Public vs. Private Health Care
Unless you happen to be made of money, you're probably well aware that a suitable health care plan comprises a significant portion of virtually everyone's financial balance sheet, even if you're fortunate enough not to have to use it.
The freedom to choose one's own health care.
Regardless of which side of the health care debate you stand on, one point can unerringly be agreed upon by all: because the cost of medical treatment continues to rise, it's imperative that each individual be covered by a health care program of some form. If you have no financial protection to draw upon, even the treatment or care of a moderate health-related incident could leave your finances devastated for years to come.
Indeed, the necessity of having quality health insurance is not in question. The issue is how best to provide such care to the populace; or, at the risk of putting too fine a point on it, who should be responsible for the bill when it arrives.
This is where the Social and Privatized health care camps diverge. A Nationalized system begins with the fundamental premise that health care is a basic necessity that should be underwritten and borne by society in general (in other words, by the government), and seeks to provide public access to these services while controlling how much is paid by the government and the individual.
A Private health care system stems from the notion that, like all other services in the free marketplace, medical care is an individual's personal responsibility and choice; it attempts to enhance public access to coverage and lower prices by way of market competition, seeking to strike an efficient balance between cost and the quality of services rendered. Both approaches have their strengths as well as their shortcomings. So, let's take a few moments to examine just a few of the basic facts more closely.
Public Health Care
First of all, it's important to know and understand some common terms in order to avoid confusing them with one another. Socialized medicine usually refers to publicly-funded or government-financed health care program in which that entity also owns the means of service delivery (i.e., government-owned hospitals and clinics). However, in a social health insurance system (also typically known as national or universal health insurance), individuals are a part of and pay taxes or premiums into a 'pool' based largely on their ability to pay rather than any particular personal health risks or conditions (i.e., not medically underwritten), and services may often be rendered through a combination of government-owned, private nonprofit and/or private for-profit healthcare facilities. The types and percentages of these service-delivery networks vary from country to country. All of Japan's nationalized healthcare programs fall into this general category.
Major points for social health care:
- The cost of any and all health care continues to rise, with no end in sight. This fact unfortunately dictates that many people simply cannot afford to purchase a health care plan of any type, and without a nationalized health program to provide a reasonable level of protection, those numbers would only escalate dramatically. And, increasingly prohibitive costs are not just a problem for individuals; businesses of all sizes are also feeling the weight of rising health care expenses.
- Low-cost health services are designed to encourage people to seek advice or care more readily in the event of a medical issue, catching problems in the earlier stages when the treatment would be less complicated, invasive and expensive. Individuals with no health plan often forego periodic physicals and other preventative measures because they simply do not have the money to pay for them.
- A social health care system makes possible a centralized information database, decreasing or eliminating the need for filling out duplicate forms and continually providing the same information over and over again, thereby increasing efficiency and reducing wasteful expenditures. Most private healthcare providers' offices and hospitals maintain their own sets of patient records, and passing that information along from one to another is by no means automatic. A centralized database also makes the doctor's job of diagnosis and treatment significantly easier (although it must be mentioned that not every country which operates a nationalized program takes full advantage of this benefit and Japan is one that doesn't).
- A simplified universal system allows medical practitioners to focus on taking care of their patients instead of being overly concerned with multiple insurance companies, each with their own array of forms, rules and coverages.
. . . and some points against:
- A government-controlled healthcare program necessarily limits not only the flexibility of the patients covered by it, but also restricts healthcare providers by requiring and/or excluding various medical procedures, very possibly resulting in a decrease in the quality of patient care.
- Decreased fees for doctors has prompted many to seek additional revenue in prescribing unnecessary treatments and/or drugs, which simply increases costs for those who are paying for the program via taxes or premiums - namely, the general public. This is done typically after the patient has waited an inordinate amount of time to see a doctor and then is given only a few minutes of his/her attention. Again, the quality of patient care suffers. Lower pay for doctors also has the effect of dissuading would-be practitioners in the upcoming generation from pursuing a career in medicine, further exacerbating the already existing shortage of healthcare professionals. Additionally, doctors and specialists may prefer to relocate their practices elsewhere, where the prospects for profitability are greater.
- Though often touted as 'free' or 'low-cost,' nationalized health care is actually neither. Just as there is no 'free lunch,' the notion of free health care simply does not exist - not in Japan or in any other country operating a social health care system. Payment must come from someone, and in this case it's the general public by way of taxes and/or premiums. And, although compulsory, many residents of Japan (both native and foreign individuals, along with a large number of businesses) are not enrolled in any of the social plans because they still cannot afford the required premiums, even though the main purpose of a public system is supposed to be affordability for all.
- Healthy people on the social program who do have the ability to pay its premiums end up 'subsidizing' the care of those with less-healthy lifestyles.
Major points for privatized health care:
- Business and industry ingenuity, market competition and profit incentives drive businesses of all types and in all fields to perform better. The excellence manifests itself in greater efficiency, cost control and customer satisfaction. The healthcare industry is no exception. Indeed, patient satisfaction is paramount to continued profitability, and therefore to continued perfecting of the business model. In privatization, the industry is forced to seek ways to better itself and its product, which should lead to more available services and better quality.
- Not only does privatization make available levels of coverage tailored to an individual's budget, it makes it possible to avoid completely treatments that he/she deems unnecessary and chooses not to purchase. For example, a single male may wish to buy a plan which has no pregnancy coverage (a considerable savings!). Yet, the same plan will cover the costs of medical providers outside of a social insurance network. And, an international health plan may even pay for repatriation of remains in the event of death of an expatiriate - eliminating a possible burden on family or perhaps even the host government.
- Average waiting times for doctor visits and special procedures are drastically lower than for public health care, and providers take a greater personal interest and time with their patients. Availability for many treatments is also considerably greater. If the patient (their business customer) becomes dissatisfied for any reason, he/she will find another service provider. Indeed, a competitive marketplace will drive the individual to seek out the best coverage and services at the best prices available.
- Personal healthcare and treatment decisions remain in the hands of the individual and his/her doctor, which serves to give the patient a more comforting feeling of control over his/her own life and course.
. . . and some points against:
- There will always be a number of people who simply cannot afford to pay for health care coverage (private, nationalized or otherwise). Indeed, low-income individuals should receive some type of subsidization for their health costs. Access to adequate health care must be available at all times, because it's a safe assumption that preventative medical care is almost always much less expensive than corrective procedures performed down the road.
- Underwriting costs, claims filing, investigations and the paperwork and personnel necessary to accomplish these tasks can be quite significant. Such expenses are, of course, passed on to policy owners as a normal part of doing business.
- Privatized health care, such as that utilized in the U.S., is not immune to the effects of uninsured patients. If a doctor or hospital (for instance, an emergency treatment facility) treats an individual with no insurance and he/she cannot pay the bill, recoupment is made by raising the prices slightly on their other bills, which the insurer must pay. The insurer, of course, will in turn raise its rates, thereby passing the increase on to its policy owners.
To be sure, this is by no means an exhaustive list. Indeed, it will probably only serve to whet your appetite on this very important topic. The purpose of this Foundation is to present objective facts - not just on one side, but on both - and to promote open and productive dialogue about the strengths and weaknesses of the health care industry here in Japan.
We believe that the right to choose the type of health care that one receives should not be taken away from expatriates and non-Japanese residing in Japan. As "Our Objective" states, no one shoe is able to fit every foot. A person may possess a very compelling reason to desire alternative coverage under a private health care plan. At the same time, any person wishing to be covered by one of Japan's National Health or Social Insurance Programs should have the right to do so.
It's all about free choice, and we think that choice is best made for an individual by that individual.