Friday, September 25, 2009

If I had to Choose Between Current US System and Current Japanese System...I Would Unequivocally Choose the Japanese System

"I’ve been living in Japan for over four years now and my experiences with the Japanese health care system have been universally positive. During my first year in Japan I was covered by the Kokumin-Kenkō-Hoken 国民健康保険 (national health insurance — i.e. “the public option”).

Since I had no registered income in Japan for the year prior to signing up with the national health insurance system I ended up paying the absolute minimum amount (the amount you pay into the national system is calculated as a percentage of your previous year’s income). I ended up paying 18,000 yen for a year’s worth of insurance, or the equivalent of around 180 U.S. dollars. This allowed me to see any doctor I chose with no limitation on consultations or on treatment. Of course, there were co-pays involved depending on the services that I needed, but these were so incredibly low as to be practically non-existent. For example, a consultation with a doctor would run me between 300 and 700 yen (three to seven U.S. dollars) and a two-week prescription for antibiotics might end up costing about 1,500 yen (about fifteen dollars).

In my second year of living in Japan new rules came into place and I was required to sign up with the insurance program offered by the university that I work for (supplementary insurance is available if you feel that the university insurance is insufficient). Now I pay somewhere between 100 and 300 dollars a month for my health insurance (I’m not sure exactly what the precise amount is since it’s taken out of my paycheck automatically and it doesn’t make enough of a dent in my earnings for me to spend very much time thinking about it).

As with a great many employers in Japan, the university that I work for requires its employees to take an annual medical exam (at no expense to the individual). This exam includes a host of standard tests (urine, blood, etc.), as well as a mandatory chest x-ray for teachers (tuberculosis is a problem in Japan, as is lung cancer). What this means, of course, is that doctors are able to offer preventative medical advice about lifestyle choices based on the readings they get from your annual exams, in addition to the obvious benefit of catching medical problems early enough that they can be dealt with at the stage when treatment is most effective — i.e., before symptoms escalate to the point of an emergency room visit.

Here's a more detailed account dealing with a sinus infection that I had: I came to the hospital with no appointment and was directed to the ear-nose-throat specialists. I did have to wait almost two hours (luckily I brought a book), but I was finally seen by the doctor who checked my sinuses, sent me for an x-ray to confirm that I had a sinus infection, and then prescribed antibiotics for me. The total cost out of my own pocket? About 3,500 yen, or 35 bucks in U.S. currency. I had a followup appointment the next week. I had to wait for about 15 minutes, the doctor asked me how I was doing and checked my sinuses again, saw that the medication was doing the trick, and sent me away. Cost? 300 yen (about three U.S. dollars).

Since I’ve been living in Japan I’ve had nothing but good experiences with the Japanese medical system and even though I have had two waits of longer than an hour, I was still able to see the doctor on the same day without an appointment and get the treatment that I needed. On the days when I had made a prior appointment I was able to see the doctor within 15 minutes of the appointed time (comparable to the States, except for one time in Berkeley when I was left waiting in the examination room for about 45 minutes before the doctor showed up). My visits to the doctor are unconscionably cheap, the doctors are always nice enough (though it’s true they don’t spend a lot of time with pleasantries), and they’ve listened to and addressed my questions. Whenever I’ve had medicine prescribed it’s been cheap and done the trick. When friends from abroad have come to visit they’ve had similar experiences (including being amazed at the incredibly cheap doctor bills). I have had the proverbial three-minute doctor visit (which was indeed a blunt instrument), but it worked —prescription given, problem solved.

Let me be absolutely clear — If I had to choose between spending the rest of my days with the Japanese health care system as it stands now or spending the rest of my days with the U.S. health care system as it stands now, I would unequivocally and without hesitation choose the Japanese system."

Trane DeVore
Kansai, Japan