Japan's primary care is provided by individual clinics, and hospital care is mainly provided by private, non-profit hospitals. However, there is a bottom line in Japan's requirements for socially-run medical care, and social capital is prohibited from organizing private, for-profit hospitals.
Primary clinics are mainly in the form of specialty clinics, but also a small number of public hospitals to provide primary medical services, Japan's pharmaceutical separation, most hospital outpatient clinics completely divested.
1/3 of the doctors in the primary care system are employed by clinics, the rest are doctors who are their own bosses. Clinics are usually run by individual doctors in practice, or by groups of doctors.
In Japan, a doctor's group consists of several doctors **** the same owning a hospital or a clinic.
Clinics can provide both general practice and specialty services. Primary care services in Japan are usually organized as 1 doctor + several nurses, and the average full-time staffing of clinics in Japan in 2011 was 7.2 people, including 1.2 doctors, 1.8 nurses, and 2.1 receptionists.
In terms of hospital composition, 15% of Japan's hospitals were organized by the central or local governments in 2013, and the rest were private non-profit hospitals.
In terms of beds, 20% of beds belonged to public hospitals and 80% to private non-profit hospitals.
Special attention is paid to the fact that private non-profit hospitals are considered part of the public **** healthcare and receive various subsidies from the government, and are also covered by public **** healthcare funds.
Japan does not allow private for-profit hospitals to open, but corporate hospitals are allowed to exist to provide medical care to corporate employees. We can understand for-profit and non-profit in this simple way: "for-profit" means that the hospital's balance can be used for dividends, "non-profit" means that the hospital's balance is considered public **** funds, the funds can not be handled privately, but can only be used in full for the development of the hospital, and the hospital's balance can be used for the development of the hospital. More requirements are embodied in the Japanese medical law, which Taiwan has also borrowed from Japan.
Clearly defined boundaries between public **** health insurance and private health insurance
Japan has established a mandatory type of universal health insurance system, also known as the public **** health care program, where every resident or employee is required to enroll in the public **** insurance program, and legal immigrants are required to enroll in the social insurance program, but black immigrants, as well as tourists are not included. A resident who drops out of the mandatory health insurance has to pay an additional 2 years of premiums when rejoining, which amounts to a penalty. About 3,400 insurance agencies are responsible for providing public **** health insurance.
Except for children and the elderly, the deductible for public **** medical insurance is 30%. for children under 3 years old the deductible is 0%, for seniors between 70 and 74 years old the deductible is 20%, and for seniors over 75 years old the deductible is 10%.
Public ****Medicare has no threshold, and out-of-pocket payments, as well as some prescription drug costs, are subsidized by income tax deductions. Also, individual out-of-pocket costs are not clear; in terms of Japan's overall health care expenditures, individual out-of-pocket costs account for about 14 percent. Employers bear half of the cost of premium financing, with the premium burden ranging from 3 to 10 percent of company revenue.
The boundaries between private and public **** health insurance are very clear, with the former taking a complementary role in Japanese insurance programs. The first is Supplementary Insurance (补充保险) to the mandatory public ****medicare, which is voluntary for residents to participate in, and pays for medical expenses mainly in the form of lump sums to make up for the lack of coverage by public ****medicare, such as daily hospitalization expenses. The second type, Complementary Insurance, covers items that are not covered by public **** health insurance, and has supplementary status in Japan. Finally, Comprehensive Insurance (Substitutive Insurance), which is developed by private insurance to replace public *** health insurance, is not allowed in Japan.
Successfully Bucking Aging Through Long-Term Care Insurance
Japan quickly adjusted its layout to develop long-term care insurance before the aging crisis.
Japan introduced long-term care insurance in 2000, a mandatory insurance that covers seniors over 65 as well as disabled seniors between the ages of 40 and 64.
Care services consist of many elements, including home care (Home Care), respite care, in-home services, and a variety of assistive facilities needed for care, which are also covered by public **** insurance. Most providers of home care are private, with 62.6% private for-profit, 36.4% private non-profit, and 0.4% government-organized.
Long-term care insurance is not allowed to cover services provided by private for-profit organizations.
Care insurance is financed half by premiums and half by taxes. everyone over 40 pays a premium, and premiums for those over 65 are based on income. In Japan, employers and employees*** share the burden of long-term care premiums, half for half. In addition, the deductible for resident long-term care insurance is 10%, and Japan sets a cap on the total amount of deductibles based on income.
Overall, Japan's mandatory public *** health insurance and nursing care insurance*** cover the cost of hospitalization, emergency care, treatment of mental illnesses, legally covered prescription medicines, home care, physical therapy, and most dental services, as well as medical services provided at clinics. People with different statuses have their insurance run by different organizations. For example, health insurance for civil servants who are employees is run by an independent insurance agency, and health insurance for some professionals is run the same way, such as doctors in private practice.
The biggest lesson for China from Japan is that the development of a "market" in healthcare is not a generalization, but rather a clear encouragement of not-for-profit hospitals and physician-led clinics, a ban on for-profit hospitals, and a definition of the boundaries of what is paid for by the public **** healthcare insurance. On top of that, China is at a crossroads of demographic change and changing healthcare needs, and rapid layout adjustments may bend the healthcare system.
EXTENDED READING:
Why the U.S. health care system is a "bad example"?
Written by Wang Jianxiu
This article was adapted from the microblog "geekheal.com"
ID: geekheal_com
When you see this title, you're sure to see many of your friends jumping to their feet and asking, "Whether it's the diversity of healthcare providers, the strength of health insurance companies, or the variety of technological innovations and Internet technologies, it's not a bad example of how the U.S. healthcare system should be. The United States is at the forefront of the world in terms of the diversity of medical service providers, the strength of health insurance companies, and various technological innovations, Internet medical innovations, the United States is not in the forefront of the world in the U.S. health care sector free market, the organization of the efficiency of the United States is so high, why do you say that he is a "bad example"? The US is the first country in the world to have a free market in healthcare, and the organization is so efficient.
Don't worry, this is not to deny the U.S. health care system, but for China to learn from the experience of a certain system, first of all, we have to look at the shoes on the feet fit or not. Let's think about this: What are the dimensions of comparability between a developed country with a per capita GDP of $54,629 and a developing country with a per capita GDP of $7,590? In what dimension is a country that spends 17.5% of its GDP on healthcare comparable to a country that has just established a universal healthcare system and spends 5.5% of its GDP on healthcare?
Let's look at the overall structure of the U.S. health care system.
According to Health Affaires, U.S. healthcare spending in 2014 was $3,031.3 billion, or 17.5% of the overall GDP, and the total U.S. GDP for that year was $17,348.1 billion, of which out-of-pocket spending was $329.8 billion, or 10.8% of the spending; the total U.S. population was 318 million, with a per capita healthcare spending of 9, 523 per capita, and a per capita GDP of $54,502. In 2014, U.S. healthcare spending increased by 5.3% over the previous year, surpassing the 2.9% increase in 2013.
Private not-for-profit hospitals are the mainstay, while the healthcare prevention system is weak
In terms of the healthcare delivery system, primary care in the United States is done entirely by family physicians in private practice, whose primary healthcare services, often included in one of the health insurance networks, take on the role of health gatekeepers.
In terms of hospital bed resources, only 15% of beds in the U.S. belong to government-run public hospitals, about 70% of beds belong to private non-profit hospitals, and about 15% of beds belong to private for-profit hospitals. According to data from The American Hospital Association in 2016, the number of general hospitals (excluding prison hospitals, university infirmaries, etc.) in the U.S. was 4,926, of which 1,003, or 20.3%, were government-organized hospitals, 2,870, or 58.2%, were private nonprofit hospitals, and 1, 053, or 21.3 percent.
In terms of resources, the U.S. accounts for 80% of the number of socially-run hospitals, but private not-for-profit healthcare organizations dominate. The United States maintains an open attitude toward hospital ownership, unlike Japan, which prohibits private for-profit hospitals. In a free and liberal environment, U.S. healthcare providers include: hospitals, free-practicing physician groups of all types, individual clinics, and partnership clinics.
In the U.S., the philosophy of the health care field is still based on treatment, for example, it would be easy for people to have a joint replacement surgery, but the U.S. doesn't do well when it comes to preventing chronic diseases.
Medical resources are becoming more and more aggregated, and private insurance companies consume too much social resources
From the perspective of the whole insurance system, the U.S. government undertakes the health insurance for the elderly over 65 years old, the poor and the disabled, which are Medicare and Medicaid, and the private insurance organizations cover at least 56 percent of the population.
Prior to 2012, the United States did not did not require people to have mandatory insurance, and after the Obama ACA was introduced in 2012, it was made mandatory for a large portion of the population, and employers were required to purchase insurance for their employees. Now, of course, Obamacare is still weathering the 2016 election, and its fate is uncertain.
There are various models of insurance networks in the U.S. The most typical are managed-care organization HMOs, such as Kaiser Group, in which a strict tiered system of care is set up, in which the insurer must choose a family doctor and make a referral to be reimbursed, and in which the insurer doesn't cover any expenses outside of the HMOs system.
In an ecosystem where insurers, healthcare services, patients, and pharmaceutical companies play multiple games, the biggest winners are the insurers. According to the U.S. STATISTIC website, the U.S. LIFE AND HEALTH INSURANCE INDUSTRY had revenues of $877.9 billion in 2014 (Figure 1). Next is the pharmaceutical market, which was $374 billion in the US in 2014 (Figure 2), accounting for 40% of the world's pharmaceutical market. Finally, there is the medical device market, which was $136 billion in the US in 2014 (Figure 3).
Figure 1
Figure 2
Figure 3
With insurers having an increasingly strong voice, healthcare providers in the United States are showing a trend whereby solo clinics are exhausted from insurance negotiations, and many of them are either switching to practicing in Canada, or simply shutting down their clinics and being hired by hospitals. Single-practice hospitals tend to join forces to increase their bargaining chips with insurance companies. Physician groups are also moving from small to multidisciplinary practices for one reason: to increase their bargaining power with insurers.
The administrative and management costs of insurance companies place a heavy burden on society. According to U.S. media reports, 21% of U.S. healthcare spending is spent on administrative costs, 85% of which comes from private insurers (Source 1).
The biggest problem: the disproportion between healthcare inputs and health outputs
Health outcomes and financial sustainability are almost the most criticized targets of the U.S. healthcare system (Figures 4 and 5). The U.S. spends 17.5% of GDP and ends up with a life expectancy per capita that is not far off from Cuba, which spends only a fraction of the U.S. per capita on health care. In terms of health output, US life expectancy is below the level of OECD countries, especially developed countries.
Figure 4
Figure 5 (Highest item is for the US)In 2014, US healthcare spending increased by 5.3% over the previous year, surpassing the 2.9% increase in 2013, with an average of $9,523 per person. While U.S. spending on total goods and services has grown at an average annual rate of 7.2 percent over the past 35 years, health care spending has grown at a rate of 9.8 percent.
The cost of health care in the U.S. has consistently outpaced the growth of the overall economy, placing tremendous financial pressure on the U.S. federal government, corporate employers and families. Healthcare costs are also the largest single consumer and spending item for U.S. households, both out-of-pocket and in premiums, according to the book Ameiricas' Bitter Pill. According to Health Affaires, the financial share of $3 trillion in U.S. healthcare expenditures in 2014 was as follows: households, 28 percent; federal government, 28 percent; private businesses, 20 percent; and local governments, 20 percent. govements (local governments) at 17 percent.
We summarize the characteristics of the U.S. health care system:
First, the U.S. has invested more than any other country in all aspects of health care innovation, and the U.S. is at the forefront of the world in terms of the use of new technologies and new drugs.
Second, decentralized payers in the U.S., dominated by commercial insurance, have insufficient synergy in controlling rising health care costs. Employers' health care burden is getting heavier and heavier. In addition, in order to increase the bargaining chips with insurance companies, hospitals tend to centralize and unite, leading to the concentration of the supply side, and the survival of individual clinics is getting narrower and narrower.
Third, the weak U.S. primary care system, especially the prevention-oriented health care system, has resulted in many chronic and elderly diseases not being aggressively intervened in, thus pushing up overall costs.
Fourth, the operating mechanism of commercial insurance in the U.S. has inflated the administrative costs of the entire industry, which has greatly depleted social resources.
Fifth, the U.S. has invested heavily in the treatment of disease while being very passive in health interventions such as chronic and age-related diseases, and lifestyle diseases, including obesity, have long plagued the country.
Seeing this we understand why US healthcare spending is surprisingly high. The U.S.'s diverse health care system and market competition mechanism are worth learning from China. But we must also understand that a national health care system must maintain a balance between health care quality, health care delivery efficiency, health outcomes, and finances. Observing the U.S. health care system can bring us a lot of reflection: for example, a better understanding of the importance of basic health care for China's future; vigilance of health care financing to expand the pressure on the financial sustainability brought about by the expansion of health care financing; and the enhancement of chronic disease management and health interventions, and so on.