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Having the world’s third largest economy after the Unites States and China, Japan has a high standard of living and an advanced healthcare system. When analyzing the health services of Japan, it is significant to reveal the policies and approaches that have helped Japan to develop such a strong healthcare sector. In addition, it is important to assess the level of development and achievement that Japan managed to reach in this sphere in spite of the recent devastating earthquake, tsunami and nuclear catastrophe. The aim of this paper is to compare the main aspects and analyze the differences between the healthcare systems of the two developed countries, the United States and Japan.
In 2011, the United States spent 17.7 percent of their Gross Domestic Product on health expenditure. By comparison, healthcare expenditures in Japan accounted for 9.6 percent of GDP. As of 2011, the estimated per capita total health spending was 4656 dollars in Japan, with a subtle difference of 513 dollars in the USA.
Although life expectancy in Japan decreased to 50 years for men and 54 years for women after the WWII, it has grown to become the highest in the world in 2013: 80 years for males and 87 years for females. In the United States, this number is almost the same for women and equals 81 years, whereas American men live nine years less than in the compared country. Infant mortality is low in Japan, with three deaths per 1000 live babies. By contrast, the United States has the fifth highest infant mortality rate among industrialized countries, which reaches seven deaths per 1000 live births.
It is important to assess the current situation with the healthcare to identify and manage the areas that require additional governmental and public attention. Thus, the main cause of death in Japan is a malignant neoplasm. Diabetes, cancer, namely lung, tracheas, colon and rectum types, Alzheimer’s disease and other serious disorders are the conditions that pose the biggest health threat. Infectious diseases except for HIV, TB, malaria and acute respiratory diseases are not very prevalent, targeting less than five thousand people annually. Radiation-related health repercussions cause serious concern for the Japanese. Contrary to the existing problems, from 2000 to 2012, advanced biomedical research and healthcare services contributed to the reduction in the rate of death from such medical conditions as stroke, kidney diseases and self-harm.
According to Holtz’s evaluation of health of the United States citizens, there are signs of prosperity and further rapid development. Such a high level of health is mostly due to the same reasons as in Japan. These include additional financing of health education, programs, research and care. Administration of new antiretroviral medications has helped to lower the rate of HIV/AIDs. Moreover, fewer children suffer from such acute infectious diseases as measles, mumps and rubella because of the mandatory immunization. Nevertheless, the United States has an increasing rate of people who suffer from hypertension, diabetes, cancer and Alzheimer’s disease. The United States has the highest rate of obesity, which amounts to 36.5 percent, in comparison with other OECD countries, including Japan (4.1 percent).
The healthcare system in the United Sates is financed through taxes and private contributions. In 2011, public spending accounted for 48 percent of total expenditure. Private health insurance constituted 33.8 percent of total healthcare spending, whereas out-of-pocket payments accounted for 11.6 percent. The organizations that provide employer-based insurance cover almost all the premium with the input from employees.
Japan has three categories of insurance: employer-based, national and insurance of the elderly. The government, employers and individual coinsurance payments support these programs. According to OECD, 80.5 percent of all health spending was covered through the public health insurance system. Citizens Health Insurance determines the amount of levy based on per-capita, per-household and income-related aspects. Employer-based insurance depends on wages, varying between three percent and ten percent of income. The government subsidizes Citizen Health Insurance as well as Health Insurance for the Old-Old.
Firstly, being a statutory body of the Ministry of Health in Japan, Labor and Welfare, The Social Security Council regulates cost control and ensures quality and safety of healthcare services. Nevertheless, they are not entailed to punish low-quality performance of some healthcare providers. Secondly, the Pharmaceuticals and Medical Devices Agency, which is a regulatory governmental organization, provides technology evaluation of pharmaceutical and medical devices. Such assessment covers medical, social and ethical aspects, excluding an economic element. Thirdly, in the health insurance system, the Central Social Insurance Medical Council regulates the coverage of pharmaceuticals and medical devices.
In the United States, the Department of Health and Human Services (HHS), the federal government agency, protects the health and well-being of all American citizens, proving vital healthcare services and concentrating on advances in medical and social spheres. The Centers for Medicare and Medicaid Services in cooperation with the Centers for Disease Control and Prevention are engaged in conducting and disseminating research and programs aimed at improvement of healthcare and safety. In addition, the National Institute of Health has narrower responsibilities, concentrating solely on biomedical research. The mission of the Health Resources and Services Administration is to ensure that uninsured and medically vulnerable layers of society have access to adequate and prompt medical help.
Hospitals in Japan are predominantly private with the exception for a few larger public ones and teaching clinics. Patients are free to self-refer, but they will have to pay more than people with a referral from a physician. As of 2011, there were 13.3 inpatient beds per 1000 people in 8500 hospitals in Japan, which considerably outnumbers three beds in 5794 hospitals in the United States. In the latter country, there are 2.5 doctors per 1000 people. In contrast to the relatively high number of beds, there are only 2.2 physicians per 1000 people in Japan. Moreover, the time of doctor’s consultation is shorter than in the United States, and the rate of hospital admissions is low in both countries. However, inpatient care in Japan may last up to 36 nights, compared to 6 nights in the United States. In 2011, Japanese patients visited a physician 13 times, which is four times more frequent than Americans did. In Japan, the number of nurses has increased 5.6-fold since 1960, with 1 540 000 nurses having been employed in 2012. In the United States, there are 11.1 nurses per 1000 people.
There is a tight relationship between insurance coverage, ethnicity, race and access to healthcare services in the United States. The decrease in employer-sponsored insurance and the rise in the cost of healthcare have led to an increase in the rate of uninsured people. Thus, in 2002 approximately 15 percent of the population lacked insurance. The law compels the medical personnel to provide urgent care and stabilize the patients in the emergency room regardless of insurance status. Nevertheless, the uninsured people experience poor access to preventive care and prescribed drugs.
Almost 70 percent of the population under the age of 65 is dependent on private health insurance. To ensure care to vulnerable people, the government founded Medicare, which is supported by federal funds received from a Medicare tax paid by the working population. It covers hospitalization and medical supplies as well as facility, physician and laboratory charges for the elderly and disabled. In addition, having federal and state financing, Medicaid protects low-income people. Women, children, the elderly and the disabled have access to physician’s consultation, nursing home assistance and inpatient and outpatient hospital care.
Nevertheless, there is an increasing number of “Americans, often referred to as the working poor,” who do not have insurance and cannot afford to pay for the private healthcare. At the same time, their salary exceeds the minimum rate, and their young age does not allow them to get assistance from Medicaid. From the ethnical perspective, almost 50 percent of African-American and Hispanic children and the elderly are placed at poverty level, which also hinders them from receiving medical care. They are often deprived of diagnostic and surgical procedures and therapeutic medications.
In comparison to the United States, Japan provides unrestricted access to healthcare to more people. Universal healthcare insurance system provides relative equality to all social groups. People who do not have employer-based insurance are supported by a national health insurance program. Every uninsured individual has the right to choose physicians and medical facilities, and, by law, everyone can get unconstrained access to healthcare provided by the Japanese Nursing Association. Contrary to the American healthcare, Japanese system covers inpatient and outpatient stays of not only the citizens but also expatriates and foreigners.
In summary, both Japan and the United States have developed healthcare system. However, a few factors still need improvement. Both countries have productive governance of the healthcare and advanced medical technology. Although the United States spends much money on healthcare, there is a considerable percentage of the population deprived of adequate access to health facilities. Having the longest life expectancy and effective insurance coverage, Japan faces the problem of insufficiency of hospital beds and physicians, which is also applicable to the similar American situation.
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