Health Care Issues In The United States And Japan

Recent data show wide disparity between Japan and the United States in the effectiveness of their health care systems. Japan spends close to the lowest percentage of its gross domestic product on health care among OECD countries, the United States spends the highest, yet life expectancies in Japan are among the world’s longest. Clearly, a great deal can be learned from a comprehensive comparative analysis of health care issues in these two countries. In Health Care Issues in the United States and Japan, contributors explore the structural characteristics of the health care systems in both nations, the economic incentives underlying the systems, and how they operate in practice. Japan’s system, they show, is characterized by generous insurance schemes, a lack of gatekeepers, and fee-for-service mechanisms. The United States’ structure, on the other hand, is distinguished by for-profit hospitals, privatized health insurance, and managed care. But despite its relative success, an aging population and a general shift from infectious diseases to more chronic maladies are forcing the Japanese to consider a model more closely resembling that of the United States. In an age when rising health care costs and aging populations are motivating reforms throughout the world, this timely study will prove invaluable.

The health care sector has become a major component of the contemporary econo mies of Japan and the United States. It absorbs significant proportions of the GDP in both countries and places increasing stress on private, government and corporate budgets. As their income rises, the citizens ofJapan and the United States choose to allocate increasing portions of it on health care services because ofthe direct contri bution of health care services to prolonged life expectancy, reduced morbidity, or other indicators of improved health and well-being. The health care sector is a ma jor source ofemployment and affects the lives of all citizens. Adequate health care services are expected to have an important contribution to the quality of human life in any society. With so much at stake, arrangements for planning, financing, and operating health care service systems have increasingly come to be regarded as im portant economic and political issues. The political importance of health care is evidenced by the health care reform proposals of the Clinton administration in the United States and the deep involve ment of the government in the medical care security system in Japan. As policy makers in both countries look ahead to the coming decades, they realize that the imperatives of economic restructuring, globalization, and their rapidly aging socie ties will affect the way in which health care is organized, delivered, and financed.

Compared to the rest of the world, Japan has a healthy population but pays relatively little for medical care. This book analyses how the health care works, and how it came into being. Taking a comparative perspective, the authors describe the politics of health care, the variety of providers, the universal health insurance system, and how the fee-schedule constrains costs at both the macro and micro levels. Special attention is paid to issues of quality and to the difficult problems of assuring adequate high-tech medicine and long-term care. Although the authors discuss the drawbacks to Japan's stringent cost-containment policy, they also keep in mind the possible implications for reform in the United States. Egalitarian values and a concern for 'balance' among constituents, the authors argue, are essential for cost containment as well as for access to health care.

Japanese and American economists assess the present economic status of the elderly in the United States and Japan, and consider the impact of an aging population on the economies of the two countries. With essays on labor force participation and retirement, housing equity and the economic status of the elderly, budget implications of an aging population, and financing social security and health care in the 1990s, this volume covers a broad spectrum of issues related to the economics of aging. Among the book's findings are that workers are retiring at an increasingly earlier age in both countries and that, as the populations age, baby boomers in the United States will face diminishing financial resources as the ratio of retirees to workers sharply increases. The result of a joint venture between the National Bureau of Economic Research and the Japan Center for Economic Research, this book complements Housing Markets in the United States and Japan (1994) by integrating research on housing markets with economic issues of the aged in the United States and Japan.

The Bureau of East Asian and Pacific Affairs of the U.S. Department of State presents the full text of the fact sheet entitled "Health Care in Japan," published June 26, 2000. Japan has the longest life expectancy, with 77 years for men and 84 for women, and the lowest infant mortality rates in the world. Health care costs remain low in Japan. Japan focuses on preventive care, which has helped in containing costs. To address concerns of the aging of Japan's population, a public nursing care insurance system went into effect in April 2000.

The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, "peer" countries. In light of the new and growing evidence about the U.S. health disadvantage, the National Institutes of Health asked the National Research Council (NRC) and the Institute of Medicine (IOM) to convene a panel of experts to study the issue. The Panel on Understanding Cross-National Health Differences Among High-Income Countries examined whether the U.S. health disadvantage exists across the life span, considered potential explanations, and assessed the larger implications of the findings. U.S. Health in International Perspective presents detailed evidence on the issue, explores the possible explanations for the shorter and less healthy lives of Americans than those of people in comparable countries, and recommends actions by both government and nongovernment agencies and organizations to address the U.S. health disadvantage.

During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages -- cancer and cardiovascular disease -- available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which -- unlike randomized controlled trials -- are subject to many biases.