My Learning Experiences from Exposure to the Japanese Health System

MAY 08, 2017
My wife grew up in Hiroshima, Japan, and all of her family lives in that area, so I became a frequent visitor to the country shortly after meeting her. While there are many aspects of Japanese culture that are very different (and of course similar as well) to the United States, I was particularly intrigued with the differences in attitudes, systems, and processes in health care. I think we have a lot to learn from health care in other countries and also have a lot that we can teach and give to other countries as well.

Chinese medicine is widely accepted and taught in pharmacy schools.
Although we teach herbals, neutraceuticals, and alternative medicine to some extent in U.S. pharmacy schools and it is widely used here, traditional Chinese medicine is considered a mainstream course of treatment in Japan and those products are typically sold right alongside Western medications. With this observation, I am not attempting to state that this is better or worse, but rather just that the tradition of Chinese medicine is so deeply ingrained in the culture that it doesn’t seem to be separated out from Western medicine. I remember chatting with a Japanese pharmacy student at Okayama University once who also recognized that it is a big difference in the educational systems and that he has taken multiple courses on the use of Chinese medicine.

The entire system runs much better, is less confusing, and has fewer administrators than U.S. systems.
Sometimes it feels that we enjoy punishing ourselves in the United States with complicated rules and procedures that don’t actually add value to patient care but instead just increase the cost of health care. For example, if I have a pharmacy and want to bill Medicare Part B for a walker, I need to fill out a 26-page application (the CMS 855S application), provide fingerprints and background screenings for owners/managers, provide a surety bond, send it to an administrator to process it (i.e. First Coast Service Options, Palmetto GBA, etc.), provide proof of liability insurance, apply for and go through several inspections (i.e. to become ‘accredited’ and another one directly on behalf of Medicare), and compile a book full of policies, procedures, and documentation of training related to fraud, waste, and abuse. After I do so, I might be able to bill a walker (assuming I provide the correct ICD-10 code) and get reimbursed a few dollars over cost. I know of a medical equipment owner that has given away walkers because it costs more to bill than it is worth and he already is accredited. I also know of an Internist who doesn’t bill for INR checks on warfarin patients for similar reasons.
While I’m sure some things can be complicated in Japan, at least from a patient perspective it runs exceptionally well. When my wife dislocated her patella in the United States and ended up flying back to Japan to complete care, she arrived on a Friday, picked up her health insurance card the next Monday from the City Hall and had an appointment with an orthopedist the following Friday. When I went with her to the hospital on a few occasions, the wait times have typically been low, the staff is respectful, and the billing is so simple that she paid it through an ATM-like machine that billed her the $20ish dollars for her portion.
She did not receive unexpected bills from third-parties later either, like for labs, anesthesia, radiology, etc.  Oftentimes we have so many hands in the pot here that patients don’t know when the bills will end, how much it will cost and how they arrived at that cost, who will bill them, why they are billing them, and whether or not the price is fair. This is clearly wrong and needs to change. Other complex industries have this figured out – for example, when you buy an airline ticket, it includes costs for air traffic control, flight attendant service, departure taxes from another country, FAA taxes, etc. If the winds are stronger that day and it takes more fuel to get to the destination we do not get billed later for a fuel surcharge. If there is a delay because of weather the airline takes the cost to redirect flights. If fuel goes up suddenly between when we purchased the ticket and when we fly the airline honors the original price. In healthcare we can and should treat our patients the same way.

There are fewer titles, job roles, and certifications.
We are a country of certifications – not just in the health care industry, but in nearly every other industry as well. It seems difficult to go too long at work without running into someone’s business card that has certifications you have never even heard of. Obviously these certifications can provide a lot of value and improve and expand your knowledge base (I felt that I learned a lot simply from preparing for the geriatric board certification), but they are without a doubt more popular in the United States. Japanese culture seems to be more focused on ‘blending in’ and ‘everyone being the same’ rather than sticking out. Because Japanese switch jobs much less frequently than in the United States, there is probably less need from the employee’s perspective to maintain certifications.
In the United States, however, most people are continually keeping their eye out for other jobs and networking even while they are in a good job just in case they are laid off or get a better opportunity. I think this is a really positive aspect of US culture because that competition pushes all of us to continually learn and increase our competitive edge on the world market. Companies that want to get the best employees are constantly reviewing their benefits packages, management practices, etc. to retain those employees. In addition, Japanese are often forced to retire at age 60 (the typical retirement age there), so even if a company has a very valuable, experienced employee they will get rid of them on their 60th birthday. Not only is this legal but it is widely accepted. From an American perspective, it is difficult to understand why this would benefit anyone (the company included), but perhaps it is also so deeply ingrained in culture it doesn’t matter whether it benefits anyone.

Takeways
In summary, continuing to learn from our international colleagues in health care, business, and other industries is an excellent way for everyone to improve the quality and cost of care in their respective countries. Most of us have been so entrenched in our own systems that it can be difficult to step out of that system entirely and ask how we can do better. Learning about systems in other parts of the world is a great way to generate a lot of fresh ideas to potentially incorporate into our own health care system.


Alex Evans, PharmD, BCGP
Alex Evans, PharmD, BCGP
Alex Evans, PharmD, CGP, works in community pharmacy in Jacksonville, Florida, and is preceptor at the University of Florida and Florida AM University. He graduated from the University of North Carolina-Greensboro with a BS in Biology and graduated from the University of North Carolina-Chapel Hill with a Doctor of Pharmacy degree. He has worked in both the community and long-term care settings. He can be reached at alex.evans.pharmd@gmail.com
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