[Dialogue] health care reform

[Don Hinkelman]

Thanks, Don, for highlighting the problem of litigation and the need  
for tort reform. I agree completely.

Part of the debate has to be pragmatic and think of piecemeal change.

Part of the debate has to think out of the box. That is why many  
reformers look at Canada, Britain or France for ideas.  But why has  
there been so little analysis of the Japan system?

Some things to note about the Japan health care system:
- the whole population is covered (not sure about the homeless and  
visitors)
- total medical costs are about half or one third of USA
- a patient pays 30% of a bill, the nation pays 70% (same for all  
fees, including drugs)
- patients who cannot afford 30%, can apply for 100% coverage, few do.
- medical and dental are both included--one system
- funding is collected through a mix of public/private insurance (I  
pay US$400/month for a family of four)
- patients can choose to go anywhere, open market competition to get  
patients
- waiting time is minimal (I usually walk in without an appointment,  
wait 15-30 minutes)
- hospital stays are double or triple the USA times (childbirth is a  
minimum six nights, seven days)
- payment to hospitals is by the government (insurance companies not  
involved)
- salaries for doctors, nurses and pharmacists are about the half the  
USA level
- malpractice litigation is extremely rare
- life expectancy is the highest in the world, other measures of  
quality health care rank it at or near the top.

Don Hinkelman
Sapporo, Japan