modern medicine in Japan
  • Health care compared—tabular comparisons with the U.S., Canada, and other countries not shown above.
  • Public health centres in Japan
    Public health centres in Japan
    In Japan, a public health centre is a facility with responsibility for public health matters. It is responsible for treatment of people with chronic health problems such as mental illness....

  • Social welfare in Japan
    Social welfare in Japan
    Social welfare, assistance for the ill or otherwise disabled and for the old, has long been provided in Japan by both the government and private companies. Beginning in the 1920s, the government enacted a series of welfare programs, based mainly on European models, to provide medical care and...

  • Birth in Japan
    Birth in Japan
    This article deals with Birth in Japan, and the specific details of childbirth exclusive to Japan in relation to beliefs, attitudes and healthcare.-History:...

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