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PHC6110 Week 9: Japan
Terms in this set (11)
What nation outside of Japan had the most influence on the healthcare system
how and why?,The Netherlands and Germany had the most influence on the healthcare system. During the 17th century, only the Dutch were allowed to trade with Japan due to the isolation policies instated by the Tokugawa government. As such, Dutch medical care practices greatly influenced the development of Japan's healthcare system. In the 19th century, Japan modeled its nationwide health insurance system after Germany.
Explain how the current Japanese healthcare system is structured, financed, and reimbursed.
The Japanese healthcare system serves its entire populace through a comprehensive social insurance program wherein everyone residing in the country must join the plan. This plan is offered through employment or place of residence. All companies with 5 or more employees must contribute to a health insurance plan for their employees called the Employee's Health Insurance (EHI) plan. The National Health Insurance (NHI) program is available to those who are not covered through employment. Premiums for both the EHI and NHI are based on income. Providers are reimbursed according to prices in the healthcare system controlled by the government's strict fee schedule for services.
Discuss the unique characteristics of Japanese culture reflected in the health system.
Kamekichi argued that firm-based social welfare (i.e. this context, social health insurance offered through employment) was a product of 'traditionalist feudal ideology and the precepts of the Japanese family system' that disposed Japanese companies to offer varying forms of non-wage benefits at the expense of fair wages. Hiroshi called this 'managerial familialism' (keiei kazoku), to describe this phenomenon of particularist cultural values applied to new economic contexts.
What problems does Japan have with inequality and social justice?
Tachibanaki (2006) cites literature that shows Japan's inequalities are most prominent in opportunity of education and opportunity of employment. Because Japan's universal health insurance is influenced by employment and place of residence, these inequalities have a pointed impact on the healthcare system. They perpetuate cycles of poor or no access to care and have a profound effect on personal health.
Considering both the advantages and disadvantages
what are some lessons the United States could learn from Japan concerning healthcare,The United States could learn to expand its health insurance coverage to place of residence and move to health plan consolidation, as high availability but equally high fragmentation of plans throws off the
How does the availability of advanced imaging technology in Japan compare to the rest of OECD nations?
Japan's healthcare system focusses on preventive and diagnostic aspects. As such, advanced imaging technology investments places the country high on the list of OECD nations.
How has Japan compensated for the increasing costs of an aging population?
Japan shifts the costs to the population that will be the future beneficiary of long-term care: Japanese citizens aged 40 to 64 will pay an additional premium on health insurance obtained through employment or residence.
Explain Japan's experience with firm-based social welfare and social insurance programs.
Japan has had overall success with firm-based social welfare and social insurance programs. By 1961, most everyone was insured, the stringent enforcement of the fee schedule for all plans and providers has effectively contained costs, and copays are relatively similar except for the elderly and children. However, health insurance enrollment is fragmented among 3500 plans, and there is a three-times difference in the proportion of incomes paid as premiums. Additionally, the uninsured and increasing elderly populations complicate healthcare service delivery and contribute to rising costs.
What role did the Japanese Imperial Railroad play in the creation of the social insurance system in Japan? (Kinzley article)
The Japanese Imperial Railroad created an industry rich with firms incentivized to build a stable workforce for its personal interests. A railroad has a complex set of components, with different types of labor dedicated to the locomotives using the railroad, the track itself, and railroad traffic, among other things. To ensure the Japanese Imperial Railroad would be effective and long-term, the state control placed on the national railroad established a social insurance program that was based in mutual assistance (i.e. receiving healthcare in exchange for long-term employment).
What are the big takeaway messages from this article? Discuss the challenges and issues mentioned that lie ahead for Japan. (Ikegami article)
This article provides three lessons for the world to learn from. First, that the attainment of universal coverage and achievement of equity in benefit packages and rates of co-payments and contributions are two different goals and each need unique strategies. Second, political driving forces influence whether or not countries move forward on the path to universal coverage. Third, a social health insurance system that is fragmented (especially in the dimensions of employment and residential status) is also weak. we believe that the way forward would be to consolidate social health insurance plans. The authors suggest that equalizing copays and contributions could be addressed by consolidation and offer three options for Japan to achieve this: 1) allow everyone to choose the plan off preference and adjust for variables that influence copay and contributions, 2) nationally unify all social health insurance plans, or 3) consolidate health plans regionally rather than through employment. The first two options are difficult due to the scope of the national health insurance schemes (which do not operate as independent entities) and the politics at work within the Japanese government. They view the third option as the most feasible, as medical spending would be appropriately distributed according to utilization by region. This would eliminate disparities in overall spending and coverage due to the employment limitation.
Based on the article's information, what is your take on the "tradeoff" between cost containment and quality of care in the Japanese health system? Explain. (Hashimoto article)
It seems that cost containment efforts have diminished quality of care and the number of providers in the Japanese health system. Inpatient care has little standardization, and Japan has the lowest number of physicians and nurses per bed among OECD countries. I think disparities in healthcare quality measures can be remedied through the authors' suggestion of payment flexibility. Because hospitals are sustained through funds and payment contracts with the government, the market power of one (government payer) overtakes the market presence of the other (hospital). Standardization across the board could be achieved with provider incentives. The number of providers, like physicians and nurses, may also be increased through those incentives, increasing access to care.
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