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Japan Health Care
A person who becomes ill in Japan has a number of
options. One
may visit a Buddhist temple or Shinto shrine, or send a
family
member in his or her place. There are numerous folk
remedies,
including hot springs baths and chemical and herbal
over-the-
counter medications. A person may seek the assistance of
traditional healers, such as herbalists, masseurs, and
acupuncturists. However, Western biomedicine dominated
Japanese
medical care in the postwar period.
Public health services, including free screening
examinations
for particular diseases, prenatal care, and infectious
disease
control, are provided by national and local governments.
Payment
for personal medical services is offered through a
universal
medical insurance system that provides relative equality
of access,
with fees set by a government committee. People without
insurance
through employers can participate in a national health
insurance
program administered by local governments. Since 1973, all
elderly
persons have been covered by government-sponsored
insurance.
Patients are free to select physicians or facilities of
their
choice.
In the early 1990s, there were more than 1,000 mental
hospitals, 8,700 general hospitals, and 1,000
comprehensive
hospitals with a total capacity of 1.5 million beds.
Hospitals
provided both out-patient and in-patient care. In
addition, 79,000
clinics offered primarily out-patient services, and there
were
48,000 dental clinics. Most physicians and hospitals sold
medicine
directly to patients, but there were 36,000 pharmacies
where
patients could purchase synthetic or herbal medication.
National health expenditures rose from about ¥1
trillion (for
value of the
yen--see Glossary)
in 1965 to nearly ¥20
trillion in
1989, or from slightly more than 5 percent to more than 6
percent
of Japan's national income. In addition to cost-control
problems,
the system was troubled with excessive paperwork, long
waits to see
physicians, assembly-line care for out-patients (because
few
facilities made appointments), overmedication, and abuse
of the
system because of low out-of-pocket costs to patients.
Another
problem is an uneven distribution of health personnel,
with cities
favored over rural areas.
In the late 1980s, government and professional circles
were
considering changing the system so that primary,
secondary, and
tertiary levels of care would be clearly distinguished
within each
geographical region. Further, facilities would be
designated by
level of care and referrals would be required to obtain
more
complex care. Policy makers and administrators also
recognized the
need to unify the various insurance systems and to control
costs.
In the early 1990s, there were nearly 191,400
physicians,
66,800 dentists, and 333,000 nurses, plus more than
200,000 people
licensed to practiced massage, acupuncture, moxibustion,
and other
East Asian therapeutic methods. Since around 1900,
Chinese-style
herbalists have been required to be licensed medical
doctors.
Training was professionalized and, except for East Asian
healers,
was based on a biomedical model of disease. However, the
practice
of biomedicine was influenced as well by Japanese social
organization and cultural expectations concerning
education, the
organization of the workplace, and social relations of
status and
dependency, decision-making styles, and ideas about the
human body,
causes of illness, gender, individualism, and privacy.
Anthropologist Emiko Ohnuki-Tierney notes that "daily
hygienic
behavior and its underlying concepts, which are perceived
and
expressed in terms of biomedical germ theory, in fact are
directly
tied to the basic Japanese symbolic structure."
Although the number of cases remained small by
international
standards, public health officials were concerned in the
late 1980s
about the worldwide epidemic of acquired immune deficiency
syndrome
(AIDS). The first confirmed case of AIDS in Japan was
reported in
1985. By 1991 there were 553 reported cases, and by April
1992 the
number had risen to 2,077. While frightened by the
deadliness of
the disease yet sympathetic to the plight of hemophiliac
AIDS
patients, most Japanese are unconcerned with contracting
AIDS
themselves. Various levels of government responded to the
introduction of AIDS into the heterosexual population by
establishing government committees, mandating AIDS
education, and
advising testing for the general public without targeting
special
groups. A fund, underwritten by pharmaceutical companies
that
distributed imported blood products, was established in
1988 to
provide financial compensation for AIDS patients.
Data as of January 1994
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