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Health Care in Japan

October 19th, 2007

There is a new entry in Snopes.com which analyzes an email about Canada’s health care system. The writer claims to be a Canadian, but in the first two sentences s/he mentions both Hillary Clinton and Michael Moore, so you are immediately guaranteed that this is a right-wing screed likely to contain wild exaggerations and outright lies. And that’s pretty much exactly what Snopes finds.

It seems that most claims about socialized health care, from both sides, tends to be idealized. There is both good and bad, and when it comes down to it, far fewer differences between the systems than either side would like to admit. One big difference, however, is that in countries with socialized medicine, you at the very least get universal or near-universal access to health care, with both the good and the bad included. Costs, errors, wait times, etc. tend to be the same, except with socialized insurance more people are covered for essentially the same price to the country as a whole, which is a big reason I support the idea.

Here in Japan, I am on the Kokumin Hoken, or the “National Health Insurance” (NHI) plan. It’s the plan you sign up for yourself. There is another system (Shakai Hoken, or “Social Health Insurance”) which depends on co-payments from your employer. Both pay for 70% of all non-cosmetic medical costs, and those costs are kept low because the government here sets prices for treatment. Most doctors, clinics, and hospitals accept National Insurance; it’s not hard to find a place which has what you need.

Let me give you a recent example. A few weeks back, I started developing a few scotomas (blind spots) in my eyes. Having just moved to Ikebukuro, I went to the closest big hospital, Otsuka Hospital, for the first time. I was signed up with minimal paperwork and saw a doctor within one hour, despite having no appointment. (In fact, I do not recall ever having been made to wait more than three hours in a hospital in all my time in Japan.) The doctor did a preliminary exam to make sure that nothing serious or preventable was going on, and arranged for an appointment two days later for a visual field test and further consultation. I came back for the second appointment, took the tests (again within an hour, including the 30 minutes I had to wait for the pupil-dilation drops to take effect). The doc found nothing wrong, but just in case, scheduled me for appointments with their Internal Medicine department to see if arteriosclerosis was a problem (perhaps limiting blood circulation to my retinas), and a follow-up exam and tests a few days after that. Appointment scheduling was a bit crowded, so I would have to wait two weeks for them.

Total out-of-pocket costs (the unpaid 30%) for the two initial visits: $30.

But within a week after those visits, the scotomas seemed to be getting a bit worse, and I was (a) not content to wait another week and a half or so to get treated again, and (b) would have felt more comfortable with an English-speaking doctor, not to mention a specialist. On the web, I found a clinic about a 45-minute drive from home which had a Harvard Med-educated eye specialist. I called and they said that the doc would be holding a kid’s clinic on a Saturday, but I was welcome to drop by. I did, and the doc saw me within half an hour (and again, I got a clinic member card with minimal paperwork, just two minute’s writing). The doc was great, and spoke English very well. After an initial exam, he handed me off to a retinal specialist (who spoke no English but the first doc came and translated when necessary). They performed a fluorescein angiogram (injected a dye into my blood and then took many images of the retinal bloodflow), and found no blockages, leading them to conclude that the scotomas were likely caused by vascular spasms, and the blind spots would fade with time (so far, they have), with a nominal chance of some blind spots remaining. They prescribed medication to help bloodflow and prevent further spasms, and made an appointment for me to visit again the following Saturday.

Total cost for the visit, consultation by two specialists, pupil dilation, fluorescein angiogram, and one week of medicine: $45.

Keep in mind that these were initial visits without an appointment, I was admitted either on the spot or for the next day, never waited for more than one hour, and received prompt treatment from specialists.

This is not to say that all medical treatment in Japan is so great; what it does mean is that you can shop around and find the doctor and/or clinic/hospital that is right for you. You’re never locked into a specific doctor or location, you can see any doc at any location you want, so long as they accept the National Insurance. In my experience, you can usually find the medical service you want and need.

Did I mention that it includes dental? I found a great, U.S.-trained dentist in central Tokyo, speaks English, does great work, and is similarly cheap, but has up-to-date equipment in a nice, clean office, even with a great view of parkland while you’re worked on. And they do good work, too.

Despite not covering cosmetic work (you’ll have to pay full price to replace upper incisors, for example, even if it’s not literally cosmetic), you can sometimes find ways around it. I had a largish mole under my lower lip that would bleed a lot if cut shaving, and I worried about cancer and so forth; I went to a clinic about it, and though they found nothing wrong with it, they volunteered to give laser treatments to get rid of the mole entirely. This was somehow covered and cost little, with good results.

My biggest gripe: no preventive medicine that I can find. The insurance does not cover regular comprehensive checkups. However, you can get around that by going to the hospital and giving a complaint that would result in specific tests which, combined, could get similar results to a general checkup.

Premiums are in the form of a “tax” (not not rolled into other taxes, it’s paid separately), which is approx. 8.5% of your income, with a cap of ¥530,000 ($4600) per year. Alas, I have just reached that cap, and so pay the maximum amount. There are a lot of other aspects and benefits to the program I haven’t gotten into (or needed personally yet).

If you’re healthy and never need work, it can be a hassle to see all that money go to the system. But if you need to see docs relatively often, and you want coverage in case of something catastrophic, I think it’s a fantastic program. Of course, your mileage may vary.

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  1. October 20th, 2007 at 09:51 | #1

    I get upset when people rant about “socialized medicine” as though it’s some evil thing, and as though we don’t have it in the United States. We absolutely do.

    A reasonable definition of “socialized medicine” would be a program where anyone can get treatment, whether they pay for it individually or not. And we have exactly that here.

    The thing is, we deliver it in the most expensive manner possible- through the emergency room.

    If you turn up at an emergency room, they have to see you. Period. It’s the law. They might make you wait, they might wind up not doing anything for you if you don’t really have an urgent problem, but they DO have to see you. And if you do have an urgent problem, they DO have to treat you.

    And if you can’t pay, guess what? Someone else winds up paying.

    I’ve often wondered (in fact, I was going to make a blog entry on it the other day because I was just thinking about it) how much of the increase in health care premiums over the past couple of decades has stemmed from the increase in non-covered people.

    See, if someone’s not covered, and they go into the emergency room and get treated and can’t pay, the emergency room has to eat the cost. But they can’t truly just eat the costs; the bandages they bought, the drugs, the salaries of the people working there all have to be paid for somehow.

    So they simply charge more from those who CAN pay. Since the huge majority of us pay via our health insurance, our insurance winds up essentially paying for those who can’t pay at all.

    Where I was going with it was wondering just how much costs would drop if everyone were somehow covered. If next year Blue Cross didn’t have to pay overly inflated costs to the emergency rooms so they could cover the indigent, how much could Blue Cross cut rates?

    Anyway, I believe that sooner or later we’re going to get some kind of national insurance plan here in the USA. And I think that if it’s done right, it’ll reduce costs, and everyone will be better off for it in the long run.

  2. ykw
    October 21st, 2007 at 04:14 | #2

    I think with socialized medicine one needs to look at avg money spent per person. In some places it is low. Others, it is high. And when it is low, the care suffers. There is one mri machine in the nova scotia province of canada, for example. In england, one needs to wait, wait, wait, for care. I think Japan, German and places like Norway and Sweden are high cost and high care.

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