I currently live in Tokyo, Japan. I am a citizen born abroad--born in Japan. I lived in the States for 15 years, but my family stayed in Japan.
When I was in nursing school about 7 years ago, my tooth started hurting.
I had dental insurance, but when I called to make an appointment, not one dentist in the area would accept my insurance. They all said that my insurance "never paid" so they stopped accepting it.
After calling over 20 dentists, I finally gave up and got seen, self-pay. I was told that I needed to see a specialist to get a root canal. However, again, no one would take my insurance, and I could not afford the $1000 + that the procedure would cost. If I need a crown placed, I would have to pay much more.
The dentist told me that the only other option I had was to go to the Emergency Room where my tooth would be pulled.
I was in my 20s! I REFUSED to get my tooth pulled! All I needed was a root canal!
So what did I do?
I saved up my student loan money, waited for 4 months until Christmas break and flew back to Japan where my family lived--and where I still was covered under the National Health Insurance.
The morning after I arrived in Japan, I went to a dentist and got a root canal. Just like that. I think it cost me, mmm, like $30.
My tooth was in such bad shape--my face was swollen, I couldn't chew because my gums were so swollen that it lifted up my infected tooth, and I was in so much pain. My dentist told me that if I had waited just a little longer, the infection would have spread to my bone--a very dangerous situation. He couldn't believe or understand why I was unable to get care.
The airfare cost about $800. The root canal cost about $30. So, it was CHEAPER for me to fly for 17 hours over the Pacific to the other side of the planet, than to walk down the street to a dentist in my neighborhood in the US, to get a simple root canal.
Plus, I got to see my family and friends and enjoy good sushi as well. What a bargain ;)
Oh, and now that I LIVE in Japan and don't have to take a plane to see a dentist, I only have to pay $30. And, I can go to any dentist of my choice. Whenever I want.
Mina
Tokyo
Arizona
Sunday, March 15, 2009
Saturday, March 14, 2009
I am thankful to live in a place with national single-payer health insurance
On Saturday I noticed that my husband's face looked strange - one side was droopy. Since he had been injured in a car accident at the end of the year and has been suffering from whiplash, we thought it was related.
He had lost feeling by Monday morning, so he went to the general practioner who serves as our family doctor at 9:30 a.m.
No appointment necessary, waiting time 15 minutes, cost out of pocket (30% of total) $11
The doctor told him to get to a general hospital immediately and wrote a letter of introduction.
I accompanied my husband to the osteopathic doctor who is treating him for the whiplash.
No appointment necessary, waiting time 25 minutes, cost out of pocket would have been $5.70 (cost was charged to insurance company of person who caused car accident.)
This doctor concurred with the other doctor and told my husband to go to the nearby university hospital.
The university hospital is a 5-minute drive from our home. The lobby was overflowing with people waiting for outpatient care. It was my husband's first visit to that hospital, so he had to register.
Wait time to register: 20 minutes
We were sent upstairs to the dermatology department. Here the wait was longer, about 40 minutes to see a nurse who took down the medical report. We were told that it would be quite a long wait to see the doctor. However, we overheard another nurse who had picked up a phone to say that there would be a patient for immediate admission and guessed that it was my husband. I left to handle matters at the business we run together.
My husband was seen by a doctor at 1:45 p.m. The doctor diagnosed facial paralysis (probably Bell's palsy) and ordered immediate admittance for treatment. When I returned at 2:30 p.m., my husband had completed paperwork for admission and was being pushed in a wheelchair by a nurse to the dermatology ward.
Because he had requested a private room, he was asked to leave a deposit of $3000. This would not be necessary for a bed in the 6-8 person rooms. We have a private insurance policy which will cover the cost of the private room.
Because the treatment of facial paralysis involves the aggressive use of steriods which lower the immune system, my husband was told to expect a hospital stay of two to three weeks. He is on an IV drip 3 to 6 hours a day. He is not allowed out of the hospital ward because of the danger of infection from the lowered immunity.
In the meantime, he is being examined for underlying causes. A heart problem has been detected. At the moment he is being examined by four different departments at the hospital: the orthopedic department for the whiplash, the otolaryngology department for the facial paralysis, the cardiology department for the heart problem, and the internal medicine department for a weight problem. All test results and explanations are given by the doctor in the otolaryngology department whom he sees at least once a day. A nurse checks his vital signs several times a day. All his exams are scheduled ahead of time so he never waits more than 10 minutes for a test or consultation.
So far, tests include CTscan, MRI, full set of spine X-rays, several blood and urine tests, stress tests for heart, various ear and eye tests for causes of facial paralysis - just about every test possible for his condition. The main doctor usually disusses the results the same day as the exam.
We are on the national health insurance plan (kokumin kenko hoken) as a family. We pay the top rate for the premiums for our family of 5, approximately $6000 a year. We pay 30% of medical and prescription costs up to about $750 total in a month. Other than the cost for the private room, we will not pay more than approximately $750 plus a small charge for the hospital food for the calendar month. Also, we will be able to deduct medical costs over about $1500 from our total income for income tax purposes.
Of course, we have both checked medical information on the Internet in both Japanese and English about the various conditions and concerning the diagnoses and advice we have received so far. All information we have gathered matches up with the treatment my husband has received so far. My sister has also checked on information available in Thailand. The biggest difference in treatment that we can detect is that the US relies on oral medication more while most of Asia relies on IV drip to adminster medication. Also, as far as I can tell, my husband would be treated as an outpatient in the US (and with the exhorbitant cost of hospital care in the US, that would be preferable.)
However, we are very glad that my husband is hospitalized because the amount of running around and time that would be required if he were an outpatient (not to mention the risk of exposure to infection) would play havoc with my work schedule as well. As it is, my college-age son has come home to help out during spring break.
Right now, our biggest concern is my husband's condition. We wonder how his health condition will affect our work and our family. The one major concern we don't have right now is how we will pay for the excellent care we are receiving.
If, God fobid, my husband is unable to continue work and has to close the business, I can enroll him and the children on the insurance plan that I will be on from April when I take a full-time job as a university professor. I will be enrolled in the private university and school plan, which, of course, is tied to the other government schemes.
The biggest drawback that I can see to the various national health insurance schemes here is that, without a private plan to pay for a private room, my husband would be in the 6 to 8-person ward. Those wards do look crowded. Otherwise, the treatment for the patients is all the same.
At times like this, I am particularly thankful to live in a place where national single-payer health insurance is available. I hope that, sometime in the near future, all my fellow Americans too are able to have access to medical care.
M. P. O.
Japan
California
He had lost feeling by Monday morning, so he went to the general practioner who serves as our family doctor at 9:30 a.m.
No appointment necessary, waiting time 15 minutes, cost out of pocket (30% of total) $11
The doctor told him to get to a general hospital immediately and wrote a letter of introduction.
I accompanied my husband to the osteopathic doctor who is treating him for the whiplash.
No appointment necessary, waiting time 25 minutes, cost out of pocket would have been $5.70 (cost was charged to insurance company of person who caused car accident.)
This doctor concurred with the other doctor and told my husband to go to the nearby university hospital.
The university hospital is a 5-minute drive from our home. The lobby was overflowing with people waiting for outpatient care. It was my husband's first visit to that hospital, so he had to register.
Wait time to register: 20 minutes
We were sent upstairs to the dermatology department. Here the wait was longer, about 40 minutes to see a nurse who took down the medical report. We were told that it would be quite a long wait to see the doctor. However, we overheard another nurse who had picked up a phone to say that there would be a patient for immediate admission and guessed that it was my husband. I left to handle matters at the business we run together.
My husband was seen by a doctor at 1:45 p.m. The doctor diagnosed facial paralysis (probably Bell's palsy) and ordered immediate admittance for treatment. When I returned at 2:30 p.m., my husband had completed paperwork for admission and was being pushed in a wheelchair by a nurse to the dermatology ward.
Because he had requested a private room, he was asked to leave a deposit of $3000. This would not be necessary for a bed in the 6-8 person rooms. We have a private insurance policy which will cover the cost of the private room.
Because the treatment of facial paralysis involves the aggressive use of steriods which lower the immune system, my husband was told to expect a hospital stay of two to three weeks. He is on an IV drip 3 to 6 hours a day. He is not allowed out of the hospital ward because of the danger of infection from the lowered immunity.
In the meantime, he is being examined for underlying causes. A heart problem has been detected. At the moment he is being examined by four different departments at the hospital: the orthopedic department for the whiplash, the otolaryngology department for the facial paralysis, the cardiology department for the heart problem, and the internal medicine department for a weight problem. All test results and explanations are given by the doctor in the otolaryngology department whom he sees at least once a day. A nurse checks his vital signs several times a day. All his exams are scheduled ahead of time so he never waits more than 10 minutes for a test or consultation.
So far, tests include CTscan, MRI, full set of spine X-rays, several blood and urine tests, stress tests for heart, various ear and eye tests for causes of facial paralysis - just about every test possible for his condition. The main doctor usually disusses the results the same day as the exam.
We are on the national health insurance plan (kokumin kenko hoken) as a family. We pay the top rate for the premiums for our family of 5, approximately $6000 a year. We pay 30% of medical and prescription costs up to about $750 total in a month. Other than the cost for the private room, we will not pay more than approximately $750 plus a small charge for the hospital food for the calendar month. Also, we will be able to deduct medical costs over about $1500 from our total income for income tax purposes.
Of course, we have both checked medical information on the Internet in both Japanese and English about the various conditions and concerning the diagnoses and advice we have received so far. All information we have gathered matches up with the treatment my husband has received so far. My sister has also checked on information available in Thailand. The biggest difference in treatment that we can detect is that the US relies on oral medication more while most of Asia relies on IV drip to adminster medication. Also, as far as I can tell, my husband would be treated as an outpatient in the US (and with the exhorbitant cost of hospital care in the US, that would be preferable.)
However, we are very glad that my husband is hospitalized because the amount of running around and time that would be required if he were an outpatient (not to mention the risk of exposure to infection) would play havoc with my work schedule as well. As it is, my college-age son has come home to help out during spring break.
Right now, our biggest concern is my husband's condition. We wonder how his health condition will affect our work and our family. The one major concern we don't have right now is how we will pay for the excellent care we are receiving.
If, God fobid, my husband is unable to continue work and has to close the business, I can enroll him and the children on the insurance plan that I will be on from April when I take a full-time job as a university professor. I will be enrolled in the private university and school plan, which, of course, is tied to the other government schemes.
The biggest drawback that I can see to the various national health insurance schemes here is that, without a private plan to pay for a private room, my husband would be in the 6 to 8-person ward. Those wards do look crowded. Otherwise, the treatment for the patients is all the same.
At times like this, I am particularly thankful to live in a place where national single-payer health insurance is available. I hope that, sometime in the near future, all my fellow Americans too are able to have access to medical care.
M. P. O.
Japan
California
It isn't perfect, but I recommend the Japanese system of health care
I have lived in Japan for nearly 20 years and have enjoyed the health system that they have for most people here. When I first started, it had a 10% deductible and that began changing about 10 years ago. It was increased to 20% and then to 30% and it has remained at this point for at least 5 years. As long it doesn't go above this, it should be OK. I believe that my Japanese Mother and Father-in-law have a 10% deductible.
This system works for most medical attention, including optometry as well as dentistry. It does not cover the cost of making glasses, and I have no experiences with dentures... However, it covers most medication that I have had to utilize.
Also something interesting is that some cities subsidize medication as well as doctor visits for children under certain ages. I know my daughter received certain vaccinations for free by the city of Sapporo. Also there are free checkups for children in Elementary schools which are contracted out to a physician who's practice is located near the school.
Hospitalization is also covered. I have had a couple of instances in which I needed tests to be run and was hospitalized. One time in a room with six other patients and another time in a private room. The private rooms in 2000 were only 8,000 yen a day (a little more than $80). Less than the price of a hotel room, so I opted for the private room rather than the six patient room. I do not know what the price was for that room, but the difference was so small than I could not fathom staying in the group room.
The good (or bad side) depending on how you look at it, is that here in Japan people go to many different doctors, perhaps a different one each time. I have always tried to pick my doctors and stay with them, however, many people do not do this. Up to now, this has probably allowed people to get multiple prescriptions for the same ailment unnecessarily. However, with the new electronic medical record system which will be mandatory soon here in Japan, this may be more easily controlled.
For the most part, I can say that the Japanese medical system has been very good. I hear other ex-pats here who claim that this is a very bad place to receive medical treatment. I agree that the Hygiene at some hospitals here in Japan is severely lacking. However, if one takes the time to carefully pick their hospitals and get referrals from medical care workers that they trust, then this system is quite a good one. I highly recommend the Japanese Medical System as long as it is properly managed "by the people, for the people".
I am not sure if this was of any help as I and my family are healthy for the most part, but I do endorse the Japanese model.
If you have specific questions, feel free to contact me.
Very Sincerely Yours,
Brian Dishman
Japan
This system works for most medical attention, including optometry as well as dentistry. It does not cover the cost of making glasses, and I have no experiences with dentures... However, it covers most medication that I have had to utilize.
Also something interesting is that some cities subsidize medication as well as doctor visits for children under certain ages. I know my daughter received certain vaccinations for free by the city of Sapporo. Also there are free checkups for children in Elementary schools which are contracted out to a physician who's practice is located near the school.
Hospitalization is also covered. I have had a couple of instances in which I needed tests to be run and was hospitalized. One time in a room with six other patients and another time in a private room. The private rooms in 2000 were only 8,000 yen a day (a little more than $80). Less than the price of a hotel room, so I opted for the private room rather than the six patient room. I do not know what the price was for that room, but the difference was so small than I could not fathom staying in the group room.
The good (or bad side) depending on how you look at it, is that here in Japan people go to many different doctors, perhaps a different one each time. I have always tried to pick my doctors and stay with them, however, many people do not do this. Up to now, this has probably allowed people to get multiple prescriptions for the same ailment unnecessarily. However, with the new electronic medical record system which will be mandatory soon here in Japan, this may be more easily controlled.
For the most part, I can say that the Japanese medical system has been very good. I hear other ex-pats here who claim that this is a very bad place to receive medical treatment. I agree that the Hygiene at some hospitals here in Japan is severely lacking. However, if one takes the time to carefully pick their hospitals and get referrals from medical care workers that they trust, then this system is quite a good one. I highly recommend the Japanese Medical System as long as it is properly managed "by the people, for the people".
I am not sure if this was of any help as I and my family are healthy for the most part, but I do endorse the Japanese model.
If you have specific questions, feel free to contact me.
Very Sincerely Yours,
Brian Dishman
Japan
Thursday, March 12, 2009
Overnight stay in hospital after accident
I was out with a friend in Kyushu, he got a little
too inebriated and fell down a flight a stairs, putting a huge gash in
his head. He was unconscious for a minute or so but he woke up and we
eventually got him to a hospital. We brought him in, showed the front
desk his Japanese health card that was in his wallet. Soon after, two
nurses came out right away and took him to the back and got him
stitched, (about ten stitches) cleaned up and gave him a place to rest
for the night on the hospital bed. He told me he got a bill a bit
later for a little over 10,000 yen, or a little over a hundred
dollars.
I wonder how much this would have cost back in the states?
Gavin
Japan
Hawaii
too inebriated and fell down a flight a stairs, putting a huge gash in
his head. He was unconscious for a minute or so but he woke up and we
eventually got him to a hospital. We brought him in, showed the front
desk his Japanese health card that was in his wallet. Soon after, two
nurses came out right away and took him to the back and got him
stitched, (about ten stitches) cleaned up and gave him a place to rest
for the night on the hospital bed. He told me he got a bill a bit
later for a little over 10,000 yen, or a little over a hundred
dollars.
I wonder how much this would have cost back in the states?
Gavin
Japan
Hawaii
Appendicitis surgery
It was early February a couple years ago and I had just finished
eating dinner with my host family in Kobe. I went to bed with a bit
of a stomachache, but nothing too serious. I woke up a few hours
later with severe stomach pains and, well, I spent a fair amount of
time that night hovering over the toilet bowl. I finally got to bed a
couple hours later and woke up feeling much better. Just a case of
food poisoning I thought.
I had a glass of water and in an instant, as if it was the catalyst
for a complete bodily meltdown, I was back repeating the same scenario
during the night before but feeling even worse. My Japanese host
mother drove me to the hospital down the street. When we arrived, the
nurses helped me on to a stretcher and I waited about twenty minutes
or so before they started taking my MRI and a few tests, I don't
remember too well. I remember there was a massive machine that
injected a giant syringe of warm fluid into my blood stream so they
could take pictures of my abdomen. A little bit after, the doctor
looked at the results and decided I had appendicitis.
Unfortunately, they couldn't do surgery on me because they were
already busy through to the next day. "So this is how it all ends" I
remember thinking for a few moments.
But the doctor came back to me a few minutes later and told me an
ambulance was waiting outside to take me to a nearby hospital that
could do the surgery right away. I arrived at the hospital, the
nurses brought me in, the anesthesiologist anesthetized me, and I woke
up in a bewildered state sometime later. The doctor came into my room
and said that it had burst so he had to disinfect the entire stomach.
Thus, instead of the normal quick twenty minute or so surgery that it
normally takes for an appendectomy, mine lasted about two hours. "It
was a little difficult," the doctor told me that night.
In Japan it seems they like to keep you around in the hospital for a
bit longer than the states, so I was kept for ten days, just to make
sure I was all well and ready to enter back into society. It wasn't a
wonderful experience, but the nurses were nice, and the doctor came in
to give me exceptional explanations of the procedure, with plastic
models of the body and everything. I ended up paying about $1,900
dollars.
Gavin
Japan
Hawaii
eating dinner with my host family in Kobe. I went to bed with a bit
of a stomachache, but nothing too serious. I woke up a few hours
later with severe stomach pains and, well, I spent a fair amount of
time that night hovering over the toilet bowl. I finally got to bed a
couple hours later and woke up feeling much better. Just a case of
food poisoning I thought.
I had a glass of water and in an instant, as if it was the catalyst
for a complete bodily meltdown, I was back repeating the same scenario
during the night before but feeling even worse. My Japanese host
mother drove me to the hospital down the street. When we arrived, the
nurses helped me on to a stretcher and I waited about twenty minutes
or so before they started taking my MRI and a few tests, I don't
remember too well. I remember there was a massive machine that
injected a giant syringe of warm fluid into my blood stream so they
could take pictures of my abdomen. A little bit after, the doctor
looked at the results and decided I had appendicitis.
Unfortunately, they couldn't do surgery on me because they were
already busy through to the next day. "So this is how it all ends" I
remember thinking for a few moments.
But the doctor came back to me a few minutes later and told me an
ambulance was waiting outside to take me to a nearby hospital that
could do the surgery right away. I arrived at the hospital, the
nurses brought me in, the anesthesiologist anesthetized me, and I woke
up in a bewildered state sometime later. The doctor came into my room
and said that it had burst so he had to disinfect the entire stomach.
Thus, instead of the normal quick twenty minute or so surgery that it
normally takes for an appendectomy, mine lasted about two hours. "It
was a little difficult," the doctor told me that night.
In Japan it seems they like to keep you around in the hospital for a
bit longer than the states, so I was kept for ten days, just to make
sure I was all well and ready to enter back into society. It wasn't a
wonderful experience, but the nurses were nice, and the doctor came in
to give me exceptional explanations of the procedure, with plastic
models of the body and everything. I ended up paying about $1,900
dollars.
Gavin
Japan
Hawaii
National Health Insurance paid all but 30% of cancer treatment
My friend Sally Chaney got pancreatic cancer, perhaps in 2005, in Kyoto, and only had 'Global' health care, from America. With chemotherapy and radiation therapy coming up in one week, she went to the Sakyo Ku ward office, where they signed her up for National Health Insurance, no charge. The National Health Insurance paid all but 30%. 'Global' picked up the 30%. Six months later she had to have a stomach operation, to repair a hole made by the radiation therapy. The National Health Insurance paid, but 'Global' refused to pay the 30% "because they only pay one time for any one illness." Sally died of it a year later.
Linda Crawford
Kyoto
New Hampshire
Linda Crawford
Kyoto
New Hampshire
The French system is better than the Japanese
Friends --
This is painful, but I feel I should contribute to the discussion of the health-care issue. My story is that of the sudden and unexpected death of my late wife, Hatsue, last May 5th.
My wife was of Japanese origin, but she had lived in the US for some 36 years, was an American citizen, and a proud and active Democrat.
We retired to Chiba city in mid-2006, and built a new home on a plot of family land. The objective was to take care of Hatsue's elderly mother, whom she felt she had neglected by staying so long abroad. She wrote in the wet concrete outside the front door, "For my mother---with love."
I should note that Hatsue was an independent-minded person who paid close attention to her health. She had a trim figure, ate well, and exercised.
We are only a few hundred meters from the Chiba Medical Center, formerly a "national" hospital that has been privatized. It is a major facility, with all the usual services.
My wife complained to an internist in June of 2007 of stomach pains. She was given an endoscopy, which proved negative. Later in the year, she complained of violent shoulder pain. She was given scans of her neck and shoulders, all of which were negative. She was transferred to a female psychologist, on the theory that the stress of moving back to a by now unfamiliar environment and building a house had caused stress that was responsible for her pain. I accepted this diagnosis, because there had indeed been a great deal of stress.
Hatsue received permission to go to a "pain clinic," where she received shots of what must have been very powerful palliatives. She was finishing a month's series of these shots and felt that she had made enough progress that she was about to schedule "rehabilitation," when she collapsed in late April.
We took here to the Medical Center, where we were told that she could not be hospitalized because of a lack of beds. I insisted on a blood test, and the results--a total lack of sodium in her system was one-- led to her hospitalization on a Sunday afternoon. Sh was given extensive tests and we were informed on Tuesday that she metastasized cancer in "at least" eight organs, including a large growth in her brain, and we were shown the x-ray pictures. She was placed on morphine (we had always agreed between us that we would not authorize desperate measures if our partner was to be in just this sort of situation).
Hatsue passed away peacefully the next Monday (Children's Day), seven days after entering the hospital. The death certificate read "lung cancer."
The cancer specialist at the Medical Center told us that a simple chest x-ray would have revealed the cancer at any point in the previous year.
I hasten to say, however, that Hatsue never evinced any of the symptoms of lung cancer. She was able to move around more or less normally, walking to her pain clinic visits for a round trip of two kilometers even during her final month.
I have consulted with American specialists and talked to academic experts on Japanese health care to try to make sense of this tragedy. The Americans refuse to speculate on failures in diagnosis, but point out that Hatsue probably had the most vicious form of cancer: small cell. If you Google "small cell cancer," you will see that the only suggestion is to try to get yourself into a trial of some new treatment. The academic experts on Japanese medicine defend the Japanese health-care system as making only the average number of diagnostic errors and note that there are no limits to test ordering that restrict Japanese physicians from testing broadly.
But those of us who live in Japan know that there are serious problems with the Japanese health-care system. I am told that a Japanese doctor see more than 6000 patients each year on average, versus an average for an American doctor of just over 2000. I
f you have gone to a Japanese doctor, you know what this means. You are granted no more than two or three minutes with an obviously impatient physician who gives you an extremely compressed "bottom line" diagnosis and treatment in a peremptory tone that brooks no questions. The ignorant patient is granted no role in his or her own health-care. To use the famous analogy, the patient is presumed to be too dumb to help to determine if the hoof beats are those of a horse or a zebra.
I am told there is no system for ongoing education for medical professionals in Japan, and that there are no specialty groups (the "academies" and the "boards" in America) that set standards and qualifications for practice in specialized fields.
This overloading of the average Japanese doctor must trace back to restrictions on entry that probably mirror the cartel-like practices that infect so many other professions in Japan.
My own conclusion after some forty years of involvement with the Japanese health-care industry is that the Japanese people owe their high longevity figures to a diet that is steadily being corrupted by American (or is it Western?) influences and to the exercise that even middle class persons get by use of the public transportation system, with its walks to the stations and the stairs that they must climb and descend on a daily basis. (The latter, of course, are being replaced by elevators and escalators.)
I understand that the French system is much more promising as a source for ideas for American health-care reform than the Japanese. The French exercise a great deal of control over medical education, and I am told that unless their model is followed, there is not much hope for American success.
Rod Armstrong
Japan
Virginia
This is painful, but I feel I should contribute to the discussion of the health-care issue. My story is that of the sudden and unexpected death of my late wife, Hatsue, last May 5th.
My wife was of Japanese origin, but she had lived in the US for some 36 years, was an American citizen, and a proud and active Democrat.
We retired to Chiba city in mid-2006, and built a new home on a plot of family land. The objective was to take care of Hatsue's elderly mother, whom she felt she had neglected by staying so long abroad. She wrote in the wet concrete outside the front door, "For my mother---with love."
I should note that Hatsue was an independent-minded person who paid close attention to her health. She had a trim figure, ate well, and exercised.
We are only a few hundred meters from the Chiba Medical Center, formerly a "national" hospital that has been privatized. It is a major facility, with all the usual services.
My wife complained to an internist in June of 2007 of stomach pains. She was given an endoscopy, which proved negative. Later in the year, she complained of violent shoulder pain. She was given scans of her neck and shoulders, all of which were negative. She was transferred to a female psychologist, on the theory that the stress of moving back to a by now unfamiliar environment and building a house had caused stress that was responsible for her pain. I accepted this diagnosis, because there had indeed been a great deal of stress.
Hatsue received permission to go to a "pain clinic," where she received shots of what must have been very powerful palliatives. She was finishing a month's series of these shots and felt that she had made enough progress that she was about to schedule "rehabilitation," when she collapsed in late April.
We took here to the Medical Center, where we were told that she could not be hospitalized because of a lack of beds. I insisted on a blood test, and the results--a total lack of sodium in her system was one-- led to her hospitalization on a Sunday afternoon. Sh was given extensive tests and we were informed on Tuesday that she metastasized cancer in "at least" eight organs, including a large growth in her brain, and we were shown the x-ray pictures. She was placed on morphine (we had always agreed between us that we would not authorize desperate measures if our partner was to be in just this sort of situation).
Hatsue passed away peacefully the next Monday (Children's Day), seven days after entering the hospital. The death certificate read "lung cancer."
The cancer specialist at the Medical Center told us that a simple chest x-ray would have revealed the cancer at any point in the previous year.
I hasten to say, however, that Hatsue never evinced any of the symptoms of lung cancer. She was able to move around more or less normally, walking to her pain clinic visits for a round trip of two kilometers even during her final month.
I have consulted with American specialists and talked to academic experts on Japanese health care to try to make sense of this tragedy. The Americans refuse to speculate on failures in diagnosis, but point out that Hatsue probably had the most vicious form of cancer: small cell. If you Google "small cell cancer," you will see that the only suggestion is to try to get yourself into a trial of some new treatment. The academic experts on Japanese medicine defend the Japanese health-care system as making only the average number of diagnostic errors and note that there are no limits to test ordering that restrict Japanese physicians from testing broadly.
But those of us who live in Japan know that there are serious problems with the Japanese health-care system. I am told that a Japanese doctor see more than 6000 patients each year on average, versus an average for an American doctor of just over 2000. I
f you have gone to a Japanese doctor, you know what this means. You are granted no more than two or three minutes with an obviously impatient physician who gives you an extremely compressed "bottom line" diagnosis and treatment in a peremptory tone that brooks no questions. The ignorant patient is granted no role in his or her own health-care. To use the famous analogy, the patient is presumed to be too dumb to help to determine if the hoof beats are those of a horse or a zebra.
I am told there is no system for ongoing education for medical professionals in Japan, and that there are no specialty groups (the "academies" and the "boards" in America) that set standards and qualifications for practice in specialized fields.
This overloading of the average Japanese doctor must trace back to restrictions on entry that probably mirror the cartel-like practices that infect so many other professions in Japan.
My own conclusion after some forty years of involvement with the Japanese health-care industry is that the Japanese people owe their high longevity figures to a diet that is steadily being corrupted by American (or is it Western?) influences and to the exercise that even middle class persons get by use of the public transportation system, with its walks to the stations and the stairs that they must climb and descend on a daily basis. (The latter, of course, are being replaced by elevators and escalators.)
I understand that the French system is much more promising as a source for ideas for American health-care reform than the Japanese. The French exercise a great deal of control over medical education, and I am told that unless their model is followed, there is not much hope for American success.
Rod Armstrong
Japan
Virginia
The quality of medicine is very high
I think the best story I could give, and one that is particularly personal for me, is the cost and
quality of having a child in Japan. My wife and I just had our first child and we were both (maybe me
more as she’s Japanese) amazed at the quality and cost to having a child in the country. First,
Japan has one of the lowest mortality rates in the world because the quality of medicine is very high.
I would certainly say this was the case with our childbirth. Second, the net cost to us was only about
200,000 to 300,000 yen ($2-3K). Although I’m sure location plays a part (we live in Tokyo), it is our understanding
that all Japanese can get the same cost almost anywhere in Japan. I would say the process here
is very easy and certainly a relief when you hear of the big costs that can occur with having a child in the U.S.
We were very impressed with the entire process.
Aaron Lloyd
Japan
California
quality of having a child in Japan. My wife and I just had our first child and we were both (maybe me
more as she’s Japanese) amazed at the quality and cost to having a child in the country. First,
Japan has one of the lowest mortality rates in the world because the quality of medicine is very high.
I would certainly say this was the case with our childbirth. Second, the net cost to us was only about
200,000 to 300,000 yen ($2-3K). Although I’m sure location plays a part (we live in Tokyo), it is our understanding
that all Japanese can get the same cost almost anywhere in Japan. I would say the process here
is very easy and certainly a relief when you hear of the big costs that can occur with having a child in the U.S.
We were very impressed with the entire process.
Aaron Lloyd
Japan
California
I appreciate the psychological security of being covered
When I enrolled in Japan's National Health Insurance program, I used to protest and complain that I had to pay for all of the people who went to the doctor for every little ailment or just hung out at hospitals to see their friends and because they had nothing better to do. However, I realized that in whatever circumstance I'm in - illness, accident, emergency - I am covered for medical treatment. Of course, the coverage is basic, but it covers dental and that really helps. I can go about my life not worrying about how I will be able to pay for medical treatment because the Japanese government will take care of most of my basic needs.
I switched to shiokyosai insurance for educators, but I now really appreciate the psychological security of being covered.
Edwin Aloiau (orginally from Honolulu, Hawaii)
Tokyo, Japan
I switched to shiokyosai insurance for educators, but I now really appreciate the psychological security of being covered.
Edwin Aloiau (orginally from Honolulu, Hawaii)
Tokyo, Japan
Our health has improved since being in Japan
My family of 5 live in Japan. We have coverage from the US. I never joined the national health care because I felt that we were covered under our own insurance from the US and that seemed suitable at the time.
However, we have been to the hospital twice since living here. I was bitten by an animal shelter dog at a fundraiser once. The jagged bite mark on my leg was bleeding and the nurse suggested I go to the hospital immediately for injection and a check up. I checked in at the Red Cross Hospital in Hiroo and waited 45 mins to see a doctor. I saw the doctor first, not a nurse, or technician or aid but the Doctor. He cleaned my wound, inspected it, applied antibiotic ointment and dressed it. I received a dose of antibiotic and a prescription for 3 pills a day for 10 days. The bill for the hospital was 7000 yen and the prescription was some similarly small amount.
My second trip to the same hospital was when my son fell 10 ft to the ground while playing on the playground. He landed on his hip and was shaking and cold and couldn't walk. We feared a fracture on the hip and took him to the hospital. They informed us that since we didn't have an appointment we couldn't be seen. We asked again, nicely, and they agreed to see us after the other patients had been seen. We anticipated a long wait. My son, however, was called back for a consult with the doctor in 30 short minutes. He did a check up and put Isaac through a full range of motion. He sent us for xrays. Xrays indicated that my son had not broken any bones. He applied an adhesive medicated bandage to my son's hip area to keep the pain from bruising down. He sent us home with a prescription for medicated bandages which I was able to fill for 1500 yen. The entire visit took about 1 hour and cost me 15,000 yen. ($140 USD)
Service has always been wonderful and polite. I feel good when I visit the doctors here. My husband and I have received medication for blood sugar and anxiety. He paid an equivalent of $45 for glucophage and I have paid the equivalent of $28 for lorazapam for anxiety spells. This is without any aid from my US insurance drug plan. This is just the cost of medication over the counter from the doctor's prescription. I was shocked the first time I ever had to have medicines here. Without any drug plan at all medication costs here are so much lower than the US. I didn't offer any national health card to cover the medicines. I assume it's because the greediness of pharmaceutical corporations isn't as rampant in Japan as it is in the US. Affordable medicines are the norm.
Since we have lived here we have enjoyed the walking and trains and bike riding. We have enjoyed the abundant healthy vegetables. We have each lost 60 lbs and no longer require medications for blood sugar or anxiety.
Our health has improved greatly since being in Japan and the times we've needed help with our healthcare it has been a pleasurable and thrifty experience.
We return to the US in June. I am more than a bit afraid to move back to the US. I fear the slovenly, sedate, lazy lifestyle that is so common in the US. And the strain that kind of lifestyle puts on the entire system in the US. There are no accessible bike lanes in many cities in the US. The people in their gas guzzling vehicles feel they own the road and would never deign to ride their bike to the grocery when they can drive the 2 miles from home to the store instead.
Americans have a lot to learn from other parts of the world with regard to health care and every other aspect of their daily living. But that's a whole other rant you didn't ask for.
W - in Tokyo
However, we have been to the hospital twice since living here. I was bitten by an animal shelter dog at a fundraiser once. The jagged bite mark on my leg was bleeding and the nurse suggested I go to the hospital immediately for injection and a check up. I checked in at the Red Cross Hospital in Hiroo and waited 45 mins to see a doctor. I saw the doctor first, not a nurse, or technician or aid but the Doctor. He cleaned my wound, inspected it, applied antibiotic ointment and dressed it. I received a dose of antibiotic and a prescription for 3 pills a day for 10 days. The bill for the hospital was 7000 yen and the prescription was some similarly small amount.
My second trip to the same hospital was when my son fell 10 ft to the ground while playing on the playground. He landed on his hip and was shaking and cold and couldn't walk. We feared a fracture on the hip and took him to the hospital. They informed us that since we didn't have an appointment we couldn't be seen. We asked again, nicely, and they agreed to see us after the other patients had been seen. We anticipated a long wait. My son, however, was called back for a consult with the doctor in 30 short minutes. He did a check up and put Isaac through a full range of motion. He sent us for xrays. Xrays indicated that my son had not broken any bones. He applied an adhesive medicated bandage to my son's hip area to keep the pain from bruising down. He sent us home with a prescription for medicated bandages which I was able to fill for 1500 yen. The entire visit took about 1 hour and cost me 15,000 yen. ($140 USD)
Service has always been wonderful and polite. I feel good when I visit the doctors here. My husband and I have received medication for blood sugar and anxiety. He paid an equivalent of $45 for glucophage and I have paid the equivalent of $28 for lorazapam for anxiety spells. This is without any aid from my US insurance drug plan. This is just the cost of medication over the counter from the doctor's prescription. I was shocked the first time I ever had to have medicines here. Without any drug plan at all medication costs here are so much lower than the US. I didn't offer any national health card to cover the medicines. I assume it's because the greediness of pharmaceutical corporations isn't as rampant in Japan as it is in the US. Affordable medicines are the norm.
Since we have lived here we have enjoyed the walking and trains and bike riding. We have enjoyed the abundant healthy vegetables. We have each lost 60 lbs and no longer require medications for blood sugar or anxiety.
Our health has improved greatly since being in Japan and the times we've needed help with our healthcare it has been a pleasurable and thrifty experience.
We return to the US in June. I am more than a bit afraid to move back to the US. I fear the slovenly, sedate, lazy lifestyle that is so common in the US. And the strain that kind of lifestyle puts on the entire system in the US. There are no accessible bike lanes in many cities in the US. The people in their gas guzzling vehicles feel they own the road and would never deign to ride their bike to the grocery when they can drive the 2 miles from home to the store instead.
Americans have a lot to learn from other parts of the world with regard to health care and every other aspect of their daily living. But that's a whole other rant you didn't ask for.
W - in Tokyo
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