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Japan - Health Care System Structure and Organization

Page history last edited by Cain Farmer 10 years, 8 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
    • Relatively less rigorous
  • 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
    • Little data available


Health Information Technology


  • Level of Electronic Medical Record (EMR) adoption (% of physicians or clinics)
    • Very low
  • Funding sources for EMR and outlook
    • In flux; government to require EMR in future
  • PHR adoption and funding sources
    • Still new
  • Telemedicine adoption
    • Used in rural settings


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