Today I went to see a dermatologist for a minor skin issue. This was my first time seeing a physician in Japan, so I learned a bit about the Japanese medical system by going through the process.
Every Japanese resident, citizen or foreigner, receives medical care under a universal healthcare system. I think it is mostly employer-based, but not employer-sponsored the way it is in America. You would typically register through your employer, and the tax you pay for healthcare is automatically withheld from your paycheck. The amount you pay into the system depends on your income level. If you are self-employed or unemployed, you register through the municipal government and pay this tax separately, and it is still income-based. Our family is registered through my husband's employer.
The patient is responsible for no more than 30% of the medical bill, and the government pays up to 100% of the bill, depending on the medical service provided, as well the patient's income level and age. 30% may seem like a lot to Americans, given that hospitals bill insurance companies thousands of dollars for a simple screening scan, but medical costs are not padded like that here. I'll tell you about what my visit entailed and how much it cost.
I have a little bump on my skin that grew from one millimeter to maybe two millimeters in the last two months. I probably would not have bothered seeing a doctor, except everyone told me that I should because it is quick and convenient - words I do not associate with healthcare. So, after receiving my national medical card, I started looking for a dermatologist. I found a dermatology clinic a ten minute walk away from my apartment and had my husband make an appointment for me. He was able to make an appointment for the next day.
This particular clinic does not have an English speaking staff, but since my issue was a small one and my mother-in-law offered to interpret, I went with it. My appointment time was 10:00 am. I arrived at 9:50 am. My temperature was taken, and I was asked to put on a pair of disposable gloves. The receptionist asked for my medical card. They then gave me a Covid-19 questionnaire with the usual questions about how I was feeling. I also completed a second questionnaire asking for personal information and details about my skin problem. After completing all the requisite paperwork, I waited for two minutes before I was called into the examination room at precisely 10:00 am.
The dermatologist was a woman probably in her 60s. I showed her my bump, answered a few questions, and was diagnosed with having a small cyst, completely benign. She said no further treatment was necessary but recommended another physician in the neighborhood in case I wanted the cyst removed. Would removal incur out of pocket costs since it is not medically necessary? No, my medical insurance would cover it. The appointment lasted five minutes.
After the examination, I returned to the receptionist to pay my part of the cost. It cost the equivalent of $8.50. And that was the end of it. No future bills. In Japan, it is typical to pay medical costs up front like this.
From what I know and what my husband tells me about his work, the universal system is a lot more straightforward than the American one. Aside from the obvious benefit that everyone has access to healthcare, the system discourages the waste of unnecessary resources so that hospitals can bill for a higher amount. In America, there was a lot of pressure on physician teams to maintain a high turnover of patient beds to maximize hospital profit. Since that is not the case here, Japanese patients, on average, stay in the hospital longer. When patients are discharged prematurely, they may develop complications that result in re-admission. This, of course, creates more paperwork. Administrative tasks are one thing Japanese physicians deal with less here. My husband's least favorite part of his old job was dealing with insurance companies and billing.
For the physician, the downside is a substantially lower salary in Japan. However, given the enormous pressure a lot of American physicians are under (dealing with the fallout from lack of preventative care, liaising with insurance companies and the billing department, forever under pressure to generate more and more revenue, etc.), I don't think it is true that all physicians are overpaid. Physician salary varies widely across specialities and subspecialties. Family medicine, internal medicine, and emergency room physicians are not paid a great deal compared to dermatologists and orthopedic surgeons. Yet they are truly on the front lines of the medical profession.
All factors considered, my husband is happy to be working as a physician here in Japan. He says the best part is being able to focus on providing medical care. I would be interested to hear any of your experiences with medical systems outside the U.S.
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