I recently attended a two-day class for newcomers to Tokyo. One of the speakers was a British general practitioner who lives and practices in Tokyo. He gave a brief overview of the Japanese healthcare system and shared some tips on how to navigate it should we need to.
Japan’s health system
In Japan, individuals are expected to have health insurance. The cost of insurance is split between the individual (30% of cost) and the individual’s employer (70% of cost). The Japanese government sets the price for the delivery of health care services. Rates are typically quite low, resulting in providers being incentivized for high volume. I am interested in learning more about how the unemployed receive insurance (stay tuned for a future post).
The Japanese medical system places more emphasis on specialists than primary care, and until recently it was very easy to self-refer to a specialist. Due to the popularity of some providers, more limits are being put on self-referral and individuals are required to be referred in by another provider. Overall, the quality of care is quite good for both primary care and specialists once you are able to get access.
There were two parts of the delivery system that surprised me
Specialty churn and burn
Due to the price set by the government, specialists in hospitals rely on high volumes in order to make a profit. My mind was blown when this doctor said that a specialist might see 100 patients in ONE day, with only 2-3 minutes of consultation time per patient. I think of the “churn and burn” felt by many physicians in the US, and can’t imagine what Japanese specialists feel like. I am interested in learning more about how this practice impacts upstream and downstream care, as well as patient and provider satisfaction.
Emergencies – don’t call an ambulance!
The other part of the delivery system that shocked me was the ambulance system. While ambulances usually show up fairly quickly (less than 10 minutes), there is often a long delay in getting to a hospital. This isn’t because backlogs at the hospital, but rather that there isn’t an automatic process for an ambulance to go to the nearest hospital.
Unlike in the United States, hospitals have the right of refusal, so the paramedics must spend time calling around from hospital to hospital to find out which hospital will accept the patient. The hospital can refuse for any reason including “we’re busy”, “we don’t have a specialist for that problem”, “we don’t speak English and don’t want a non-Japanese speaker as a patient”, etc.
I was told by this doctor and others who have lived in Japan for longer that unless the issue is one that requires immediate paramedic attention (such as a heart attach that needs defibrillation), to hail a taxi, remain bloody or as “urgent” as possible, and go to one of the hospitals in Tokyo that are more foreigner friendly and tend to have more robust emergency departments. Even then, a hospital can turn you away, but generally you will at least be triaged by an RN first.
Some other interesting differences between Japanese and US/British pharmaceuticals:
- Many drugs are not licensed here, particularly antidepressants and ADD. Travelers are allowed to bring these into Japan in limited quantities, but be careful as recently there have been arrests made of foreigners bringing these drugs into Japan.
- Some drugs don’t come in the same form that we are used to. For example, you cannot find liquid Motrin/ibuprofen for children. I was told by many people to stock up on these medications before we arrived.
- Some over the counter medications are not available without a prescription, including allergy medications, antifungal creams or emergency contraception.
- Some vaccines are not available (although the international clinics can carry them). Interestingly the vaccination schedule is compulsory here to attend public school, unlike in the United States where parents can opt-out.
What are you interested in learning?
I am interested to continue to learn more about the Japanese healthcare system. What topics are you curious about?