Japan has 15.8 inpatient hospital beds per 1,000 persons, the highest number among OECD countries and more than three times the American ratio (Table 1). By contrast, with 1.6 physicians per 1,000 population, Japan has the fifth lowest physician-per-person ratio, 43 percent less than the American rate of 2.3 per 1,000 (Table 1). Japan also has one-half to one-third the American number of intensive care beds per capita (Table 1). And Japan is tied with Austria for the lowest hospital staffing ratio (that is, the number of employees per bed) among OECD countries (Appendix 1, Table 3).
As for the use of these resources, at 8.3 percent, Japan admits a smaller proportion of its population to hospitals every year than any other OECD country except Turkey, a rate barely over one-half that of the United States (Table 1). On the other hand, of all OECD countries, at 50.5 days, Japan has the longest average length of stay for inpatient hospital services, more than five times that of the United States (Table 1).
Although Japan has one of the lowest physician-to-population ratios among OECD countries (Appendix 1, Table 3), at 12.9, Japanese doctors have the highest number of physician contacts per capita, more than twice the American rate . It must be noted, (Table 1) however, that the average length of a physician visit in Japan is only 6.9 minutes, compared to over 20 minutes in the United States.1
To the extent that OECD data are available on hospital admission rates for selected procedures, with the exception of appendectomies, Japan's rates are lower than those in the United States (Table 2).2 Comparative survey data indicate that surgeons in Japan perform fewer than one-fourth the number of operations per capita that their colleagues in the United States do (Table 1).3 This pattern is supported by findings on cesarean section rates, which are half as frequent in Japan as in the United States.4 The United States is known abroad for its unusually high cesarean section rate.
It would be wrong to conclude from these data that Japan rations high-tech medical care. On the contrary, among OECD countries, Japan has the highest number of computerized axial tomography (CT) scanners per capita, the highest number of extra-corporal shock wave lithotriptors per capita, and the highest number of patients per million treated for end-stage renal disease failure.5 In addition, Japanese spend more than any other nation on drugs as a percent of total health expenditures, more than twice the American rate.6
Japanese doctors' clear preference for non-invasive procedures is demonstrated by the kinds of medical technologies imported and exported. Equipment requiring invasive operations (e.g., pacemakers and artfficial heart valves) is almost all imported, whereas diagnostic equipment (e.g., CT scanners) is produced in Japan and exported in large quantities.7
In contrast to the United States, Japan's low rate of hospital admissions (Table 1) reflects its tendency to emphasize ambulatory over inpatient hospital care.8 But once hospitalization occurs, as we have seen, Japan holds the OECD record for long lengths of stay and low hospital staffing ratios (Appendix 1, Tables 3 and 4). This is encouraged by a reimbursement system that pays hospitals on a per diem basis and a style of medical practice that emphasizes bed rest and complete recovery while a patient is still in the hospital.
Beyond these more measurable differences in resource availability and use of medical care in Japan and United States, there are a host of political-institutional and cultural factors that reinforce each health care system's distinctiveness. The United States is a federal system whose 50 states have significant autonomy on matters of health insurance and public health policies. Although the federal government exercises a dominant role over the Medicare program and regulatory aspects of health policy, Americans are multiethnic, suspicious of excessive governmental authority and inclined to solve social problems at the local level. Japan is a centralized, unitary state with a highly homogeneous population and a tradition of powerful state intervention in the economy, including its many health insurance plans.
NOTES:
1Okamitsu (1993).
2McPherson (1989).
3Ikegami (1992).
4Notzon, Placek and Taffel (1987).
5Yoshikawa et al. (1992). In Japan in 1991, there were 945 patients per million treated for end stage renal disease failure in contrast to 784 in the United States (OECD Health data file, 1993).
6lglehart (1988) reports that in 1981 reimbursement for drugs by Japanese health insurance was equal to 38.7 percent of all health expenditures and that in 1987 this figure dropped to 28 percent. More recent data from OECD Health Systems: Facts and Trends (Paris: OECD, 1992) indicate that this figure has dropped to 18.4 percent, in contrast to the U.S. figure of 8.3 percent. However, these data exclude pharmaceutical expenditures for inpatients, which are substantial. Ikegami (1990) reports that "about 30 percent of Japan's personal health expenditures are for drugs," which we assume include inpatient drugs, and supports the contention that the Japanese are among the highest spenders on drugs.
In terms of pharmaceutical expenditures per capita, in U.S. dollar pharmaceutical purchasing power parities, Japanese spent $332 per capita, Americans $182. However, if these expenditure data are adjusted by GDP purchasing power parities, the difference narrows: $179 for Japan, $182 for the United States.
7Ikegami (1989).
8Ikegami (1992a).
1Okamitsu (1993).
2McPherson (1989).
3Ikegami (1992).
4Notzon, Placek and Taffel (1987).
5Yoshikawa et al. (1992). In Japan in 1991, there were 945 patients per million treated for end stage renal disease failure in contrast to 784 in the United States (OECD Health data file, 1993).
6lglehart (1988) reports that in 1981 reimbursement for drugs by Japanese health insurance was equal to 38.7 percent of all health expenditures and that in 1987 this figure dropped to 28 percent. More recent data from OECD Health Systems: Facts and Trends (Paris: OECD, 1992) indicate that this figure has dropped to 18.4 percent, in contrast to the U.S. figure of 8.3 percent. However, these data exclude pharmaceutical expenditures for inpatients, which are substantial. Ikegami (1990) reports that "about 30 percent of Japan's personal health expenditures are for drugs," which we assume include inpatient drugs, and supports the contention that the Japanese are among the highest spenders on drugs.
In terms of pharmaceutical expenditures per capita, in U.S. dollar pharmaceutical purchasing power parities, Japanese spent $332 per capita, Americans $182. However, if these expenditure data are adjusted by GDP purchasing power parities, the difference narrows: $179 for Japan, $182 for the United States.
7Ikegami (1989).
8Ikegami (1992a).
| Table 1 Comparisons of the United States and Japanese Health Systems (1990) | ||
U.S | Japan | |
| Health Status | ||
| Life Expectancy at Birth | ||
| Males | 72.00 | 75.90 |
| Females | 78.80 | 81.90 |
| Infant Mortality Rate | 9.10 | 4.60 |
| Life Expectancy at 80 | ||
| Males | 7.10 | 6.90 |
| Females | 9.00 | 8.70 |
| Expenditures | ||
| Per Capita Health Spending1 | $2,867 | $1,267 |
| Total Health Expenditures as % of GDP2 | 13.40 | 6.60 |
| Resources | ||
| Active physicians per 1,000 | 2.3 | 1.6 |
| Inpatient hospital beds per 1,000 | 4.70 | 15.8 |
| Hospital staffing ratios3 | 3.35 | .79 |
| Intensive care unit beds per million4 | 244.50 | 79.20 |
| Coronary care unit beds per million4 | 46.30 | 17.80 |
| Neonatal intensive care unit beds per million4 | 44.70 | 22.40 |
| Medical Care Use | ||
| Physician visits per capita5 | 5.30 | 12.90 |
| Hospital admissions as % of population | 13.70 | 8.30 |
| Average length of hospital stay | 9.10 | 50.50 |
| Inpatient days per capita6 | 1.20 | 4.10 |
| Number of surgical operations per 10007 | 91.0 | 22 |
| Source:OECD Health Data (CREDES), 1993 1. These figures are in $U.S. price purchasing parities for 1991. 2. 1991 3. Non-medical staff per bed. 4.Woodward and Asano, 1991. U.S. data from the American Hospital Association, U.S. ICUs and CCUs Table 13. Japanese data, from 1987, are from the Health and Welfare Statistics Association, 1989. 5. 1988 6. 1991 7. Surgical operation rates are based on survey data. For Japan they are from a patient survey done by the Ministry of Health and Welfare. For the U.S., they are from the 1986 Annual Survey of the American | ||
| Table 2 Admission Rates for Selected Procedures (1980)* Number of Admissions per 1,000 Population | ||
U.S | Japan | |
| Tonsillectomy | 205 | 61 |
| Coronary Bypass | 61 | 1 |
| Cholecystectomy | 203 | 2 |
| Inguinal Hernia Repair | 238 | 67 |
| Exploratory Laporotomy | 41 | - |
| Prostatectomy | 308 | - |
| Hysterectomy | 557 | 90 |
| Operation on lens | 294 | 35 |
| Appendectomy | 130 | 244 |
| Renal dialysis1 | 784 | 945 |
Adapted from K. McPherson, "International Differences in Medical Care Practices," (Health Care Financing Review, 1989, Annual Supplement). * These figures are not age standardized and assume equal proportions of men and women. Some are likely to be incomparable for artifactual reasons. Source: OECD Health Data File, 1989. 1. These data for 1991, not based on hospital admission rates, are from the OECD Health Data File, 1993. These rates are per 1 million population. | ||
