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Compared to any countries in the world, Japan has a health care
system thatcosts half as much and often achieves better medical
outcomes. It does so bybanning insurance company profits and
limiting doctor fees. Japanese people visit adoctor nearly 14 times
a year, more than four times as often as people in
Westerncountries. Concerning about the need of health care, people
living in Japan willstraightly go to hospitals or private clinics
when they need one, since there are no
primary health care as we have it in Indonesia. In Japan,
patients are free to choosephysicians or health facilities and
cannot be denied coverage. Hospitals, by law,must be run as
non-profit and be managed by physicians, and private clinics mustbe
owned and operated also by physicians. In Indonesia, patients are
supposed togo to primary health care first before going to any
hospitals, in order to filter thepatient flow that frequently
happens in hospitals. And there are some hospitals inIndonesia that
are actually running to find more profit in every day.
Patients who come to hospitals in Japan are questioned about
their major complaints, anddirected to department most closely
related to their stories, and the treatment plan will be
conducted from there. If we have infectious and tropical disease
positioned as the top of
prevalence chart in Indonesia, Japan has cardiovascular and
malignancy cases at the top. If weare to compare about the
patients, here in Japan, most patients are in their old times,
which
means they are in late adulthood or elderly. Adolescent or young
adults are rarely seen as
patients here in the hospital I had worked for one month. And
concerning about cardiovascularand malignancy problems, these
patients will go through some additional examination, such as
X-Ray, or CT-Scan, or anything else, to screen for any other
illness present other than previous
findings based on their major complaints. Some people will say
this as over-diagnosis, but I
personally say this is a pretty good method of conducting a
thorough examination of the patient.
Since health insurance is mandatory for every Japanese resident,
underwent some
expensive additional examination or therapy would not be such a
big problem, because the
insurance company will cover most price costs for their clients
health needs. The health caresystem in Japan provides healthcare
services, including screening examinations, prenatal careand
infectious disease control, with the patient accepting
responsibility for 30% of these costs
while the government pays the remaining 70%. Payment for
personal medical services is offered
through a universal health care insurance system that provides
relative equality of access, withfees set by a government
committee. Compared to our local Indonesian health insurance
companies who got the money from their clients, Japanese health
insurance companies receive
money flow from the government itself. Clients pay taxes to the
government and their money isused for health insurance companies
for their own health needs. It is like a cycle of money flow.
With low health care cost, there will be questions about quality
control and gaps in treatment for
urgent care, since Japanese hospitals will experience a
"crowding out" effect, with space for
emergency care and serious medical conditions sometimes
overwhelmed by a flood of patientsseeking routine treatment. When
you need beds for your patients who are in emergency
conditions, but the beds are occupied by other patients with
less urgent condition. The
government has been unable to reduce the length of hospital
stays, and the doctors areoverworked as you can see.
I personally think that Indonesian doctor-patient relationship
is much betterthan they have in Japan. We have been taught to build
an interpersonal relationshipto patients, understanding their
personal worries and fears, being a friend rather
http://en.wikipedia.org/wiki/Healthcarehttp://en.wikipedia.org/wiki/Healthcarehttp://en.wikipedia.org/wiki/Prenatal_carehttp://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Universal_health_carehttp://en.wikipedia.org/wiki/Healthcarehttp://en.wikipedia.org/wiki/Prenatal_carehttp://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Universal_health_care
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than just stranger. In the hospital I had worked, I often saw
some doctors barelyspoke to their patients. Maybe because I was in
surgery ward, or maybe it dependson the personality of the
supervising doctor, so they did not take communicationskills as
something matters, I am not sure. Anyways, they gave
preoperativeinformed consent in a very brief explanation, even
explaining the whole operativeprocedure and mistakes possibilities
during the operation. That one was good to
adopt.
In Japan, medical students go through a six-years education,
consisting 4years of preclinical education and 2 years of clinical
education, before they finallywork as doctors. After they graduate
from medical school, they will have to takenational examination for
newly graduated doctors. We have the same method inIndonesia, those
who have finished their medical school should take theexamination.
But we have to take the examination once in every 5 years, if Im
notmistaken. This Japanese examination only has a written test, but
Indonesian alsohas a practical examination other than just written
test. Moreover, freshlygraduated Japanese doctors could freely
choose the hospital they want to work at,unlike Indonesia.
Indonesian doctors are placed selectively random, based on the
need of doctors in each region in Indonesia. A little bit
uncomfortable, but stands forjustice, nevertheless.
Japanese people produce cars, electronics and other modern
technology, yethave the highest life expectancy an lowest infant
mortality rates among anypopulation in the world. Such thing could
only happen not only because of thepeople who are concerned about
their health themselves, but also supported by agood health care
system. I fully hope that Indonesia would have a good health
caresystem as Japan, thus awareness of seeking health care would be
increased, leadingto improving national health.
Ajib Diptyanusa
Kurume University Japan
