ONE of the most common discussions we have in the physio rooms over the years is about the state of the Japanese health system. Many foreigners visiting or living in Japan are quite reluctant to present themselves to a Japanese hospital, primarily due to concerns over the language, but overall the Japanese health system is pretty good.
IT’S a very ‘socialist’ health system, whereby everyone contributes to the national health-care scheme and, from approved providers, the government will cover 70% of the cost, with patients covering the other 30%. Private-health insurance is often taken, but only to cover the 30% and Japanese will rarely attend clinics that are not part of the national-health scheme. With the increasing number of medical procedures becoming available it can be difficult for a national health care scheme to cover the cost of providing these treatments to everyone.
The Japanese mentality of ‘gaman’ (defined as ‘the ability to endure the seemingly unbearable with patience and dignity’) means there is often an acceptance that non-life threatening problems should just be endured – or in other words “take one slice of humble pie with a cement pill chaser and call me in the morning”. This reminds me of a Japanese patient who told me that when she let out a moan during labour the nurse scolded her with a quick “shame on you”, so she had to keep quiet and gaman. Pain relief is often not as high a priority with many forms of care as it can be in The West.
Patients and doctors, sometimes, do not aim for a 100% return to function and this is convenient because the government system cannot afford that expectation amongst everyone. The sempai/kohai (master, senior person/lower, junior person), coupled with following the US system, whereby doctors are all-powerful and ancillary health professionals who are given short shrift (note boulder-sized chip on shoulder) and are not accustomed to explaining conditions or being questioned by patients. This has led to some cross-cultural conflicts between Japanese doctors and foreign patients over the years.
Difficulty reading new English studies, a lack of requirement for ongoing education and the kohai doctor having trouble bringing new ideas to the table, can mean that Japanese doctors can be slow adopters of new research and techniques.
The local Kutchan hospital here in Niseko does a remarkably good job with its unexpected influx of foreigners they’ve been subjected to over the past seven years. They now provide English translators and they have a new MRI and X-ray machine. Orthopaedic doctors are in Monday to Friday from 8:30-12:00pm. They do have a habit of draining fluid from acutely injured knees for diagnosis that has long-been abandoned in The West, and the A & E doctors tend to cast injured knees until seen by an orthopod. But aside from that the level of care is generally acceptable.