Japan's healthcare system is universal, accessible, and relatively cheap compared to that of the US (11.2% versus 16.9% of GDP). It is a multi-payer system that manages to avoid excessive rationing and wait times. Compared to Americans, the Japanese see their doctors more often, have more diagnostic tests (the highest rate of MRI/CT scans in the world), and have much longer hospital stays. Their average life expectancy, at 85, is second highest in the world, right after Monaco. What gives?
For one thing,the Japanese government controls the costs of services. As a result, Japanese healthcare professionals, including physicians and nurses, are paid way less than their American counterparts. Since the government sets low rates for physician visits and procedures, Japanese doctors spend little time with their patients - on average about 6 minutes, compared to 16 minutes for US doctors. Japanese doctors make up for the low rates by really packing their schedules, but their annual earnings are still just half of what US doctors make.
The Japanese healthcare system does illustrate how regulation can sometimes be the friend of innovation. The government overseers set low reimbursement rates for MRIs. So what did the Japanese do? Develop cheap MRI machines. Create the right incentives and inventions will follow. The Japanese also have a healthy (!) co-pay: 30% for many visits and procedures, but their total costs are capped so they don't go broke.
But yeah, there are problems and some things aren't as impressive as they seem to be, like the famed Japanese lifespan. Japanese-Americans actually live longer, on average. That's because healthcare systems have less to do with longevity than diet, lifestyle, and genes. And cost is becoming a weakness of Japan’s health care: it is teetering on the edge of bankruptcy, what with too many sick old people and too few tax/premium-paying young people.
What can we learn from the Japanese healthcare system? Let me count the ways:
- Multi-payer and universal healthcare can go together.
- Insurance companies can be part of the system.
- Regulations can spur cost-saving innovation.
- Governmental cost oversight is essential.
Links and References:
General Physician Average Salary Income - International Comparison
http://nbakki.hatenablog.com/entry/Annual_Salary_by_Occupation
http://www.worldlifeexpectancy.com/usa/life-expectancy-asian-american
Wooldridge, A. N., Arató, N., Sen, A., Amenomori, M., & Fetters, M. D. (2010). Truth or fallacy? Three hour wait for three minutes with the doctor: Findings from a private clinic in rural Japan. Asia Pacific Family Medicine, 9(1), 11. http://doi.org/10.1186/1447-056X-9-11