Inku
Japan Society of Fairfield County

Culture Watch, Society Watch (13)
by Dr. Ikuko Anjo Jassey


     At the beginning of August, my husband was dehydrated and lost consciousness on campus. His blood pressure was way too low and his heart rate way too slow when he was taken to a nearby hospital by ambulance. Consequently, he stayed at the hospital for two days for tests: Angiogram; MRI; and EKG-that I always mix up with KGB. A month later, the bill came. It amounted to $24,000. Twenty-four thousands dollars is a fairly large amount of money for a majority of people. Fortunately, this was covered with his primary and secondary insurances. If you don't have insurance, needless to say, you have to pay the full amount from your pocket, regardless of the cost. Despite this fact, it is reported that about sixteen percent of Americans do not have medical insurance, simply because they cannot afford to pay the premium share. If my husband lived in Japan, what kind of insurance would he be entitled to have and how much would he pay for his tests, provided he took the tests that cost exactly the same amount? Or how much would he have to pay as premium share? Keeping these questions in mind, let me browse through some health insurance plans in Japan.
     Perhaps it is better to start with Japan's insurance plans in a simple manner. Japan's health insurance plans are broadly classified into two types: (1) Health Insurance (Occupation-based public health insurance); and (2) National Health Insurance for the self-employed, farmers, the unemployed, the retired, and others. Take my husband's case as an example. He is still a private university employee in this country where there is no retirement age. On the contrary, since seventy years old is the retirement age for professors at most private universities in Japan, he would be no longer a university employee. Thus the insurance he would carry is National Health Insurance with which he, as a patient, covers 30 percent of his medical fees, and the government the remaining. However, being eligible for Health Insurance for the Elderly that is provided to those over seventy-five years old, he is required to cover 20 percent of the cost, instead of 30 percent. Consequently, his payment amounts to $4,800. Still, compared to the former medical insurance plan for the elderly practiced from 1973 to 1983, which provided free medical treatment if you were over seventy years old, today's plan has been compelling for the elderly with a financial burden. Let me take one more example: My mother's case. She, a National Health Insurance holder, died in 1989 at sixty-three years old after an eight-month hospitalization with an initial eight-hour operation. Except for the last two weeks when staying at a private room, she was placed in a room of six patients covered by the insurance. The total medical cost was approximately $6,000. In terms of National Health Insurance, it has not changed much for some time.
     Then, how much premium share do Japanese people pay yearly for their medical insurance in order to receive medical services as an inpatient or as an outpatient? In case of people who hold Health Insurance of Public Schools in Funabashi City, Chiba Prefecture, they pay 3.7 percent of their income. The premium also differs among municipalities. Regarding National Health Insurance, take households in the above City. The average premium share per household for the year of 2006 was approximately $1,500. The premium share for National Health Insurance differs among local governments, and it is collected on the basis of income, property, and number of insured within a household.
     Thus Japan's medical plans once rated "excellent" have tremendously changed. No more senior citizens go to a hospital with a trifle reason, such as a light cold or an itchy eye since their medical cost is not free any more. The good old days when older people went to see a doctor with the second (or maybe the primary) hidden reason of meeting with their friends and of entertaining themselves at a hospital lounge were gone. Or the days when anyone--a primary insurer of Health Insurance--was treated just with the 1,000-yen (about $10) co-payment also disappeared. With the rapid increase of the elderly population, specifically one in every five people is over 65 years old in 2004 and one in three by 2050, Japanese people are already gasping with a burden of a high premium share. "Well, the only measure to avoid high medical cost is," my friend's husband, who retired last March from a local government, wrote in his e-mail, "to do our best not to become sick." He is still sixty years "young" and has a fairly long way to go....

Notes:
1) Non-Japanese citizens also receive the same health insurance benefits as Japanese citizens do.
2) The public health insurance system provides almost universal coverage. The occupation-based public health insurance (Health Insurance)is further classified into three types of insurances: Society-managed Health Insurance for large firm employees; Government- managed Health Insurance for small and medium sized firm employees; and Other Occupation-based Health Insurance for civil servants, private school employees, day laborers, etc.
3) Regarding Health Insurance of the Elderly, if the patient's annual income is more than 1,450,000 yen (about $14,500), he/she pays 20 percent of the cost. (This will be raised to 30 percent in October 2006.) Those whose annual income is less than the above amount pay 10 percent of the fees. If a patient is on welfare, all expenses are covered by the government.
4) In both insurance plans-Health Insurance and National Health Insurance, the co-pay is about $8.00.
5) Japanese insurance plans cover dental but does not cover vision.
6) Please note that the above description about the Japanese health insurance system is simplified; the actual system is regulated in far greater details.
7) For your information, today's average premium share for administrators and teachers at public schools in Connecticut are 15% and 10%, respectively. With reference to the Norwalk public school district, Connecticut, the premium share is 10% for both administrators and teachers.

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