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Introduction to Healthcare Systems
When people think of the United States of America, they think of a country that strives for perfection among other things, but is the U.S. really the best at what counts? Healthcare is one of the most important systems within the United States and should be the most important system in most countries. There are 195 countries in the world, but today I have chosen to compare the United States healthcare system to Japan’s healthcare system to see how they not only differ, but the similarities they have as well.
Overview of the United States Healthcare System
To begin, I will outline each country’s healthcare system so that way we can get an overview of just how exactly things work in each country. The United States Healthcare system works through both public and private insurance that are funded in many ways, one of the main ones being government funding. Private providers take up the majority of the U.S. healthcare system, offering healthcare insurance through employers. The quality of these insurance policies depends on what types of coverage the insurer has selected and decided to offer to their employees. Public healthcare policies that are offered cover a wider variety of individuals and the qualifications for each one are different. There are 3 primary public healthcare insurance: Medicare, Medicaid, and the Childrens Health Insurance Program. We will start with Medicare that in 2015 alone covered 55 million American citizens. Medicare there are 4 different parts to this type of health insurance. Medicare Part A covers hospital taxes and is funded through taxes taken from peoples payroll. Part B of Medicare is what people pay the most attention to, this part covers regular doctors visits, outpatient services, and things like diagnostic screenings and any other outpatient services a patient requires. Part C is an alternative plan to receive your benefits, this means you simply go to the doctor or hospital when needed and do not need any prior authorization before deciding to make a trip either to the doctor or the hospital. Part D of the Medicare plan is a prescription drug section of the medical insurance plan, helping people to be able to afford perceptions they may need after surgery or for an illness or even a common cold! Medicaid is similar to Medicare, but it has different qualifications within the plan, this plan alone covered a mix of 70.5 million American adults and children. The government only partially funds this health insurance plan. Each individuals needs are taken into account whenever applying for this program, each state requires that each applicant is mean-tested to see if they qualify for Medicaid in that certain state. For this specific health insurance, the state has complete and total control over who is allowed to have this coverage and who is not allowed to have it. The final type of public U.S. health insurance is the Childrens Health Insurance Program, which is also known as CHIP, this program is regulated by the federal government, but it is still decided whether or not someone qualifies for this insurance or not at a state level. This program is limited to children and is sometimes open to expectant mothers as well. ACA (Affordable Care Act) is an expansion of CHIP and some people who reside in low-income states can get their children’s insurance if the parents are employed under ACA. In the United States, there is still about 13.4 percent of Americans are uninsured and turn to non-profit community health centers or even hospital emergency rooms to tend to their general healthcare needs. The percentage of people covered by the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA) simply allows uninsured Americans to have access to emergency rooms even though they do not have a healthcare policy. The outline of the American government is not the simplest, but it is verily easy to understand from a topical perspective. Most of the public American health insurance policies require the insured to go to a doctor who is within their coverage and if they chose to go elsewhere, they may have to pay out of pocket for the services they are seeking.
Understanding Japan’s Universal Healthcare System
Moving forward, I will give a brief overview of the Japanese Healthcare system so it will be easier to understand and follow the similarities and differences once I get into those. The healthcare system in Japan is a Universal Healthcare system that requires all residents and citizens of Japan by law to have health insurance coverage. Japanese healthcare system offers more types of healthcare insurance than the United States does. In total there are 8 health insurance systems and over 3,500 health insurers. Health insurance systems in Japan are broken down into the following systems: Union Managed Health Insurance, Seamans Insurance, National Public Workers Mutual Aid Association Insurance, Government Managed Health Insurance, Local Public Workers Mutual Aid Association Insurance, and also Private School Teachers Employees mutual aid associated insurance. The other two health insurance systems are typically reserved for anyone who is self-employed and also students as well, National Health Insurance is grouped into two categories: National Health Insurance for each city, town, or village and the National Health Insurance Union. People without insurance from employers such as people who are unemployed can participate in a national health insurance program that has been set in place and administered by the local government. Unlike American Healthcare Insurance, patients in Japan do not have to go to a specific doctor that is within their network. Patients in Japan are free to select which facilities they go to and the coverage they have cannot be denied when going to said facility. Hospitals are required by law to run as a non-profit hospitals and they are all managed by physicians. Any type of corporations that are For-profit are NOT allowed to own and or operate hospitals at all, as well as all clinics MUST be owned and also operated by physicians just like hospitals are. Patients in Japan only accept about 30% responsibility for any of these costs and the government then picks up the other 70% of the cost that is left. Even though hospitals and clinics are operated by physicians, the government sets the medical fees so that way costs are affordable for the patients. This cost is calculated based on their family income and also on the age of the patient that is insured. Depending on what treatments they receive, patients are responsible for anywhere from 10% to 30% of their medical fees. Even though this is a good deal, patients cannot just go to the doctor as much as they please, a monthly threshold is set for each household. Any fees that go over or exceed this threshold are then waived by the government or they can also be reimbursed by the government as well. To determine a familys threshold, they also take into account the income and age of the people within the household before setting the monthly threshold for a family. With this being said, fees are also waived for low-income households that are receiving any type of subsidy from the government.
Comparative Statistics: US vs. Japan
Next, we will look at some statistics to help us really compare and contrast the United States Healthcare system vs Japan’s healthcare system. In 2008, Japan only spent about 8.2% of the whole nation’s GDP or gross domestic product whereas in 2008 the United States spent a whopping 16.6%. The rising cost of healthcare started way before this, for example in 1980 spending on healthcare rose rapidly within the U.S. as well as other nations, but Japan chose to tightly regulate the health industry during this time which led to the reining in of costs, saving them more money in the end. In the United States, American citizens are not required to have health insurance but they will be liable for all of the costs associated with going to the doctors office or even a hospital without insurance whereas in Japan every resident is required to have some type of medical health insurance. Health insurance policies take care of some of the cost in the United States but the amount that is taken care of varies between health insurance plans and is not very stable, in Japan, patients who are insured are only required to pay 30% at the MAXIMUM for the treatment they received while the government foots the rest of the bill. The average life expectancy in Japan in 2009 was 83 years old, with men expected to live until they are 79.6 years old and women expected to live until they are 86.4 years old. In 2009 people in the United States had an average life expectancy of 75.7 years, which is 7.3 years less than the average life expectancy in Japan. Males in the U.S were expected to live 75.7 years and women 80.6 years. How did Japan achieve such a high life expectancy? They focused on reducing the mortality rate as well as reducing communicable diseases from around the 1950s into the early 1960s. This is when they saw a very large reduction in things such as stroke mortality rates decreasing a bit after the mid-1960s. Besides the shocking differences in life expectancy, we can also look at the difference between the United States and Japan when it comes to how easy it is to access medical needs.
Accessibility and Efficiency in Healthcare Services
Moreover, access to health services is both different and similar in Japan just as they are in the United States. In both countries, anyone can go and seek medical attention when it is needed, but in the United States people are responsible for more of the cost if they go to the emergency room frequently versus in Japan where patients will only have to pay a maximum of 30% of the cost. Most doctors offices in Japan do not require any prior reservations before going, doctors offices in the United States do offer walk-ins but it is more typical for someone to schedule an appointment before going and visiting the doctor unless it is very urgent. Most patients in Japan prefer to use fancier equipment for a minimal visit such as a CT scan or even MRI and this has led to patients taking advantage of visiting physicians and the easy access to these facilities. Patients in the United States also abuse easy access to healthcare facilities but not as often as patients in Japan, since patients in the United States have to pay more for these services. If a patient in the United States went and got an MRI it is not guaranteed exactly what percentage of their insurance will cover the cost of that testing. In Japan, the abuse of medical facilities can be seen clearly when patients with mild illnesses choose to go to the emergency rooms and hospitals they have there, instead of going to a more appropriate primary care doctor. Once a patient seeks out medical help in Japan, they cannot be turned away either, so a physician is required to treat someone in a hospital even if they simply have a common cold. To try and counteract this Japan has set a threshold for each household when it comes to the fees they acquire when going and seeking medical attention. This threshold would seem to stop people from abusing their access to health facilities, right? Incorrect. Even though its a good idea, the patient does not assume responsibility for any expenses that surpass this threshold. If they surpass the threshold the government assumes responsibility for the amount that surpasses the threshold and sometimes, they even waive the extensive fees that pass the threshold altogether. In contrast, the United States does not have a threshold for households but as I stated before patients within the United States do assume more responsibility for the costs of these services, seemingly it deters people from going very frequently especially to hospitals when it is not an emergency situation. Besides the access to healthcare facilities, there are many comparisons and contrasting features when it comes to spending in Japan and the United States when it comes to healthcare.
Healthcare Spending: A Comparative Analysis
To continue, in more recent years the United States has spent significantly more than Japan on administrative costs. In 2018 the United States’ administrative costs per capita (in dollars) were $843 compared to Japan’s only spending of $75, the average of these costs that were created between the U.S., Japan, and 10 other countries was $175. The U.S. is lacking in the upper hand when it comes to how much they spend on Long-Term care per capita (in dollars) as well, they spend around $511 whereas Japan spends $839. The average again including the 10 other countries is $940, comparatively putting them both below average on spending when it comes to Long-Term care per capita. What we must also look at is if higher spending leads to better health outcomes for insured patients. The data provided by the Peter G. Peterson Foundation in 2017 shows that Japan had the best health status when it came to life expectancy at birth whereas the United States was nearly the country with the worst health status. The U.S. also found itself at the worst end of the spectrum when it came to infant mortality rates, unmanaged asthma, and also unmanaged diabetes. The biggest contrast in spending between the United States and Japan comes when we look at the healthcare costs per capita (in dollars). In 2019 the United States spent $10,589 in healthcare costs per capita whereas Japan only spent $4,766 leaving a huge difference of $5,823 between the United States and Japan.
Conclusion: Evaluating Healthcare Efficiency
As you can see, the United States is not as efficient as people believe when it comes to healthcare as compared to other countries. The United States has fewer policies, spends more per capita in many areas, and is lacking when it comes to life expectancy. Japan has the high ground in most subjects when it comes to healthcare and seems to keep their patients in mind more than how much money they can make from someones illness.
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