Konichiwa! Now I know I said I’d speak more on the American health care system first, but this New York Times Article was too good to pass up. So, to begin my dissertation on “The Health care Headache,” I’ll start with the Japanese system and how this “mass weight loss” initiative so keenly integrates itself into the “Health care System of the Rising Sun.”
So lets pretend: Akira Nomoura works for the Nintendo Corporation in Japan, and like the other employees, he’s enrolled in his company’s insurance plan. Now, this plan is not like American insurance companies, no, no. This insurance plan is operated directly by the Nintendo corporation, and each month, about 4.0% of Akira’s salary is paid directly into the insurance plan. Nintendo will make an additional payment of about 5.0% of Akira’s salary into the company’s own plan.
Cool, a system where the companies pay into insurance programs operated by the companies themselves and does better than match the percentage of the salary the employee pays into the respective insurance plan…
…But wait, what about retired people and the unemployed?
Well, in this system, it looks as if unemployed people cannot qualify for health insurance, which is not necessarily a bad thing, considering employment is necessary for a grandeur of other things besides health care (car payments, food, water, rent, etc…)
But the retired are not left out of the equation. Hakura, a retired worker from the Nintendo corporation. Rather than paying into the Nintendo plan (which is only eligible for working employees), Her insurance has been switched to a “citizen’s insurance plan” run by the municipal government in Yokohama, where she decided to retire. Nintendo, however, does care about their dedicated, retired employees and will make payments into the municipal citizen’s insurance plan in Yokohama for Hakura. Hakura is expected, though, to pay an insurance premium to the municipal government’s plan indexed to her salary when she was working for Nintendo.
Interesting. Companies continue to pay into local government run insurance companies for their retired employees. But wait, not everyone can work for a major corporation like Nintendo, what about small business employees?
Good question. Taro works in a flower shop in Osaka that is privately owned. The flower shop does not operate their own insurance plan, but Taro (and the other employees/employer) at the flower shop are covered under the Japanese national government’s operated insurance plan. Taro will pay about 4.5% of his salary into the plan, and his employer will match it. All payments go to the Japanese National Plan.
Japan’s system is rooted in a “mandatory employment based insurance plan” and has been since 1922. Companies with 700 employees or more are required to operate their own insurance plans.
Lets outline the Japanese plan:
Workers in Large Firms -payroll tax-> Society managed insurance plan – Subsidies for retirees-> Citizen’s Health insurance plan.
Workers in Small Firms-payroll tax-> Government managed insurance plan -subsidies for retirees-> Citizen’s health insurance plan.
General Tax Subsidies -> Government managed insurance plan [small firms]-> [see small firms flow]
General Tax Subsidies -> Citizen’s health insurance plan [for retirees and self-employed]
Self Employed and Retirees -income-based premiums-> Citizen’s Health Insurance plan.
So we have covered…well, coverage. But what happens when something medical goes wrong? Well, fortunately (by the way it’s set up) this system places no restrictions on the 1) choice of hospital one goes to. 2) physician one sees. There are 3 general types of health care institutions in Japan: 1) small clinics, staffed by a physician and other employees dealing mostly with outpatient procedures, yet stocked with 1 or 2 inpatient rooms. 2) small hospitals owned by a physician and staffed by a physician staff (inpatient and outpatient). And 3) large hospitals, public and private, equipped with specialty staff and inpatient and outpatient departments. The hospitals and clinics are run, and operated by medical personnel as in…[gasp]… The physicians themselves! The patients are supplied with any and all care that they may need, so long as their paying their plan premiums that their companies (or government[s]) establish.
Physicians are paid by a fee-for-service system regulated by the government. The government also regulates the prices of medications. In Japan, there are no prescriptions. Physicians can distribute medications directly to their patients upon visit. The average patient count a physician has on a daily basis is about 66.
Now, to the New York Times article: Japan is “tightening the belt” on the nation, not allowing men between the ages of 40 and 74 to exceed a waist size of 33.5 inches, and women 35.4 inches (as established as a guideline for Japan back in 2005 for diabetes and other health risks).
During physicals, physicians are required to measure the waists of its citizens within this age bracket and if they fail “national” inspection, are required to take health classes for 3 months time to encourage weight loss. Dieting guidance and restriction will take effect if the problem is not corrected within this 3 month time.
If you read the article in full, you’ll also learn that some physicians in Japan disagree with the nation’s policy to “shrink” the nation, in that “Japan has no need to lose weight.” Tell that to Mr. Nogiri, “the flower shop owner with a flat stomach and barely discernible love handles”, who clocked in at 33.6 inches. 0.1 inches over the National limit. I never thought I’d see the day…Mr. Nogiri: Illegally Obese.
What do you think about the Japanese Health Care system? Do you think America could benefit from such a program? Why or Why not? And how about this National initiative to “shrink” the national waist line? Is it a positive initiative? or is the Japanese government being too harsh with their waist line restrictions?
Let me know what you think. This is your health care future! If you don’t have opinions yet, find some!!
fredbertino, getting his wisdom teeth extracted tomorrow, signing out. Sayonara!
Research provided by: Understanding Health Policy: A Clinical Approach by Thomas S. Bodenheimer and Kevin Grumbach. (c) 2005