Global Health Care Systems: United States vs. Japan
It is difficult to find a country that is more opposite in cultural scene to the United States than Japan. Their attitude to money, to diet and to social relations is completely different, and as the result the Japanese health care system also does not have much in common with the US variant. Such difference are interesting for further investigation, because it gives a possibility to understand the unusual yet very effective health care experience better and to look at the American system from a new perspective.
Health Statistics and Costs
Life expectancy for men in Japan is 80 years. Men in the US live until 76 years on average. Women in the US generally live up to 81 year, while the life expectancy for women in Japan is 87, which is the highest in the world. Infant mortality rate in Japan is 2.13, while in the US it is 6.8. The overall mortality rate in Japan is 84.85, while in the USA it is higher and constitutes 141.23 (Rice et al., 2013, p. 69).
Cancer and HIS/AIDS are considered to be the incurable or very difficult to cure diseases. In the US 1.2 millions of people are HIV/AIDS positive, while in Japan there are only 1.056 reported cases. 350.8 people of 1.000 suffer from cancer in Japan (OECD, 2009, p. 13). The rates in the US are lower, only 133 people have this disease. Though, there is one problem that is major in the United States and is not that urgent for Japan. The rate of obesity in America is 30.6 %, while it is 3.5 % among the Japanese. As the result, more people in the US die from the heart diseases. 106.5 people of 100.000 die because of it (Rice et al., 2013, p. 70). In Japan only 30.2 people of 100.000 die from cardiovascular diseases.
Health Care Financing
The Japanese health care system is financed mainly by the public sector. The health care receives almost 82.1 % of their budget from the public insurance system. The total amount of money spent on medical care equals approximately 10.3 % of the Japanese GDP (OECD, 2009, p. 14). The fees are usually charged from wages. The organizations have to pay half of the premiums for their employees, and the rate of the tax for health care varies from 3 to 10 % of the monthly income. Those people who work for the state have their own health insurance system, which is called the Mutual Aid Society, that covers the premiums on their salaries. The private health care financing also exists in Japan. Though it does not refer to the basic needs of a person. It covers the expenditures on curing the injuries from the traffic accidents, expensive artificial teeth (the basic insurance allows to chose cheaper analogues) or other objectively expensive orthodontics. It is traditionally considered that private medical insurance is complementary to the life insurance in Japan. The majority of adult Japanese citizens use private insurance as the protection from out-of-pocket payments that might be needed in case of long term hospitalization (Matsuda et al., 2008, p. 27-28).
The American health care system is different in this issue from its Japanese counterpart and is financed mainly from private sources. If a US citizen wants to have a health care insurance, he/she has to purchase it. The prices for the insurances are high and as the result nearly 15 % of the Americans do not have it (Holtz, 2008, p. 1). Sometimes a person can receive the medical care insurance as a supplementary advantage of the work for a big company. Even though the biggest part of the US health care system is financed on personally, there is still the federal health care budget. It is divided among the states and such social programs as Medicaid, that are publicly financed from the taxes, allows people with low income receive medical help for free (Rice et al., 2013, p. 58).
Health Care Administration
In Japan the health care system is regulated by the Ministry of Health. Labor and Welfare, in particular by its department that is called the Social Security Council. It controls the costs of the drugs and their quality, and also creates the state policy concerning the health care organization and coping with problems. The department called the Health Science Council is responsible for public health policies. The third governmental department, the central Social Insurance Medical Council, is in charge of fee schedules or payment rules (Ikegami, Anderson, 2012, p. 27).
The state department that regulates the work of the health care system in the United States is the Department of Health and Human Services. It is divided into smaller committees like the Japanese department. The research in the medical sphere is undertaken by the National Institute of Health and the Agency for Health Care Research and Quality. The latter investigates into the means of improving the health care services delivered to the Americans. The Food and Drug Administration is responsible for the quality of the production related to the health care, among which are food, drugs and vaccines. The last department of the US federal government that is connected with the health care system is the Health Resources and Services Administration, and it works with the problems of the uninsured poor, isolated people and other representatives of the vulnerable population (Rice et al., 2013, p. 47-48).
Health Care Personnel and Facilities
In Japan, there is no division between the clinics that provide all medical services included in the insurances and the hospitals where people can receive primary medical help. Nearly one third of the doctors in Japan are officially employed by the hospitals, the others are considered to be self-employed. It is necessary to note that many clinics are owned by the medical corporations or individual physicians. The teams that render the primary care usually consist of a physician and several nurses. The tradition of choosing a family doctor is very popular in Japan and government encourages it. Almost 75 % of Japanese hospitals are private and not-for-profit, the other 15 % are owned by the local or national government (Matsuda et al., 2008, p. 26). The prices for consultations are lower in larger clinics than in small hospitals. It is also necessary to mention that for-profit hospitals are prohibited by law in Japan.
Unlike Japan, for-profit health care organizations are allowed in the United States and constitute almost 15 % of the entire number of clinics in the country. The other 15 percent of hospitals are private and the rest 70 % are not-for-profit clinics. There is a variety of sources from which the hospitals receive funding (Holtz, 2008, p. 4). The patients pay for all services, per-diem and per-case. Only a minor part of the physicians are officially employed by the hospital on the salary basis, the majority of them receive fees for the individual medical services and consultations. It is not possible to state that in the United States the prices in the larger hospitals are comparatively low, as it is in the case of the Japanese health care system. The correlation between the number of nurses and physicians is approximately 4:1, which is higher comparing to 2:1 ratio for Japan (Rice et al., 2013, p. 246).
Access and Inequality Issues
The Japanese government tries to decrease the inequality in the level of cancer treatment in different prefectures of the state. There is also a problem that is discussed by the Ministry of Health, Labor and Welfare that the expectancies of life differ depending on the social and economic status of people. In fact, all Japanese citizens regardless their financial status receive equal medical help. However, the life style of the poorer people is less healthy than the one of those who have money, and thus they live less (OECD, 2009, p. 13).
It is possible to assume that the US have more problems connected with providing health care for the poor. The Medicare insurance costs much, and as the result there are many American residents who rely only on the primary urgent help in case of the sudden incident (Holtz, 2008, p. 8). There is also Medicaid, a program sponsored by the federal government to give free insurance for the most vulnerable levels of the society. However, there are too many people who want to use this help and as the result the federal budget faces serious deficit in the health care sphere (Holtz, 2008, p. 10).
The health care systems of the United States and Japan do not have much in common. The medical sphere is regulated by the government in Japan, which is opposite to the American tradition. People can receive professional help in every clinic of the country in Japan for comparatively moderate price or under their obligatory health insurance, and they do not need to worry that the level of service might be lower than in the other places. The government controls all medical institutions. As the result, there are no striking inequalities in the Japanese society comparing to the US. The Japanese government starts campaigns to eliminate the differences in life expectancy rates among wealthy and more poor citizens, but the statistical rates of the Japanese are still several times better than the ones of the Americans. Their way of living and the health care system might seem strange for the Americans, but as the statistics show, they are efficient.
Holtz, C. (2008). Global health in developed societies: United States. In Holtz. C., Global health care: Issues and policies (pp.1-21). Sudbury, MA: Jones and Bartlett.
Ikegami, N., and Anderson, G. F. (2012). In Japan, all-payer rate setting under right government control has proved to be an effective approach to containing costs. Health Affairs 31(5), 1049–56.
Matsuda, S.K. et al. (2008). Development and use of the Japanese case-mix system. Eurohealth 14(3), 25–30.
OECD (2009). Health-care reform in Japan: controlling costs, improving quality and ensuring equity. OECD Economic Survey 32, 10 – 15.
Rice, T., Rosenau, P., Unruh, L. Y. et al. (2013). United States of America: health system review. Health Systems in Transition 15(3), 1–431.