Talk:Health care system in Japan/Archive 1

Archive 1

mandatory to enroll

Re: mandatory to enroll: This is not strictly true. If you don't work for a medium or large company, you need to buy the insurance from your city. If you don't do that, you are not insured. There is no particular sanction or attempt to force you to buy it. I have personally fallen into this class for a period. The insurance is there to buy, no matter what your health condition is, if you have the 50,000 yen or so per month, but it is not mandatory in any real sense. Of course, almost everyone buys it, voluntarily. And you can always get health care if you pay for it. The insurance pays 70 percent of the cost if you have it. Also, even if you work for a large corporation you can ask to not have the deduction made. Most companies won't agree unless you show other insurance coverage, but that is because of company policy, not government requirements. 122.25.150.19 (talk) 16:33, 24 August 2009 (UTC)

Problems

The bit 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 simply doesn't correspond with my experience with the Japanese health system. I have no idea what "excessive paperwork" is being referenced since I have received far more paperwork in the U.S. system than in the Japanese system and I have never seen any "long wait" for services (in fact, my experience is the opposite: I have seen longer waits to see a physician here in the U.S. for pregnancy matters where physicians who specialize in that area of medicine seem to be a bit scarce.) As to overmedication, perceived overmedication is certainly discussed a good bit in Japan, particularly in regard to the prescription of antibiotics, but my own personal take is that it isn't having a very negative effect on the population overall despite the obvious dangers of increased antibiotic resistance. [unsigned user]

I agree with you. This seems written from the POV of someone who is making stuff up to slander Japan's universal health care system, which is usually regarded as one of the best in the world. I've marked it as needing citations. Fiction Alchemist 14:47, 20 August 2007 (UTC)

It seems that the references do include a page that mentions this stuff, but it's not listed as a direct citation, which confused me. Does anyone have any other citations for the page? Again, I've always read that Japan's system is working fine. The referenced page is the only page I've seen that complained like this. Fiction Alchemist 00:11, 22 October 2007 (UTC)

rural hospitals

This article mischaracterizes the contents of the linked reference. It inaccurately states that rural hospitals received a higher allocation of health care personnel, but in fact the opposite is true:

http://www.physorg.com/news124904935.html http://uk.reuters.com/article/topNews/idUKT29658920070830

What the linked article actually stated was that rural facilities receive a higher share of advanced medical equipment. A chronic shortage of doctors, especially in rural areas, is perhaps the most serious difficulty facing the Japanese health care system, but it seems to owe as much to demographics (a rapidly aging population coupled with a reluctance to allow immigration of doctors) as to economics (doctors' salaries are strictly regulated).

My experience in Tokyo is similar to the comment above: There is virtually no paperwork to speak of, waiting times are vastly shorter than in the New York, and medication is simultaneously overprescribed, when it is unnecessary, especially antibiotics, and underprescribed, in the sense that the amount that is given is often insufficient. (E.g., I received a 1-week course of antibiotics for an infection that in the US would normally be treated for 2 weeks. It took exactly 7 days for my symptoms to disappear, leaving no margin for error.) In other parts of the country, even in the suburbs of Osaka, the shortage of medical personnel has led to increasing waiting times during emergencies and in particular to long ambulance drives searching for a hospital that can accept the patient (my mother-in-law experienced this last month). Moreover, the comment above about pregnancy seems to contradict the widely publicized acute lack of obstetricians in Japan, which is due in part to very low birth rates and increasing numbers of malpractice lawsuits. [1] --Gmalcolms (talk) 02:49, 17 March 2008 (UTC)

This guy must have lived in Japan a decade or so ago. If your doctor is under 50 years old, he will generally be pretty strict with antibiotics. And doctors can prescribe up to 3 months of medications now (up from 1 to 2 weeks in the early 1990s). Medicines are not overprescribed unless you take into account various kampo (which American doctors wouldn't prescribe) or stomach medicines, which are sort of automatically added to prescriptions to prevent other medications from upsetting your tummy (you can decline these). Because of a chronic condition and moving around, I've been able to see dozens and dozens of doctors of all sorts, and comments like the above are typical blind-man-elephant comments made by an experience with two or three random doctors. —Preceding unsigned comment added by 122.25.150.19 (talk) 16:38, 24 August 2009 (UTC)

Split

This article should be split into Health in Japan and Health care system in Japan as they are two very different topics. If I don't hear any feedback I'll make the changes. -- Esemono (talk) 11:16, 28 November 2009 (UTC)

Done -- Esemono (talk) 08:08, 17 March 2010 (UTC)

"one of the best in the world"? Say what?

The very first line flies in the face of Wikipedia's neutral point of view policy. Best how? According to whom? I live in Japan, and from my own experience I can say it has good points and bad points. For the bad points, check out the hugely popular manga "Say Hello to Blackjack". At the very least, such a bold statement requires a citation. Sorry, but I'm going to cut it. If someone wants to put it back in, only do so if you can maintain NPO and provide citations.Matt Thorn (talk) 04:57, 28 March 2010 (UTC)

Cost to patient

The first line:

The Health care system in Japan provides healthcare services, including screening examinations for particular diseases at no direct cost to the patient

is incorrect. Members of either National Health Insurance (kokuho) or Employee Insurance (shakai hoken) must pay 30% of most medical costs up front. Insurance only covers the remaining 70%. The percentages are different for children and seniors. See http://www.sia.go.jp/e/ehi.html for official info from the Social Insurance Agency regarding Employee Insurance, and http://www.city.shinjuku.lg.jp/foreign/english/guide/tax/tax_4.html for info from Shinjuku Ward, Tokyo regarding National Health Insurance (both in English).Akigawa (talk) 17:18, 6 May 2010 (UTC)

question | why only to the USA?

. . .

The article contains this line: "Japan's suicide rate is high compared to the USA." Unless I've missed something, Wikipedia is global, not US specific. Let's lose the we-are-the-world mentality, can we? Why only "to the USA"? Why not to "other countries"? . . . —Preceding unsigned comment added by Avaiki (talk • contribs) 21:22, 13 September 2009 (UTC)

Because the USA is the number one super power and the greatest nation in the world. It is the envy of all other countries and that is a fact. That is why the article compares to the USA. —Preceding unsigned comment added by 110.134.244.230 (talk) 17:01, 22 June 2010 (UTC)

> It [USA] is the envy of all other countries

Residents of Switzerland or Sweden do not envy USA at all, they are perfectly happy with their high quality of life. Minimal crime, superb healthcare, unhindered natural environment, working public transport system of famous accuracy, strong national currency, undivided society and hi-tech economy they have it all. 91.82.37.212 (talk) 21:28, 9 October 2011 (UTC)

Team Medical Dragon

It looks like the line about the manga "Team Medical Dragon" has been sitting there with a citation needed flag for quite some time. The claim sounds like nonsense to me, and just an attempt to insert manga/anime into a topic where it's totally irrelevant. EMS reform, particularly regarding ambulance refusals and ED overcrowding, has been a major topic in the Japanese medical literature and government documents since at least the late-1990s, and it was the high-profile incidents leading to the deaths of several people after ambulances were turned away from multiple hospitals that drove the public outcry over the issue. Having conducted original research on emergency medicine in Japan and having been a resident of Japan during the time that these incidents happened, I never once heard any reference to "Team Medical Dragon" or any other manga/anime as a driving factor behind reform in the news, scholarly literature, or discussions on this topic. Does anyone have a citation or any other reason to keep the aforementioned line? Akigawa (talk) 20:33, 20 October 2011 (UTC)

NPOV removal?

I noticed this "Foreigners in Japan live within a grey zone where government officials recommend joining the national health scheme but do not force them."

The footnote for that links to a newspaper editorial by Ron Kessler an activist/lobbiest, , who in the editorial admits he lobbied the Japanese immigration service on this issue and who has links to insurance companies that have an interest in keeping non-Japanese out of the legally mandated national health insurance schemes and in their own (see: http://hoofin.wordpress.com/2009/12/12/freechoice-jps-ron-kessler-is-connected-to-healthone-japan/). This really doesn't qualify as NPOV, so I'd like to see what others think about removing it.Osakadave (talk) 12:37, 30 November 2010 (UTC)

I added some more links that support that foreigners aren't required to join the Japanese system. -- Esemono (talk) 13:20, 30 November 2010 (UTC)

It's absolutely untrue that non-Japanese aren't required to join. Rather, the requirement isn't enforced.

The SIA says everyone must be enrolled:

"You must be covered by the Employees’ Health Insurance if you work for a company or factory which employs 5 workers or more, or if you work for a HOJIN corporation, irrespective of your age or nationality." http://www.sia.go.jp/e/ehi.html#cov

See also:

"All employees, including foreign nationals, who work for an applicable company must participate both of these insurance." http://www.yilco.jp/management-e.html

At best, this passage is misleading. Also, it doesn't mention anything about the background like the fact that many Japanese employers of non-Japanese refuse to enroll their employees or the struggle for non-Japanese to be included. Perhaps a change of wording from "Foreigners in Japan live within a grey zone where government officials recommend joining the national health scheme but do not force them." to something more accurate and NPOV, like "While people of all nationalities are required by law to be enrolled in a national health system, enforcement has been lax." This could be followed by something touching on the problems non-Japanese have had in gaining access, including the MOJ's Guideline 8 and the 2009 controversy. At least that would balance it out. Osakadave (talk) 00:31, 5 December 2010 (UTC)

But they're not required by law. A Japanese government ministry has shown that government employees are forbidden to force foreigners to join the system. -- Esemono (talk) 00:48, 5 December 2010 (UTC)

Yes, they are required by law - see the SIA page above which specifically says that. The Japanese government ministry you're talking about was the Immigration Bureau, not the Social Insurance Agency. The guideline you're talking about was about an Immigration guideline, not the Social Insurance law. Withdrawing the Immigration Bureau guideline requiring people to show they were enrolled when renewing their visa did not repeal the Social Insurance law requiring they be enrolled in the first place. It was an attempt to enforce the existing law. A misguided one to be sure, but the law itself still stands Osakadave (talk) 01:23, 5 December 2010 (UTC)

In your link where does it say that foreigners are forced to join the NHI? I see a regulation that talks about forcing companies to provide health insurance, regardless of nationality, nothing about forcing foreigners to join the health system. As it stands now the government agency in charge of enforcing foreigners to join the health system, the Immigration Bureau, has stated that foreigners are not required to join and having health insurance is in no way linked with their VISA status. If Japan were to force foreigners to join its health system then it would enforce this through the immigration VISA renewal process. The fact that the immigration department has stated that foreigners don't have to join the system shows that there is an exception for foreigners. -- Esemono (talk) 01:50, 5 December 2010 (UTC)

"You must be covered by the Employees’ Health Insurance if you work for a company or factory which employs 5 workers or more, or if you work for a HOJIN corporation, irrespective of your age or nationality." http://www.sia.go.jp/e/ehi.html#cov If you must be covered you must join. It does not say you are excused from being covered because you don't have Japanese nationality. It says the exact opposite of what you're claiming it does. The Immigration Bureau has nothing to do with the SIA and ias not reponsible for enforcing the Social Insurance law. The fact that the Immigration guideline was withdrawn, again, doesn't mean theat the law has been repealed. It just means Immigration reconsidered what's required to renew a visa. Osakadave (talk) 02:05, 5 December 2010 (UTC)

You're linking to a regulation that dictates that a company must provide COMPANY health insurance. The link doesn't say anything about a foreigner must join the system only that a company can't discriminate against foreigners in its employ.-- Esemono (talk) 02:28, 5 December 2010 (UTC)

Read the page linked - it's very clear that the SIA is indeed talking about the national system and that you must be covered no matter your nationality. It has nothing to do with discrimination. Osakadave (talk) 02:41, 5 December 2010 (UTC)

That's your interpretation, I read your link and get that companies must provide health care to their employees not that foreigners have to join the system. Regardless the article says "Foreigners in Japan live within a grey zone where government officials recommend joining the national health scheme but do not force them." Which is exactly what the sources say. Wikipedia doesn't allow you to insert your own personal opinion just information from RS. -- Esemono (talk) 08:36, 5 December 2010 (UTC)

It's not my interpretation, it's what the law says. I'm not inserting my point of view, rather asking that a biased one be removed. Osakadave (talk) 05:39, 11 December 2010 (UTC)

I don't get how it's biased. As the sources say The Ministry of Justice has declared that foreigners don't have to join the Japanese Health system, that immigration is forbidden from forcing you to join and that having Health care in no way affects your VISA status. How does the article differ from this? -- Esemono (talk) 00:58, 12 December 2010 (UTC)

Neither the MOJ nor the Social Insurance Agency have said any such thing as "foreigners don't have to join the Japanese Health system". What was said was that the Immigration Bureau wasn't going to use that as a criteria to renew your visa. Once again - it was the Immigration Bureau talking about visas, not the SIA, the agency responsible for covering Social Insurance stating that you aren't required to be covered. How you have gotten the idea that the Immigration Bureau speaks for the SIA, I haven't a clue, but it does not. Osakadave (talk) 01:48, 12 December 2010 (UTC)

This discussion is interesting and all, but more than the NPOV problem, I think, is the simple fact that the sentences about enforcement generally and foreigners specifically don't belong in the entry. These are not fundamentally-important aspects of the system. Kurtz25 (talk) 01:31, 2 February 2011 (UTC)

If you read Japanese, there are various government links (at both the local and national levels) that are very clear on this issue. All foreigners legally in the country (i.e. registered) for more than one year are required to be enrolled in the National Health Insurance plan unless they are otherwise enrolled in a plan provided through their employer. See the NHI site <http://www.kokuho.jp/kokuho-kanyuu.htm>, or <http://www.city.omaezaki.shizuoka.jp/zeimu/info/FQA/FAQ_kokuhozei_4.html> Omaezaki City in Shizuoka (see Q4), or <http://www.city.chikushino.fukuoka.jp/kenkou-fukushibu/kokuho-nenkinka/kokuhogoha.html> Chikushino City in Fukuoka, or <http://www.city.amagasaki.hyogo.jp/kokuho/kokuho_sikumi/067sikumi.html> Amagasaki in Hyogo. These are just a few examples. Since the Health System in managed at the local level, it is local governments, NOT the immigration bureau, that are responsible for enforcing the laws, including for the foreign residents within their specific jurisdictions. Of course, illegal foreigners are EXCLUDED from the system. 218.40.66.119 (talk) 13:15, 12 May 2011 (UTC)[NagoyaBill]

This has sat long enough without additional comment, so I am making some changes to the article. It is abundantly clear that enrollment in either the national or social health insurance systems is compulsory for foreigners (I will provide additional citations at the end of this post). Furthermore, I agree with Kurtz25 that the sentences regarding enforcement and foreigners are irrelevant and I will remove them. If this topic absolutely must be covered in this entry, it should go in a separate section.

It's also worth noting that "a fair number of individuals are not covered by insurance" is vague, and the source is an editorial by a foreign author who has a long history of opposition to the Japanese insurance system. Unless someone can produce evidence that this is a significant issue for Japanese people, not just the hobby horse of a discontented foreigner, it doesn't belong here. As for the sources cited claiming that foreigners are in a gray area regarding the insurance requirement, two of the sources have nothing to do with it and are concerned only with a new visa regulation. The third source is also on the visa topic, but plainly states in the first paragraph that some foreigners are required to enroll.

Since this seems to be a contentious topic, I will include a list of official Japanese government statements on the matter. I have not located the actual law, but these are official government websites so unless someone produces a source that trumps them in authority and reliability I don't think there is anything left to debate.

• "Every foreign national who has registered and whose period of stay designated by the provisions of the Immigration Control and Refugee Recognition Law is longer than one year (including those who are qualified to stay one year or more but whose current period of stay is less than one year) is required to enroll in National Health Insurance unless they enroll Social Health Insurance or they are under coverage of Livelihood Subsidies."
• "外国人登録を行い、入管法により決定された在留期間が1年以上であ る方(1年以上日本に滞在すると認められる方を含む。)は、国民健康保険(1の 方)又は後期高齢者医療制度(2の方)が適用され、加入の手続きをする必要があります"
• "外国人登録をしている人で職場の健康保険に入っていない人も、国保に加入しなければなりません。"
• "日本に居住する外国人も、１年以上在留資格があり、他の健康保険に加入していない方は国民健康保険に加入しなければなりません。"
• "You are fundamentally required to join the National Health Insurance System upon your arrival in Japan." or the same source in Japanese "日本に一年以上在留するすべての外国人は「国民健康保険」に加入する義務があります。"Akigawa (talk) 18:29, 12 November 2011 (UTC)

US centric

This article is supposed to be about the health care system in Japan, not a comparison between the US and Japanese health care systems, which seems to be what it's becoming. While some comparisons may be useful, the number of comparisons to the US needs to be toned down. The comparisons to the OEC, UK and Canada IMO reflect a better level of coverage, with the article potentially expanded to include more countries (and perhaps more comparisons to the OECD in general) and a reduction in the number of comparisons to the US. 15:23, 17 April 2012 (UTC)

Time Aspect

I feel as though we should include a section about how long the average person in Japan must wait until they can see a doctor. In many countries, you must wait weeks up to seeing a consultant for something mediocre -- I believe it is different in Japan. Thoughts? Adamh4 (talk) 21:33, 24 April 2014 (UTC)

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Healthcare Effectiveness Indicators?

The 'Total health spending per capita' chart seems confusing. It is not clear what it is trying to communicate. Japan is on the chart, but it is not highlighted in any way. The description indicates that the amounts have been adjusted but the actual chart legend does not mention this (it says 'spending' and not 'adjusted spending', etc etc). The chart seems to show a markedly smaller investment in total dollars in Japan vs the US, but is that statistically significant? There is too much guesswork here. — Preceding unsigned comment added by Ftrotter (talk • contribs) 11:03, 22 October 2018 (UTC)

Should there be a reference to generally accepted healthcare indicators in Japan (infant mortality rates, life expectancies, leading causes of death) in this article?. Is this kind of information available and/or relevant? I was under the impression that Japan has an excellent record in this regard and came to this article to check. --66.68.170.212 00:56, 23 February 2007 (UTC)

Yeah, check this out: http://www.photius.com/rankings/world_health_systems.html Japan scores 10th best in overall on this list. It scores favorably in the other categories as well. C.V. Reynolds (talk) 20:17, 21 November 2007 (UTC)

Sorry, I put that in the wrong spot, I think. Well, to answer YOUR question, check this one: http://www.huppi.com/kangaroo/8Comparison.htm Japan does fare very well in this area. C.V. Reynolds (talk) 20:21, 21 November 2007 (UTC)

Requested move 25 November 2018

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this section.

The result of the move request was: no consensus to move the page to the proposed title at this time, per the discussion below. Dekimasuよ! 01:25, 11 December 2018 (UTC)

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Health care system in Japan → Healthcare in Japan – in line with similar articles. Rathfelder (talk) 20:02, 25 November 2018 (UTC) --Relisting. Dreamy Jazz 🎷 ^{talk to me | my contributions} 10:49, 3 December 2018 (UTC)

• Comment Although Category:Healthcare by country and most of its contents uses just 1 word, the main article Health care doesn't. Maybe the main article should be renamed. Crouch, Swale (talk) 20:34, 26 November 2018 (UTC)
• Oppose – The two-word form seems to be 10X more common. This would take more convincing. Please use the multiple-RM template if you try again. Dicklyon (talk) 19:47, 2 December 2018 (UTC)

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The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

@Rathfelder: I think a new RM needs to be started. I will support this move. Harmanprtjhj (talk) 04:44, 8 February 2019 (UTC)

Page feels lacking in detail

Notably, the "Access" and "Insurance" parts of the page. There will be something like "a bill was passed to lower costs by preventing disease earlier on" with zero follow up on whether this worked, or what critics think.

Overall, the page is lacking in depth. I don't know enough to fix this, of course, but considering how large Japan is, there should be a lot more here. 172.58.38.138 (talk) 17:55, 30 November 2021 (UTC)