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Healthcare in Japan

I don’t know why, but somehow I get dragged into these discussions; I recently had a debate about healthcare on my Facebook page. Normally people throw at me the normal liberal panaceas that strike me as utterly askew reality, but this time someone threw the Japanese Healthcare System at me. That was a new one (and in a way I’m glad, typically someone mentions the British and Canadian systems, which have fatal flaws and I’m sick of mentioning them). So I did a bunch of research, and while I think the US could learn a lot from the Japanese system, it has some (no surprise here) fatal flaws:

Japanese hospitals experience a “crowding out” effect, with space for emergency care and serious medical conditions sometimes overwhelmed by a flood of patients seeking routine treatment, said Naohiro Yashiro, a professor of economics and health-care expert at International Christian University in Tokyo.

“Patients are treated too equally,” he said. “Beds are occupied by less-urgent cases, and there are no penalties for those who over-use the system.”

The government has largely been unable to reduce the length of hospital stays, which are four times as long in Japan as in the United States. Hospital doctors are often overworked and cannot hone specialized life-saving skills, according to recent reports by McKinsey. Statistics show that the Japanese are much less likely to have heart attacks than people in the United States, but that when they do, their chance of dying is twice as high.

There are shortages of obstetricians, anesthesiologists and emergency room specialists because of relatively low pay, long hours and high stress at many hospitals, doctors and health-care analysts said. Emergency room service is often spotty, as ER beds in many hospitals are limited and diagnostic expertise is sometimes lacking. In a highly publicized but not unprecedented incident, a pregnant woman complaining of a severe headache was refused admission last year to seven Tokyo hospitals. She died of an undiagnosed brain hemorrhage after giving birth.

“We are in a hospital desert at night,” said Yashiro, citing insufficient pay incentives for the robust 24-hour staffing common at large U.S. hospitals.

Skilled doctors tend to leave Japanese hospitals for the higher pay and predictable hours of private clinics. There, they become primary-care doctors, making up for low treatment fees with astonishingly high volume, seeing patients in an assembly-line process that leaves little time for questions.

As is so common when discussing healthcare, we find out there is no free lunch. The Japanese have many more hospitals and clinics, and more doctors per capita than the US. One way to help lower healthcare costs is to have more supply, and controlling administrative costs the way the Japanese do would be tremendous. But I doubt Americans could stomach a doubling of the heart attack mortality rate.

(But we might, people who die of heart attacks can’t complain or vote. And people who haven’t had heart attacks never believe it will happen to them.)

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