Health care in Japan

In the Japanese health care system, healthcare services, including free screening examinations for particular diseases, prenatal care, and infectious disease control, are provided by national and local governments. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. People without insurance through employers can participate in a national health insurance program administered by local governments. Since 1973, all elderly persons have been covered by government-sponsored insurance. Patients are free to select physicians or facilities of their choice.

In the early 1990s, there were more than 1,000 mental hospitals, 8,700 general hospitals, and 1,000 comprehensive hospitals with a total capacity of 1.5 million beds. Hospitals provided both out-patient and in-patient care. In addition, 79,000 clinics offered primarily out-patient services, and there were 48,000 dental clinics. Most physicians and hospitals sold medicine directly to patients, but there were 36,000 pharmacies where patients could purchase synthetic or herbal medication.

National health expenditures rose from about 1 trillion Yen in 1965 to nearly 20 trillion Yen in 1989, or from slightly more than 5% to more than 6% of Japan's national income. In addition to cost-control problems, the system was troubled with excessive paperwork, long waits to see physicians, assembly-line care for out-patients (because few facilities made appointments), over medication, and abuse of the system because of low out-of-pocket costs to patients. Another problem is an uneven distribution of health personnel, with cities favored over rural areas.

In the late 1980s, government and professional circles were considering changing the system so that primary, secondary, and tertiary levels of care would be clearly distinguished within each geographical region. Further, facilities would be designated by level of care and referrals would be required to obtain more complex care. Policy makers and administrators also recognized the need to unify the various insurance systems and to control costs.

In the early 1990s, there were nearly 191,400 physicians, 66,800 dentists, and 333,000 nurses, plus more than 200,000 people licensed to practice massage, acupuncture, moxibustion, and other East Asian therapeutic methods.

Cultural influences
Traditional Chinese medicine was introduced to Japan with other elements of Chinese culture during the 5th to 9th century. Since around 1900, Chinese-style herbalists have been required to be licensed medical doctors. Training was professionalized and, except for East Asian healers, was based on a biomedical model of disease. However, the practice of biomedicine was influenced as well by Japanese social organization and cultural expectations concerning education, the organization of the workplace, and social relations of status and dependency, decision-making styles, and ideas about the human body, causes of illness, gender, individualism, and privacy. Anthropologist Emiko Ohnuki-Tierney notes that "daily hygienic behavior and its underlying concepts, which are perceived and expressed in terms of biomedical germ theory, in fact are directly tied to the basic Japanese symbolic structure."

Western medicine was introduced to Japan with the Rangaku studies during the Edo period. A number of books on pharmacology and anatomy were translated from Dutch and Latin to Japanese. During the Meiji period (late 19th century), the Japanese health care system has been formed after the model of Western biomedicine. At that time, western doctors came to Japan to create medical faculties at the newly built Japanese universities, and students also went abroad. Innovations like vaccines were introduced to Japan, improving average life expectancy. From the Meiji period through the end of World War II German was a mandatory foreign language for Japanese students of medicine. Patient charts in Japanese teaching hospitals were written in German.

But even today, a person who becomes ill in Japan has a number of alternative options. One may visit a Buddhist temple or Shinto shrine, or send a family member in his or her place. There are numerous folk remedies, including hot springs baths (Onsen) and chemical and herbal over-the- counter medications. A person may seek the assistance of traditional healers, such as herbalists, masseurs, and acupuncturists.

AIDS
Although the number of AIDS cases remained small by international standards, public health officials were concerned in the late 1980s about the worldwide epidemic of acquired immune deficiency syndrome (AIDS). The first confirmed case of AIDS in Japan was reported in 1985. By 1991 there were 553 reported cases, and by April 1992 the number had risen to 2,077. While frightened by the deadliness of the disease yet sympathetic to the plight of hemophiliac AIDS patients, most Japanese are unconcerned with contracting AIDS themselves. Various levels of government responded to the introduction of AIDS into the heterosexual population by establishing government committees, mandating AIDS education, and advising testing for the general public without targeting special groups. A fund, underwritten by pharmaceutical companies that distributed imported blood products, was established in 1988 to provide financial compensation for AIDS patients.