Knowledge is power (even in Japanese health care)
When I talk about the cavalier way many Japanese doctors treat (in both senses of the word) their patients, friends of mine back home often chuckle, “Well, Sean, you don’t have to go to Japan to find a high-handed doctor who thinks you’re too stupid to be worth explaining things to!” The thing is that, here, it’s been largely institutionalized. The behemoth Ministry of Health, Labour, and Welfare is This entry was posted on Friday, January 21st, 2005 at 20:25 and is filed under misc. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.
I have serious doubts that this will work because the MHLW is picking up the tab. Do you really study the bill in the States if your insurance company is picking up the tab? I do, but I’m professionally interested. Even if you read it, do you complain if you think your insurance company was overcharged?
The way to force some accountability is to set up tiered account system. Everybody gets, say 100,000 yen to spend for the year. If you go over, you have to start paying premiums. If you go over 200,000 yen, the premiums go up, and so forth. As soon as money starts coming out of consumers’ pockets, you had better believe people will be scrutinizing each line item.
Man, why you always hafta burst my bubble?
I figure, it goes in baby steps. There are still enough Japanese households in which the housewife who controls the budget pores over the contents of any envelope that says “receipt enclosed” to generate some noise. No, it won’t be loud; as you say, most people pay the (comparatively minuscule) fee at the hospital/clinic counter and go on their way without any doubt. And they don’t think about it afterwards, because it’s the way they’ve done things for decades. But Mrs. Tanaka here and Mr. Sato there will see the 6000-yen surcharge for “processing” and very politely go back and say, “Our household is much obliged for your taking care of my dear spouse, but I wonder whether I could trouble you to explain what this item is, because…well, one grows old, and I’m afraid things like this confuse me dreadfully.” It won’t fix things overnight–unsurprisingly, I agree that allowing the market to send signals is the only thing that really will–but at least the alert people will start to notice how they’re being pumped. It’s a step in the right direction, and when you’re working with a machine as entrenched as this, every little bit helps.
Attitudes about medicine and the authority of doctors can certainly be different in other countries. About a year ago, my girlfriend and I vacationed in England and Scotland. I got sick almost the moment we landed (and wrote about it at http://home.earthlink.net/~swheeler843/News/2003/12/20031202.html).
The key quote from the linked article comes from the doctor who diagnosed me, when I asked him if he would be performing any tests: “You Americans and your evidence-based medicine!”
You can’t be too careful about that airline yogurt, huh?
The doctor you consulted seems to have been taking the perfunctory approach, but I think there is something to the charge that Americans overdo it sometimes. My own GP doesn’t take National Health; I gladly pay to see him because he talks to me like an adult, tells me what the little bags of powder are supposed to do, and listens to my own account of what’s going on.
There was one time, though, when I was getting all agitated over what exotic ailment could be causing some sore throat or something, and he smirked at me and said, “Just because this is the first time you’ve had it, that doesn’t mean it’s the first time I’ve seen it.”