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Japan - Health Care System Structure and Organization
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last edited
by Cain Farmer 14 years, 4 months ago
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Organizational Structure of the Health Care System
- Public-administered financing through numerous schemes
- Delivery is highly fragmented/decentralized
- Low current integration, though many regional disease-specific efforts to integrate care between local clinics and hospital specialists (e.g. Chiba for diabetes)
- Recent incentives introduced to increase primary referral to specialists as a means to stimulate systemic integration
- Most healthcare delivery in medical private sector
- 8,943 hospitals; 18% public
- 98,609 clinics; 5% public
Primary, Specialty and Hospital Care
- Primary care delivered primarily through local solo clinics
- Specialty care divided into:
- Less complex (delivered by local solo specialty care clinics)
- More complex (delivered by hospital specialist departments)
- Highest level of care delivered by ~150 hospitals including medical schools, government specialty centers, and strong urban hospitals
- Little or no formal system for integration and referral. Strongest current motive for referral choice is alumni relationships.
- Internal Medicine, Peds, GYN, at local solo clinics provide most primary care
- Doctors and nurses; no mid-levels
Key Health Care System Reforms
- Reduction in spending through reductions in national price list
- Reduction in demand by gradually increasing copayments
- Promotion of Evidence-Based Medicine (EBM) use
- Primary prevention of lifestyle related diseases
- Introduction of integration between clinics and hospital for improved chronic disease care
- Conversion of excess acute care beds into long term care beds under separate payment system
Health Care Workforce
- 8.4 acute care beds per 1,000 population
- 263,540 practicing physicians (2006)
- 2.0 practicing physicians per 1,000 population
- 49% primary care (Internal Medicine, Peds, GYN)
- Average hospital physician income = 14,100,000 yen = 145,565 USD
- Average solo clinic owner income = 25,300,000 yen = 261,178 USD
- 46,764 Public Health Nurses (2005)
- 27,047 Midwives
- 822,913 Registered Nurses
- 411,685 LPNs
- 10.3 total nurses per 1,000 population
- Average RN salary = 4,561,800 yen = 47,095 USD
- Health care workforce issues
- Physicians and other health care professionals public or private employees?
- Most physician and nurses are private employees
- Physicians and other health care professionals hospital employees or in independent practice
- 64% hospital employees
- 36% solo clinic practice
- Board certification or other credentialing of physicians, nurses and other providers
- Licensing administered by Ministry of Health, Labor and Welfare
- Board certification by medical specialty societies
- Sophistication and rigor of credentialing
- Health care workforce training
- At four year universities and junior colleges
- Medical school is six year combined undergraduate and professional school
Health Care Benefits
- National health insurance covers medical and dental care, including medications
- National long term care insurance covers long term care for disabled
Access to Care
- 100% of population required to purchase insurance from source based on place of income
- All have access to all institutions; virtually unfettered access for all, everywhere
- Primary care generally delivered first come first serve/appointments often required for hospital specialty care
- No local budget caps; no rationing of care per se; competition among institutions to attract patients; no long waits for needed care
Availability & Adoption of New Medical Care Technologies
- Unfettered ability to install latest technologies; Japan has highest per capita level of high tech medical equipment
Medical Equipment, Supplies and Facilities
Health Care Performance Data
- Delivery of evidence-based care
- Relatively less dispersion of EBM; relatively more reliance on institutional experience
- Safety and medical errors
- Coming under increasing scrutiny as lawsuits increase
- Patient outcomes
Health Information Technology
- Level of Electronic Medical Record (EMR) adoption (% of physicians or clinics)
- Funding sources for EMR and outlook
- In flux; government to require EMR in future
- PHR adoption and funding sources
- Telemedicine adoption
Return to Japan
Japan - Health Care System Structure and Organization
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