We will jump continents now to Japan and look at their health care system.  Having lived in Japan, I have actually seen how the Japanese deal with health care.  The Japanese did not get universal coverage until the 60s when small businesses revolted and demanded the government do something so their employees could have coverage as well as the large employers. They argued that they contributed as much to the economy as the large employers who could afford to offer coverage, and that led to universal coverage.

Everyone is covered and everyone is required to pay into a national health insurance fund.  Fees are set by the national government.  All providers are paid the same fee for each service.  Employers pay 50 to 80% of the health insurance premiums.  Individuals and dependents pay for premiums out of their salary—at about 8.5%. In addition they have co-payments. Co-payments account for about 20 to 30% of individual health care costs.

Health insurance companies are required by law to offer a basic benefit package that includes medical consultation, medications, as well as home health care and nursing care. 

Individuals are assigned to a private insurer, according to their employment situation.  The government funds the National Health Insurance which insures the unemployed, the elderly and the self-employed, such as lawyers and doctors.
Health care providers largely have their own private practices and it is quite common for a doctor to own a hospital.  In fact, nearly 80% of all hospitals in Japan are owned by doctors.  By law all hospitals are required to be nonprofit.  The other 20% are large, public, state owned and managed teaching hospitals. 

The Japanese are truly conscientious about their health.  Many large companies start the day with employee tai chi type of exercise. In the winter and the flu/cold season nearly everyone wears a white surgical style mask over their nose and mouth.  During the same season, when we lived on a Japanese Air Self-Defense Force base, we had to wash our hands in something like ammonia before we could enter the base.

As for malpractice in Japan, it tilts in the favor of the doctor, but with a real kicker.  All the member of the Japanese Medical Association, or a little over 40% of all Japanese doctors , have a collective insurance pool they pay into. Private doctors and hospital employees can buy insurance in the private market, but it is not required by law.  The professional liability program reviews out of court claims, but the system is biased toward the doctor rather than the patient. The review board’s decision is binding, but patients who disagree may go to court.   In Japan, injury or death from a medical error is a criminal offense. 

Read more about Japan’s health care system: Japan Factsheet.

There is no cookie cutter approach to health care. All systems reflect the values of their country of origin. 

Cheers and more later.  Kathleen

Thinking productive workers meant healthy workers, Bizmarck introduced the first national health insurance system in Germany in 1883. The US was close to adopting this model, but with advent of World War I, the US backed off. 

Like France, everyone participates--the employer, employee and the government.  Like the US, it is a public/private system.  Everyone pays for health care which is organized around the employer who contracts with private insurance companies to manage the care.  The employer must pay at least half the premium and the other half is deducted monthly from the employee’s salary.   The government covers the health care contribution costs of the unemployed and the low income.

Now this is an interesting thought.  Everyone in Germany—wealthy or poor—has the same benefits. If the individual cannot pay, the government pays his or her premium contribution.  Think what this would save if we did that here? So, instead of having 50 different Medicaid programs with 50 different benefits and premiums, the government simply paid the premium and the individual could use the same services as everyone else.

This is not a government-run, centralized system.  Each of Germany’s 16 states share responsibility with the federal government for the upkeep and maintenance of hospitals and clinics.  State regulated insurance companies oversee cost controls.  The insurance companies are both public and private.

There are over 200 private insurance companies that over 400 different plan options.  Doctors have private practices. Some doctors are hospital employees and of the 2,030 hospitals in Germany, 790 are public; 820 are private non-profit and 420 are private, for profit.

As for malpractice, initial claims are sent to mediation with expert panels set up by the physicians’ guild.  Patients are free to reject the mediation results and take their cases to court, very much like the US system.

So much for “socialized medicine.”

For more on the German health care system, see our factsheet.

Cheers and more later. Kathleen

We are starting a series on our blog on what other countries’ health care systems look like.   Significant misinformation exists on other health systems, so we thought we would start by taking a look at a few key countries that operate most like the US.  Anne Kinzel, JD, has been writing about France.  She has one more post on that, but we wanted to start with some other countries as well.  Basically, covering everyone is not rocket science.  It does, however, take political courage and public will.

Before we take a look at these systems, here is what many of them have that we do not:

• One national agency that negotiates rates and defines services
• One standard set of services for everyone
• Employer and individual may add more benefits
• Administrative simplicity
• Standards
• Majority of physicians are primary care
• Private, nonprofit insurance companies
• Mediation prior to litigation for malpractice

The simple act of having one basic set of services for everyone eliminates the vast complexity that drowns our health care system.  If we had one basic set of services that everyone was eligible, we would eliminate probably a third of the cost of our health care system. 

We will look at these issues in greater depth as we move forward.  We invite your comments and insights. 

Cheers and more later.  Kathleen