Despite being one of the most industrialized countries in the world, the United States has a healthcare system that is unlike any other industrialized country in the world.
Until recently, the United States lacked a health-care system for its residents, as well as universal health-care coverage (Davis, 2016). During President Obama's presidency, the Affordable Care Act was enacted.
The majority of the population in the United States has some form of health insurance, with a portion having an insurance plan via their employer.
Japan has a health-care system for all of its residents, known as the Universal Health Care System. It is mandatory that every citizen in Japan has an insurance cover that pays for their medical care.
The patients in Japan provide for with a range of health care's services that they can access once they accept to take responsibility and pay 30% of the amount while the government pays the rest of the 70%.
The government also sets aside some funds every year for the health care system purposes. The health care services that Japan patients can access include screening examination, prenatal care, and infectious disease. The screenings include the MRI and CT scans.
Unlike the US, Japan government requires every resident to have health insurance.
Since Japan government regulates the medical system and strives to make it affordable to every individual, uninsured patients are hence responsible for paying for their medical bills 100% (Davis, 2016) though the government has waived the fee for low-income earners and homeless people who are brought in by ambulance.
Accessibility to Health Care Systems
In the US a lot of people can get accessibility to healthcare services by aid insurance services. The unemployed adults in the United States also face poorer both physical and mental healthcare compared to the employed adults. This is the case for both the insured and the uninsured. The unemployed adults face challenges in accessing medical care because of the high costs. According to statistics in 2009-2010 it is estimated that 48.2% of adults aged 16-24 years had insurance compared to 81.5% of the employed adults (Mills et al., 2013). Over the past decade, many children have gained health insurance. Children are not missing out on the needs like dental examinations and physical exams. Due to growth in Medicaid and Children's Health Insurance program, most children are getting the care they need. The retirees in the United States can also access the medical care through Health Insurance Market Place plan. The retired ones can also take retiree health benefits and they can hence be considered covered. Once you are covered you don't have to pay any fee that those people without insurance pay. Unlike the health system in USA, those in Japan require that everybody be insured, the children, adults, and the retirees. The government automatically caters for that.
The major reason why Americans face the problem of accessing health care was the prohibitively high cost involved.
It is said that a low-income earner in America is more likely not to go the health centre when they are sick unlike in any other developed country. A percentage of physicians in the US have acknowledged that most patients have had difficulty in accessing health care due to the high costs involved. The physicians and doctors also charge a significant amount of fee for medical examinations.
Health costs in Japan are supposedly very low compared to any other advanced country.
However, the utilization costs of health services are very high. For example, if a patient is referred to a hospital from another local hospital, the preferred hospital tends to charge them more. This is a big challenge for the patients as they end up paying more in different medical facilities even after paying medical examination fees. In the meanwhile, the Japanese can access health care services in any region public hospital and also any private hospitals or clinics. Even when patients are referred to another hospital, no extra charges are paid in the new medical facility.
Mills in his book explains that due to the low cost of health services there has been a huge number of people visiting the hospital for minor problems and this has led to shortages of doctors and their services (Mills et al., 2013).
It has also been documented that retired individuals have problems accessing the health care in Japan. "Injured man dies after the rejection of treatment in 14 hospitals"(Yamaguchi, 2009). One old man went to several hospitals and was rejected. The same is said for a young pregnant woman who died after losing a lot of blood, having been dismissed by several hospitals.
Requirement for Referral
In the US referral is a written order to see a practitioner who is specialised/qualified to provide health care service. In the US referrals are required from primary doctors in cases such us inpatient services, outpatient services for wound, speech therapy etc. Even after referral, there might be fee charges required in the referred hospital for one to receive medical aid.
In Japan the medical system is quite unique. There are no referrals.
A patient can visit any specialist that they want but of course they will have to add an additional fee. Patients neither have regular primary doctor in Japan nor are they limited to any special medical attainment. They can easily choose their own health care facilities and later part-way through their care. In case they are able to pay a surcharge, they can then receive medical assistance at Regional Support Hospitals and Special Functioning Hospitals with no need of a referral letter.
According to research in 2006, about 60% of patients visited a certain Special Function Hospital without being referred.
A patient can stay at the hospital as long as 32.5 days maximum (Tatara, 2010). The Japanese healthcare system is quite unique. There is no specialist certification or some board of certification in Japan.
Specialists in Japan do not have any special certification.
Once they finish their studies they are free to specialise in any field when they get their on-the-job training. After passing some national exams and also completing general clinical training for two years, they can chose to specialize anywhere. Although there is no specialist certification system in Japan, one can become a member of society certified specialist simply by doing and passing relevant exams that render you to be called a specialist.
Coverage of Pre-Existing Condition
In health, pre-existing conditions are health conditions that were diagnosed or purchased by an insurance provider. The US continues to struggle with the issue of the pre-existing condition long after other developed nations have sorted this problem out. Even though the passing of Affordable Care Act was enacted there is still issues with Providers of health insurance who want to advantage of the patients so that they can make profits (Mills et al., 2013). Before the passing of Affordable Care, health insurers were the ones determining what pre-existing condition was and whether to finance it or not unless the government intervenes.
A citizen moving from the US to Japan might have a startling experience regarding medical coverage of pre-existing condition.
Even though Japan has a high cost of living, the healthcare in Japan provides a much more accessible and comprehensive health coverage for its people compared to the USA. In Japan, no one is denied any medical attention due to a pre-existing condition. With or without the pre-existing condition A Japanese national has to receive full cover despite the status that they have.
The system in Japan provides care for all the citizens and very few appointments requirements which are also offered at a low cost.
Since there is already the universal insurance that was enacted by the government, the other insurance providers cannot exploit individuals with pre-existing conditions.
Talking of appointments, a basic one costs roughly $20 that is even without insurance.
This amount is about what the US people with insurance would still pay. Unlike the US, everybody in Japan takes part in the insurance system that is universal. The government committees set aside fees for the insurance system, then people access it through work, but some who cannot obtain it through work can have participation in national health insurance program in their local government (Tatara, 2010). The US is far much behind with millions of people uninsured and even underinsured The Japan government watches over its citizen's health issues.
Financial Implications for Patients
In the US until the introduction of Affordable Care Act, patients had to part ways with a lot of money so that they could get healthcare's services. The healthcare system was so expensive such that only those in middle and upper class could afford health care (Mills et al., 2013). Those that were not employed, the retired or the low-income earners did not have the means to go to the hospital. Those that were able to pay for insurance services received proper treatment from their primary doctors. But the ACA has enabled most individuals to access the services at affordable cost.
Data and research also show that physician and hospital prices are highest in the US.
The average price for surgery in the US is roughly $75,345 which is about $30,000 more than in other places like Japan (Davis, 2016). Scans like MRI and Ct scans were also recorded to be highest in the USA, by the International Federation of Health Plans. This is not the case in Japan because they offer lower and cheaper services. In Japan the low cost of health has enabled many people to access the healthcare service.
Medical feels have been strictly regulated by the Japanese government such that they are so affordable.
The amount the patients are responsible for paying to depend on the family income and the age of the person insured. The patients pay from 10%, 20% or 30% of the amount and the government pays the rest. Research shows that in the year 2008 Japan had set aside 8.5% gross domestic product of the nation on the healthcare. This is about $2,873 of US per capita (Davis, 2016). Though the low cost has increased the number of patients seeing one doctor, this has led to poor services being provided and even other losing their loved ones since the doctor has to see too many patients.
The US should enact policies that control the way the health insurance sectors operate primarily in pre-existing conditions.
The US has the best specialist among the industrialized nations, but its health is still neglecting primary health and preventive care. The US should look for methods to lower the health cost. This could include enacting a national health service where doctors or nurse provide medical service, and the government pays them (Mills et al., 2013). Providing the means to lower the health fee will also cater for the needs of the poor and unemployed. Those who cannot access the heal care can hence do without much (Tatara, 2015).
In Japan, the government should try and improve on service delivery.
Though the cost is low, there are still people who cannot get access to these health care services due to overcrowded hospitals or shortage of specialists.
References
Davis, K. (2016). Mirror, mirror on the wall: an update on the quality of American health care through the patient’s lens. New York, NY: Commonwealth Fund.
Health systems: the next decade, proceedings of the twelfth annual conference of the Society for Advanced Medical System, in conjunction with the Fourth Annual Symposium on Computer Applications in Medical Care,Wash., D.C., 1980. (2010). Wash., D.C.: SAMS.
Mills, R. J., & Bhandari, S. (2013). Health insurance coverage in the United States: 2002. Washington, DC: U.S. Dept. of Commerce, Economics and Statistics Administration, Bureau of the Census.
Tatara, K., Okamoto, E., Allin, S., & Matsuda, R. (2010). Health systems in transition: Japan: health system review. Copenhagen: WHO.
