Look To Japan On Health

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Appeared in the Globe and Mail, 09 September 2004
The Japanese health care system is arguably one of the very best universal access health care systems in the developed world. It provides unrivalled access to high-tech equipment and delivers some of the best health outcomes in the developed world, all at a substantially lower cost than systems found in other developed nations. For Canadians, a comparison with Japan’s immensely successful health care system provides insight into the current discussions on both how health care should be delivered in this country, and just how much we’re willing to pay for it.

According to the OECD, Canadians paid just over $100 billion for their care, or 9.4 percent of GDP, in 2001. By contrast the Japanese paid just 7.8 percent of GDP. In other words, our health care system cost 17 percent more than it would have if it were a carbon copy of the Japanese system.

It’s much easier to get a CT or MRI scan in Japan because, again according to the OECD’s most recent statistics, they have a lot more machines than we do. In Canada, we have 9.7 CT scanners per million population, while the Japanese have 92.6. We have 4.2 MRI machines per million population in Canada, the Japanese have access to a whopping 35.3. A similar story holds for other technologies such as lithotriptors, where the Japanese have access to 6.4, 15 times as many as Canada (0.4).

With regards to waiting times, Canadians waited 16.5 weeks for treatment from the time their GP referred them to a specialist to the time that they actually received the service in 2001-02. That waiting time was 77 percent longer than in 1993, and has grown to 17.7 weeks in 2003. Meanwhile the Japanese did not and do not wait for health services. Health care services required by Japanese citizens are readily available with virtually no waiting time.

Finally, the Japanese health care system produced better health outcomes. In a comparison of 28 OECD countries, Japan ranked 2nd and 1st for infant and perinatal mortality, while Canada ranked 16th and 12th respectively. The Japanese health care system also managed a substantially better performance in comparisons of avoidable mortality (16 percent better) and years of life lost to disease (11 percent better).

To sum up, Canadians paid an extra $17 billion dollars to receive about one tenth the access to high tech equipment, to wait nearly 18 weeks longer than necessary, and to achieve worse health outcomes from care than were possible according to a comparison with Japan.

That was the price that Canadians paid for our medicare system.

Unlike Canada’s system, the Japanese health care system is characterized by competition and more appropriate incentives for both patients and providers. Both private and public health care providers deliver medical care in Japan on a competitive basis. Patients must simply decide where and when they will receive their health care. The money paid to hospitals follows the patients and not the bureaucratic will, so hospitals that do a better job at treating patients are rewarded with more patients and more revenues. As a result, the Japanese enjoy less expensive, more abundant, and higher quality health services, just as economic theory would predict and international evidence proves.

The Japanese also make better use of their resources by sharing the cost of medical care with the patients who consume it. All health services are subject to co-payments of between 20 and 30 percent, up to reasonable limits. Implementing similar fees in Canada would mean a savings of as much as 19 percent on total health expenditures and better access to health services that resulted from patients making more informed decisions. According to international evidence, these fees will not lead to a reduction in health outcomes as long as low-income groups are exempted.

While the premiers are away debating just how much more money is necessary to prop up our failing health care system, Canadians need to understand that the system they are propping up is already far more expensive than it needs to be. For Canadians, the choice is not between the status quo and an ‘American style’ health care system, but rather a choice between what we have now and what is a better way to deliver universal access to health services. Understanding just that much will inevitably lead to the recognition that we need to reform how we deliver healthcare not how much we spend on it.

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