At The Commonwealth Fund’s annual meeting in November 2012, Ryoso
Matsuda, a professor in the College of Social Sciences at Kyoto’s Ritsumeikan
University, presented a detailed profile of the Japanese Healthcare System. In his profile, Matsuda covers how Japan has
been successful in implementing national healthcare in each of the country’s 47
regions or prefectures, determining fees for healthcare services, and deciding
how much its citizens pay for their healthcare, yet unsuccessful in
implementing electronic health records.
According to Matsuda, the role of Japan’s government is to regulate all aspects of the
universal public health insurance system. This includes setting fee schedules,
subsidizing local prefectures, insurers, and providers to implement national
health insurance policies, and determining then enforcing regulations for both
insurers and providers. Everyone in Japan must have health insurance coverage.
For those under age 75, employees (and their dependents) who work for small or medium-sized
companies must enroll in the coverage offered by their employer or enroll in
the Japan Health Insurance Association. The rest who are under age 75
–including the unemployed, self-employed, and retired - are covered by Citizens
Health Insurance plans. Japanese citizens over age 75 are covered by specific health
insurance plans which are run by insurers in each prefecture.
No
one can choose their plan or coverage.
If anyone has failed to enroll in an insurance plan and then decides
later to enroll, they have to pay a penalty equal to two years of insurance
premiums. If someone is a long-term visitor to Japan or a resident non-citizen,
they are required to enroll in a public health insurance policy. Illegal
immigrants are not covered for health care in Japan. In spite of all of this
coverage, supplemental private health insurance policies are purchased by the
majority of Japanese adults.
One
of the hallmarks of the Japanese healthcare system is cost-sharing. Thirty
percent of the cost of care is paid for by those enrolled in a policy. For children, that percentage drops to 20%,
and for those over age 70 or with low incomes the percentage drops to ten
percent. Government employees have their
own insurance system known as a Mutual Aid Society. Private physicians also
have their own insurance plan.
The public health insurance system finances 80.5 percent of all health
expenses in Japan, There is some varying of premiums from prefecture to
prefecture, but it does not vary too much. Premiums are based on wages, assets,
and number in household. The only
privately funded health care that is given is orthodontic care, artificial
teeth for cosmetic purposes, and treatment for auto accidents.
Japanese physicians are all trained as specialists. They choose to work in hospitals or in
physician-owned and managed clinics with many different types of specialists
working together in one place. Patients can choose to go to any clinic they
want and see whatever type of doctor they need, or whatever type a physician
refers them to. There is no widespread
“gate-keeping” like there is in the United States where you must see your
family physician first to get a referral to a specialist. However, some of the larger hospitals and
academic medical centers charge an extra fee to see patients who were not
referred by a physician.
Electronic health records (EHR) has not been successful in Japan despite
being in use for a decade. They are not widely used or liked by Japanese
physicians, and are seen as successful or unsuccessful experiments in different
prefectures. Patients and physicians seem to be much happier with the
experimental use of cloud computing to pass on patient records. Electronic
billing, on the other hand, is mandatory in Japan and has been very successful.
Japan
has a national healthcare system where all citizens are insured, and insurance
rates are based on one’s ability to pay.
Everyone pays something for insurance, and those who want supplemental
insurance purchase it. Physicians are accessible to patients, and patients do
not need to work through the maze of obtaining specialty care since they are
allowed to directly book appointments with any specialist. Electronic health records have not been
well-accepted or widely implemented. It looks as though placing patients’
records in the “cloud” is a more desirable way to go,
4:30PM
Emily Crigger
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