Gov: Sick Around the World – Japan and Germany

     The Japanese go to the doctor three times as often as Americans, have more than twice as many MRI scans, use more drugs, and spend more days in the hospital. Japan spends about half as much on health care per capita as the United States. Japan uses a social insurance system in which all citizens are required to have health insurance. The Japanese receive insurance either through their work or purchased from a community based plan. Those individuals who cannot afford the premiums receive public assistance. Most health insurance is private and cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit. Doctors and almost all hospitals are in the private sector. In Japan there are no gatekeepers. Having no gatekeepers means there’s no check on how often the Japanese use health care. The Japanese can go to any specialist when and as often as they like. Every two years the Ministry of Health negotiates with physicians to set the price for every procedure. This helps keeps costs down.  Japan has been so successful at keeping costs down that Japan now spends too little on health care. The result is half of the hospitals in Japan are operating in the red.

     Germany, like Japan,  uses a social insurance model. But unlike the Japanese, who get insurance from work or are assigned to a community fund, Germans are free to buy their insurance from one of more than 240 private, nonprofit sickness funds. For its 80 million people, Germany offers universal health care, including medical, dental, mental health,  homeopathy and spa treatment. As in Japan, the poor receive public assistance to pay their premiums. Sickness funds are nonprofit and cannot deny coverage based on preexisting conditions; they compete with each other for members, and fund managers are paid based on the size of their enrollments. Germans can go straight to a specialist without first seeing a gatekeeper doctor, but they pay higher co-pay if they do. Like Japan, Germany is a single-payment system and medical providers must charge standard prices, but instead of the government negotiating the prices, the sickness funds bargain with doctors as a group. This keeps costs down, but it also means physicians in Germany earn between half and two-thirds as much as their U.S. counterparts. This system leaves some German doctors feeling underpaid. A family doctor in Germany makes about two-thirds as much as he or she would in America. However, German doctors pay much less for malpractice insurance, and many attend medical school for free. Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds.