Tuesday, September 7, 2010

More on Japanese Healthcare

The other day Joe and I were talking about the pro's and con's of American and Japanese healthcare. I think we came to the conclusion that it really varies from person to person depending on their individual experiences and level of coverage. For example, if I were currently in the States and uncovered (as I am), I probably wouldn't be too happy right now.

For my part, my experiences with Japanese healthcare haven't been bad. My chief complaints are that things often take time and running around (though I guess that's often the case in the States, as well) and that most doctors here are specialists. Back home since most doctors (GP's anyway) learn a smattering of everything, you can see your family doctor for most things, and if he can't handle it he will usually refer you. I readily acknowledge the fact that I'm no expert, of course - that's just my impression based upon my experiences and having a doctor in the family.

In my most recent case, this bump on the back of my neck got red and painful last week, so I called a dermatology clinic, but was told they were very sorry that I didn't have a referral. Thus I wound up going to my local 内科 (internal medicine) clinic. I had been there before, so I thought I knew what to expect. Last time the doctor had seen me for 2 minutes, not even looked at my problem because it was out of his realm, and promptly written me a referral and charged about 2000 yen for it. Well, at least it was speedy. This time I expected a referral, but instead he prescribed me some antibiotics and told me to come back in a few days if they didn't work. They didn't - I developed a fever on Sunday. Took off work and went back on Monday and procured a referral to a general surgeon.

The surgeon was a welcome surprise, an interesting character. He looks to be in his 60's, which probably means he's actually like 90. He got his medical degree in Milwaukee, so his English was more than passable. The office was kind of run down - looks like business is slow these days. Anyway, he wasted no time in telling me he needed to lance the sucker. Needled me with a local, then lit a cigarette and shot the shit for a few minutes. Both amusing and disconcerting to have him standing next to me smoking while waiting for my neck to go numb.

Well, I survived anyway. Have to go back every day for the next few days to have my bandage and gauze changed. If anything goes horribly awry, I'll be sure to report.


  1. My feeling is that people with good, private health insurance get a much better level of care than those in Japan (with a lot less crap to put up with), but those with no, minimal or low coverage are worse off.

    American "haves" are better off than the Japanese. American "have nots" are much worse off. Japan has what I'd call an "in-between" situation, but I prefer it to the U.S. system because I'd rather everyone had 65% of the high level care in the U.S. than many people had no care at all.

    Also, and this is pretty important, both systems have a bias toward illnesses that are more prevalent in their respective cultures. American care for heart disease, high blood pressure and diabetes is better than Japanese care, but Japanese care (and screening) for all types of cancer is better. These differences make direct comparisons even more complicated.

  2. Yeah, well-said. Personally I think a country should provide for those who have no medical coverage. I don't think those who can afford it should be covered tax money, but that's of course debatable.

    It is indeed complicated to compare - I've heard plenty of horror stories of experiences in both countries, just as I've known people who have been treated very well.

  3. Way I see it, the solution shouldn't just be a matter of more public coverage vs. more private coverage, it should be about driving down costs by creating tons of new doctors.

    Flood the market with doctors and nurses, and cheaper drugs, and suddenly the whole public-private debate becomes much less of an issue, because the numbers are so much smaller. Nobody seriously argues for privatizing road repair-- because it's relatively cheap, it's obvious it should be public.

    An added benefit is you employ a lot of people. Especially now in the U.S., there are so many highly intelligent unemployed people everywhere!

    Without enough doctors, no economic system will turn a triage situation into anything else...

  4. Hmm...driving down costs is a good thing, but gotta be careful not to sacrifice quality, I think.

    And your point is well-taken, but the problem is motivation. Many intelligent people are motivated to become doctors not only because it is a respectable profession but because there is the potential to earn a lot of money. If the market were flooded with doctors, it stands to reason that salaries would decline as there would be a lot more supply and less demand. think this is one of the problems with teachers. It's a tricky thing.