Comparison of the US and Japanese Health Care Systems
The country that was chosen for this essay to compare with the US health care system is Japan. It was chosen because Japanese health care system is one of the most developed in the world. It is famous for its unique approaches, high standards of living, and care about population and, as a result, one of the highest life expectancy rates in the world. After Hiroshima and Nagasaki, there was no health care in the country, and infectious diseases spread very fast, in particular, tuberculosis. However, due to the outstanding efforts of the government and the people, Japan coped with the numerous social and economic difficulties, reaching the leading positions in the world. Moreover, the USA and Japan are situated on different continents, have a different mentality, different cultures and way of thinking. Thus, a comparison of the two countries and their health care systems presents a vast area for research.
Health Statistics and Costs: Comparison Between US and Japan
In terms of the life expectancy at birth the USA ranks 43-rd place in the world with an average of 79,68 years due to the spread of obesity and the development of health care in other countries (Central Intelligence Agency, 2015). About one-third of the American adults are obese; another third are overweight. The index of obesity, which is already among the highest in the industrialized world, has doubled over the past quarter of a century. What is more, diabetes caused by obesity is already recognized as an epidemic by health care experts. The obesity rate is 35% that is 18th place in the world. The mortality rate in the USA is 8.15 deaths per 1,000 people, which is 93-rd place in the world. Infant mortality rate is 5.87 deaths per 1,000 live births, which is 167th place in the world and is worse than in any country in Europe (Central Intelligence Agency, 2015). Incidence of tuberculosis was 3,3 people per 100 000 population in 2013. Leprosy – 188 incidents in 2013. It should be also noted that the USA is the first country in the world in health expenditures – 17.1% of GDP (World Health Organization, 2015).
In comparison, Japan occupies the second place in the world in terms of life expectancy at birth. On average, people live 84.74 years (men – 81.4 years, women – 88.26 years). The mortality rate is 9.51 deaths per 1,000 people, which is 54th place in the world. Infant mortality rate is 2.08 deaths per 1,000 live births and holds a 222nd place from 224 positions. The obesity rate is much lower than in the USA – 3,5%, that is 157th place in the world (Central Intelligence Agency, 2015). Leprosy – 3 cases in 2013. Incidence of tuberculosis was 18 people per 100 000 population in 2013. The rate of health expenditures is 10.3% of GDP, which is 22nd place in the world (World Health Organization, 2015).
Thus, according to the statistics analyzed above, Japan is a healthier country than the USA is. The life expectancy is higher, mortality is lower, and the percentage of common diseases is lower, as well. However, due to the air pollution in Japan, more people suffer from tuberculosis there.
Health Care Financing: Comparison Between US and Japan
The health care system does not exist in an independent and pure form in any country of the world. However, a particular funding mechanism dominates in every nation. In the USA, private system of health care is a dominating one. Medical insurance is made on the private basis, although it can be also provided through voluntary contributions by employers. However, not every employer provides insurance to employees due to its high cost. In this case, people insure themselves through insurance companies. However, due to the high costs of insurance programs, not every citizen can afford it, and thus, many people remain uninsured. Insurance is also made through government programs Medicare and Medicaid. Medical care is provided mostly by private doctors and hospitals. Because of the private system used, medicine in the USA is of high quality, but it is very expensive and is contrary to the system of social solidarity.
In comparison, Japan uses a mixed system of health care financing. It has elements of centralization and decentralization. Today, the vast majority of Japan’s population is subject to two major health insurance systems: state and public. They are presented by such programs as national health insurance system, based on the territorial principle, and insurance system of employees, based on the production principle. The number of contributions is determined basing on the possibility of payment of the public and access to services – basing on their needs. In addition to health insurance systems, Japan has public funds through which, according to the law, disease prevention is made.
Therefore, the USA and Japan use completely different systems of health care financing. The quality of medicine is at the similar level. However, costs spent on it are much higher in the USA, which the major reason for considering the transition to another system by the US government.
Healthcare Administration: Comparison Between US and Japan
In the USA, there is no separate Ministry of Health. Management of the industry is made by the Department of Health, Education and Welfare, namely the Public Health Service as a part of the Department. It resolves the following issues: sanitary border security, external medical communications, organization of medical statistics, monitoring the activities of regional health services, quality control of food, drugs and cosmetics (FDA), the organization of medical services of civil defense, and medical assistance to certain categories of citizens (Medicare and Medicaid).
In Japan, health care management is provided by the Ministry of Health. It coordinates all activities connected to the health care aspects of the country. Management is carried out at four levels: governmental, prefectural, of health centers and local urban and rural bodies. Although being positioned as the last in the list, rural bodies play a significant role in health care provision – in addition to solving current affairs, they assume full responsibility for the implementation of local health programs that “close” regional issues. A particular role belongs to the health centers (created by prefectures and municipalities at the rate of one center per 100 thousand inhabitants). Salary to the staff, payment for hospital services, the prices of medicines, medical procedures, equipment and products – are all defined by the Central Council of the Ministry. The Ministry of Health is also responsible for insurance and sanitary control.
Health Care Personnel and Facilities: Comparison Between US and Japan
The system of medical institutions in the United States is formed mainly in accordance with the financial possibilities and needs of the local population and according to the laws of the market. Residents of the country are free to choose the doctor, and doctors are free in their selection of the nature and place of practice. Planning of health care at the federal level is not performed. Municipal and county health departments provide only a small amount of care through public clinics. Outpatient medical assistance to the US citizens is almost entirely provided by private practitioners. Physicians’ density in the USA is 2.45 physicians per 1,000 population. The hospital bed density is 2.9 beds per 1,000 of the population (Central Intelligence Agency, 2015). Also, it should be noted that the salary of physicians is one of the highest in the country.
Hospitals in Japan provide both outpatient and inpatient services. According to the statistics, Japan ranks first in the world for the supply of public hospital beds – 13.7 to 1 000 citizens. In Japan, the number of bed-days per year per capita is the highest in the world – 4.0 (in the US it is 1.2). The average length of stay of a patient in the hospital is also the highest in the world, being 19 days (in the US – 9.1) (World Health Organization, 2015). The vast majority of hospitals and clinics in Japan are owned by private individuals; however because all tariffs for their services are established by the government, patients feel no difference between private and public medicine. However, Japanese hospitals have difficulties with hospitalization of patients who need emergency care or are in serious condition due to the huge flow of patients requiring more trivial treatment. Also, the number of day-and-night personnel is smaller if compared to major US hospitals. Physicians’ density in the country is 2.3 physicians per 1,000 population (Central Intelligence Agency, 2015).
Thus, mostly private clinics are providing health care both in Japan and the USA. However, in Japan, the number of hospital beds is much higher, and the prices for medical services are lower. In the USA, from the other side, there are more physicians and nurses available to the patients, especially day-and-night personnel, and their salaries are higher.
Access and Inequality Issues: Comparison Between US and Japan
Due to the high cost of personal insurance (near $4000 per person), only 60% of employers can provide insurances to their workers. Frequently, only big organizations can afford this. Thus, employees provided with insurance by their employers sometimes have to pay for medical services in a variety of deductibles and co-payments. According to various estimates, the number of uninsured Americans ranges from 20 to 50 million people (8-20% of the population) (World Health Organization, 2015). According to this data, it constitutes a significant problem because many of these people cannot pay for the treatment and delay it, which ultimately leads to higher costs for medical services. Besides, servicing a large number of uninsured patients may lead to bankruptcy of a hospital or doctor. In addition, most people possessing insurance packages are insured only for certain types of medical care.
As it was already mentioned, the system of insurance is contrary to the system of social solidarity. In such cases, the premiums of every individual are adjusted based on the risk factor that reflects the state of their health. However, there are positive sides, as well. In addition to health insurance, there are aids to workers in case of loss of working capacity, life insurance, etc. The government of the USA provides payments for uncompensated medical care and provides insurance to civil servants, veterans of war, armed forces, and American Indians.
In comparison, one of the main principles of health insurance that is used in Japan is a social solidarity and subsidiarity. It means that risks of certain groups are distributed in the entire population, and the size of contributions is set at levels accessible to the public. Considering the expenditures an average Japanese family budget, public health insurance share is low. For a family of four with one member working, it is about 4%. Usually, an insured employee is paid 100% of outpatient treatment and almost completely for the hospital treatment. However, patients entirely pay themselves for medication, services of private nurses, or a separate ward at the hospital. Only a small number of citizens covered by the laws on the poor, combating tuberculosis and concerning persons aged over 70 years old are eligible for free or reduced medical care.
Therefore, in Japan, contrary to the USA, there are more insured people because the prices for medicine and insurance are lower and depend on people’s ability to pay. However, in the USA, are more people covered by the laws aimed at helping the poor strata of the population.