Here is my earlier review of the Japanese healthcare system. Additional information on medical care in Japan is below.
Funding
- The system is largely funded through payroll taxes. Employees pay a larger share of the payroll tax than employers.
- Insurance is bought from public sector sources.
- There is no private sector insurance companies.
- Co-pays are generally 30%.
Insurance
- Government managed plans cover 30% of workers.
- Society plans cover 25% of workers.
- Mutual Aid Association Insurers cover government employees and teachers.
- There are separate insurance plans for certain groups of workers (e.g., day laborers, seamen).
Physicians
- Physicians generally work on a fee-for-service basis. Physicians with positions in a hospital, however, are on salary.
- Physicians can sell prescriptions directly to patients. Unsurprisingly, Japan has the highest consumption rate of pharmaceuticals per capita in the world.
- There is no private sector practice.
- There are no GPs. All physicians are specialized, (except for physicians in rural areas)
- Physicians do not emphasize prevention (e.g., periodic physical exams are not encouraged). The government is the institution that takes the lead in providing preventive education.
- Students move immediately to their internship following 6 years of college with no medical school in between.
- Physician ratio: 1:500.
Malpractice
- The Japanese Medical Association provides malpractice insurance for 45% of Japanese physicians.
- Few claims are filed (less than 1 per 100 physicians). Because of this, malpractice insurance is only about $500/year
Hospitals:
- There are no community health centers, only clinics offering specialized services.
- Patients entering a hospital have been required to find a sponsor who will agree to pay for the services delivered when the patient cannot.
- When patients seek treatment in a hospital, they are expected to pay part of the bill in advance, with their insurance reimbursing them later.
Regulation:
- All fees for all procedures are set by a government-organized panel including insurers, providers and citizens.
Source: Roth, WF (2010) Comprehensive Healthcare for the U.S.: An Idealized Model. Productivity Press, 174 pages.
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Very interesting.
Japan is often mentioned as a good model in terms of quality of care, access to care, overall mortality/life expectancy and cost.
Which attributes of their health care model do you believe are most influential in their relative success?
Mike
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