Facts about Japanese health care, and *The Healing of America*

The Japanese are the world's most prodigious consumers of health care.  The average Japanese visits a doctor about 14.5 times per year — three times as often as the U.S. average, and twice as often as any nation in Europe…The Japanese love medical technology; they get twice as many CAT scans per capita as Americans do and three times as many MRI scans.  Japan has twice as many hospital beds per capita as the United States, and people use them.  The average hospital stay in Japan is thirty-six nights, compared to six nights in the United States…Japan lags, though, in terms of invasive surgery; Japanese patients are much less apt than Americans to have operations such as arthroplasty, transplant, or heart bypass.  This is partly economics — since the fees for surgery are low, doctors don't recommend it as often — and partly cultural.  As a rule, Japanese doctors and patients prefer drugs to cutting the body.  On a per-capita basis, the Japanese take about twice as many prescription drugs as Americans do.

Japan, by the way, has invented a smaller and more basic MRI machine, which costs about one-tenth of the cost of the machines used in the United States.  

That is all from T.R. Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.  I thought this book was very readable, very interesting, and has very good information about different health care systems around the world.  The author is extremely critical of the U.S. system; the premise of his book is that he takes his shoulder injury to doctors in many different countries.  Since not much can be done for the shoulder, the expensive and complicated U.S. system doesn't come off looking very good.  Not everyone will agree with the author's perspective but overall I recommend this book.

Comments

Less surgery on hearts and joints, what a surprise. If we ate like the Japanese, I bet those surgeries would decline here as well.

Also, the Japanese live longer than anybody else. It looks like seeing a doctor is good for you.

"Less surgery on hearts and joints, what a surprise. If we ate like the Japanese, I bet those surgeries would decline here as well."

You mean if we ate like they used to eat. Overweight and obesity is still comparatively low in Japan versus the U.S., but like most of the rest of Asia and the world it's increasing dramatically, and the now-common "epidemic" term is being applied to it.

liberalarts i would take that bet.

@colin; have to disagree. Where the US system fails is not responding to heart attacks, but an overly aggressive approach to preventive medicine. Replacing knee joints, hip joint, open heart surgery -- how much good do they do? Why do we bother treating certain forms of cancer -- you will die of it within a few years. Look at Ted Kennedy.

An SPC approach to medicine makes a lot of sense in Japan. They are virtually all Japanese. Racism has its positives. An SPC approach here would make little sense, which is why we have a management by exception approach at higher cost and worse outcomes. Direct comparison makes absolutely no sense. It is the fundamental attribution error applied to the medical system.

I'm glad you are highlighting a book on comparative medicine.

I have represented medical device manufacturers and also served as Chair of the International Business Development committee for a device manufacturers trade association.

Our problem in the US is that 1) we reimburse for procedures, and not outcomes; 2) there is a dearth of comparative research; and 3) Doctors often own the equipment they use to perform procedures and get paid for that as well.

Let me give you some examples (names have been deleted to protect the not so innocent):

1. Medical device manufacturer makes a product with disposable that treats a condition. Ask the device manufacturer why the product doesn't sell in Europe, Latin America, etc. Answer: The device and the disposable work in ameliorating the condition for about 6 months to a year (or not at all), and then the patient will have to do a procedure, so Europe goes right to the surgical the procedure. Well, then, I stupidly ask, why do doctors use the device and sell the disposable if a year later the patient will be back? Answer: there is a DRG code for the procedure with the device and the doctor gets some money for markup on the procedure and use of the equipment. Now you know why device and drug manufacturers lobby against government studies on effectiveness.

2. Here's another example from an emergency room doctor: JCAH (a hospital accrediting organization) mandates that a certain test be given if a patient presents him/herself with certain symptoms. Test results will be back in three days. If no tests are given, patient will show more definitive symptoms so that treatment would obviously be given. Test costs $150 dollars; patient could identify symptoms in three days if not tested and call the doctor or could show up for exam by nurse. 1 in 100 chance of no problem for persons who have initial symptoms. Emergency room doctor suspects, and I agree, that JCAH was lobbied by test company to place this test in the protocol for treatment and accredidation. And, besides, the hospital also makes money for its pathologist running the test.

Now, lets assume a different world: pay people for outcomes and not procedures. In all of the events above, if patient were to present him/herself with the symptoms, there would be a different course of treatment with same effectiveness.

This is not rocket science. We should be working with other countries in doing comparative effectiveness. Its your money, whether you pay out of your pocket or the government pays. Wake up.

Error correction to previous post: 1 in 100 chance there is a problem.

"On a per-capita basis, the Japanese take about twice as many prescription drugs as Americans do"

This is probably a big part of the answer. Drugs may be expensive (albeit maybe not there, as they benefit from US subsidy like everybody else), but they're a lot cheaper than hospitalization, and do a pretty good job of reducing it in chronically ill patients.

"the expensive and complicated U.S. system doesn't come off looking very good"

Does anybody seriously think it would get any less expensive or complicated if the govt took it over?

"BTW Americans of Japanese descent live even longer than Japanese in Japan"

Hadn't heard that one. I'm always leery of comparisons of how long people in other countries live, given the wild variations in definition of "live birth".

Bill,

It's not my money. It's only my money if I don't attempt to control my costs or the government takes my money.

Two examples. Took kid to urgent care for a hacking cough. They wanted X-ray. I refused X-ray until I could take him to his family doctor. Family doctor diagnosed allergies. X-ray damage and cost avoided.

Went to emergency room for low temperature on recommendation of family doctor for possible bacteria infection. We are on high deductible/HSA, we overpay for their stupid Tylenol (they have to hide the costs somewhere), but ask to not be admitted, save money.

What matters long-term is incentives, hospital billing procedures create the wrong incentives for doctors, but the solution is not to attack the beneficial incentive structure for folks like me.

"Why do we bother treating certain forms of cancer -- you will die of it within a few years"

Yes, why do WE... when YOU will die" I think that pretty much sums up my argument against single payer and Government health care.

Well, I contend that you have to be your own doctor, just like you have to be your own auto mechanic to the extent you have to do a sanity check. So, you may disagree, fine.

The pertinent question is did the government create the Mayo clinic, or did they create the DRG reimbursement system? Did the government play some part in the doctor education system? Do you think a government system will reward staying up to date or will it encourage ossification? These are of course trick questions.

There was a post Tyler put up here a couple weeks ago that briefly talked about ways everywhere can't be exactly like Mayo even if people wanted to be.

http://medinnovationblog.blogspot.com/2009/01/interveiw-with-richard-buz-cooper-md.html

That's good, but the first time the government had a chance to muck up the system, they implemented the system you say is the problem.

I believe Mayo closed its last HMO (in Scottsdale, AZ) several years ago. It had previously closed HMO's in FL and MN. Seems they could make more money doing fee for service medicine than functioning as a multi-specialty group practice HMO.

A significant part of the reason why Japanese healthcare costs are so low is because reimbursement rates are low. I remember hearing that the payment for one night in a hospital was the equivalent of around $65.

Just a note on prescription drugs: much of the self-medicating that we would do in the US and Canada with over the counter medicine is not practiced in many countries in Asia - Japan included. Even withr the common cold a doctors visit is common as is the prescription for acetaminophen that comes with it.

Andrew --

You have four posts in this thread, all asserting that "government" will screw up our health care.

Every other developed country in the world has a government-funded health-care system of some kind. Are you claiming that they're all screwed up?

If so, how about some evidence? If not, then give the general ranting about "government" a rest and offer some specific reasons why the US government can't do what other governments can.

A better question is which other nation has a better health care system that isn't universal coverage?

You could have pointed to Switzerland in 1994, but then they mandated universal insurance in a manner that is the model for Romneycare.

You could have pointed to Taiwan in 1994, but then after studying lots of other nations and totally rejecting the way the US system works, they adopted single payer.

For those who think competition is the means to find the best solution for a problem, the "product" chosen overwhelmingly is some form of universal coverage. The governments prefer universal coverage. The tax payers prefer universal coverage because its cheaper. The people prefer their universal coverage to a far higher degree than the American people prefer our system. Give me Canada's, Britain's, France's, Japan's, Switzerland's, Taiwan', Singapore's, ... over our US health care system.

Are the statistics in the excerpt age-adjusted? According to the CIA World Factbook, 22.2% of the population of Japan is 65 and older, and 13.5% is 14 and younger. In the United States, it's 12.8% and 20.2% respectively. Relatively speaking, Japan is a country of old people, and old people consume healthcare much more than young people.

HSA high deduct is the ONLY good thing about US care. It places FINANCIAL responsibility on people's shoulders. When they have to pay for it with real money and not nonsense co-pays, people actually start doing cost/benefit analysis. Socialism is always attractive to the masses because it 'sounds' fair. But it never works out that way. If 'fairness' was so good, why isn't the fed tax a straight 17% across EVERY single breathing citizen no matter how little or how much they make? That is the ONLY definition of 'fair'. What we have now is nothing but class warfare and driven by envy.

Single payer or other forms of socialism hide the costs in rediculous tax rates and in saddle the national economy. If at tax time you had to write a check for the full annual amount based on multiple catagories of services, (eg. national defense, national health ins, unemployment ins, graft/pork/other) people will wake up and start asking WTH is all this money going and am I getting what I think I should be getting out of it. The answer will likely be a very big NO.

HMOs especially but PPO too are the wrong answer. Major medical insurance is all anybody needs. It is quite cheap as it should be. When private people have to open up their wallets to pay Doc Smith $100 to take a look at Johnny's runny nose, maybe they'll just keep the kid at home instead. Costs are high because nobody actually feels the pain of paying the premiums (hidden in employee benefits).

Divorce medical insurance from employment either by eliminating it completely or passing the full cost onto the consumer. Why can I cover my family of 4 for ~1000/mo privately whereas COBRA would cost me 2x or even 3x that amount?

When nobody is accountable for costs, costs will always rise. It's the EXACT same problem seen in college tuition. You always get more of what you subsidize. Applies to poverty, tuition and medical rates equally.

The american economy is an amazing thing if the gov't would just stay the hell out of the way.

Until the day comes when people from other countries stop coming here for their health care needs, then ill jump on the universal coverage bandwagon.

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