Saturday, April 19, 2008

Japanese Healthcare Revisited

I received the following comment for this post. The answer became fairly long, and I did promise to revisit the issue, so I’m uploading it as a separate post on its own. I find it amusing that it retains the feel of a comment.

What if you are critically ill and in an ambulance and the crew cannot find a hospital that will accept you? Perhaps they are busy, or think you might have a contagious disease. And you die. Then what?

That's just one of the puzzling questions I had after watching the Old Japan Hand. I have more when I read the newspapers or see how my mother-in-law was treated when she had a serious illness and required long-term hospitalization. Well, the cost was low to us at first, so I guess that's all that is important.


I'm sorry to hear about your mother-in-law, Dan. She apparently got much worse treatment than my grandfather, who spent his last years in a hospital.

Cost is, of course, always important, and in the long run, you end up getting what you pay for, and vice versa. So you have to strike the balance somewhere. This means that every public healthcare system will fall short of the ideal and only the wealthy will get everything they ask for, at their own cost.

One way to cut costs is queuing. That’s why you see those piles of months-old magazines and used comic books in waiting rooms. Some queues can be much longer, and systemic. For example, some national healthcare systems keep you waiting for months for surgery, which could result in serious harm to the health of the patient.

Another way is to cut services altogether. It’s clear from the video that many hospitals are facing financial difficulties, and one of the consequences beyond the purview of the documentary appears to be a deterioration of emergency services in some areas. I don’t know how pervasive this problem is (not in my neighborhood, if personal experience is any gauge - which admittedly may merely highlight the dangers of the anecdotal approach - particularly with the extra money the local government has put been putting into its medical services in recent years), since I haven’t followed the issue closely enough to see any statistics. I also do not know how much of the problem is due to local budgetary constraints (which would give added urgency to the promised reassignment of gasoline tax revenues to general purpose funds) or management issues (for someone has to coordinate the system, and governments, local and national, can be slow-moving and unimaginative, to put it gently, which means that your relatives on your wife’s side should vote early and vote often - I mean, every chance they have).

Doctors and medical institutions game the system on the revenue side too. I think that the documentary mentioned the high proportion of money going to medication. That’s one price you pay, pardon the expression, for a fairly rigid pricing system. Then there’s the sagaku beddo, where the hospitalized patient pays extra for an accommodation upgrade.

So Japan, like most countries, winds up with an imperfect (from a Bill Gates or Sumner Redstone perspective anyway) system. T.R. Reid finds the Japanese public satisfied (define satisfied, yeah, of course), and that conforms to his personal experience from his Tokyo days as WaPo Bureau Chief. I think that I can say the same for myself as well as that of my immediate family.

Of course, all is not well with the system, and the documentary touches on those points as well. But it just might be that T.R. Reid has accentuated the positive more than other foreign correspondents in Japan do. If so, that may owe something to his sunny and positive outlook. Still, it’s good to have someone let the world know that we’re not all a bunch of whale-killing, kangaroo-slaughtering, right-wing, walking vending machines.

ADD April 20: The “walking vending machines” is a reference to this all-time low in NYT Japan-Is-Weird stories. I say “low” not because of the subject of the story but because the gullible writer apparently missed the joke.

6 comments:

Janne Morén said...

My experience with the Japanese health care system is good too. My impression is that lines are shorter for "everyday" stuff - it's faster and easier for for me to refill my prescriptions every few months here than it was in Sweden - and the quality of care has been very good. I think a reason for that is the large number of small clinics, which makes care very accessible.

And I suspect that's why emergency care is suffering a bit (if it is; haven't seen any real statistics). Three or four small, marginally staffed and equipped emergency units in small hospitals is not as effective as one large, specialized trauma center. Distributed care is generally much preferred for anything non-life threatening; centralized care is better for the really serious stuff. From what I've seen - and despite the occasional horror story - Japan manages to balance those requirements well enough.

Jun Okumura said...

Janne:

You always cut to the quick, don’t you?

My experience with the “everyday” stuff agrees with yours, and I can’t find any reason to disagree with your point about “the large number of small clinics” either.

Your comment on the effect of the size of hospitals on emergency care makes sense to me too. To illustrate your point, the emergency care in our cluster of suburban Tokyo cities, which has at least two large, well-equipped municipal hospitals fairly close to where I live, is good. There may also be other incentive-related issues that are not related to hospital size. If I come across anything on this, I’ll come back to it, likely as another post.

Janne Morén said...

You always cut to the quick, don’t you?

I apologize. I don't intend for my posts to be antagonistic or hurtful; if they come across as such I will try my best to soften them. It is all too easy easy to come across quite differently from what you intended, on a medium such as this.

Jun Okumura said...

My bad, Janne, I used the term cut to the quick in the derivative and less common sense of reaching the core of the issue rapidly and directly. Please keep it up.

Janne Morén said...

Ah, OK. I have been criticized for my too-abrupt tone in other forums so a rebuke was entirely believable.

I haven't heard that meaning before; you don't mean cut to the chase by any chance?

Jun Okumura said...

Janne:

Posted independently, here.