John Creighton Campbell is professor emeritus of political science at the University of Michigan and a visiting researcher at the Tokyo University Institute of Gerontology. He co-authored “The Art of Balance in Health Policy: Maintaining Japan’s Low-Cost, Egalitarian System” (Cambridge University Press, 1998). Dr. Campbell spoke with the freelance writer Sarah Arnquist.
BY THE NUMBERS
Japan
* Life expectancy: 83 years
* Infant mortality: 3 per 1,000 live births
* Health spending as a percentage of GDP: 8
* Percentage of health spending that is private: 18
* Doctors per 10,000 people: 21
Q. How does the Japanese system provide health care at lower cost than the American system?
A. Japan has about the lowest per capita health care costs among the advanced nations of the world, and its population is the healthiest. That is largely due to lifestyle factors, such as low rates of obesity and violence, but the widespread availability of high-quality health care is also important. Everyone in Japan is covered by insurance for medical and dental care and drugs. People pay premiums proportional to their income to join the insurance pool determined by their place of work or residence. Insurers do not compete, and they all cover the same services and drugs for the same price, so the paperwork is minimal. Patients freely choose their providers, and doctors freely choose the procedures, tests and medications for their patients.
Reimbursement rates to doctors and hospitals are negotiated and set every two years. The fees are quite low, often one-third to one-half of prices in the United States. Relatively speaking, primary care is more profitable than highly specialized care, so Japanese doctors face different incentives than U.S. doctors. As a result, the Japanese are three times more likely than Americans to go to the doctor, but they receive many fewer surgical operations.
Q. What is the most important lesson Americans should learn from the Japanese system?
A. In the 1980s, health care spending was increasing as quickly in Japan as in America, but the Japanese government learned how to influence medical care provision without rationing by manipulating how it paid for services. Annual spending growth has thus been quite low despite a rapidly aging population. Including everyone in a controllable system was a prerequisite. Japan is not a single-payer system, but like France and Germany, it has been able to control costs by tightly regulating multiple insurers.
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1 comment:
One good thing our former Governor did...Blagojevich, was the "Allkids" program, where all children will have health insurance in Illinois no matter what their parents make. It is also on a sliding scale, the higher your income the higher the premium. But it was coverage for all children with no pre-existing.
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