Archive for the ‘Healthcare’ Category

Working the system: Beware of doctors with private rooms

Friday, December 14th, 2012

Sleeping alone in a place like this could cost you.

Japan’s national health insurance system isn’t perfect, but it’s fairly airtight. Unless you have a condition that might benefit from some sort of experimental treatment which has yet to be approved by the government, everything is covered, meaning you won’t pay more than 30 percent of the cost of that treatment. And if the amount you do pay exceeds a certain amount, the government will pay for most of that as well, so there is very little danger of, say, a patient having to mortgage his house to pay for care, even for a so-called catastrophic illness, which is something that occasionally happens in the United States.

But that doesn’t mean there aren’t medical situations where people end up paying a lot of money; it’s just that they probably don’t have to. This is why we’ve always been mystified by the supplemental health insurance business in Japan. Why buy extra insurance when the national system takes care of everything? One of the main reasons is private rooms, which the government doesn’t pay for. National insurance covers overnight stays, but only for non-private rooms, and only a very limited amount. If a patient wants a private or semi-private room, or even a special type of bed in a non-private room, he or she has to pay for it out of pocket.

Some doctors use this exception to make money. An acquaintance of ours, whom we’ll call A-san, recently told us a story about a visit she made to a private gynecology/obstetrics clinic in Saitama Prefecture. A-san was worried about her 77-year-old mother, who lives separately from her and has been suffering from a gynecological disorder for almost a year. Though she had been to her local hospital, the doctor there said he could not treat the condition properly, and while it wasn’t life threatening, it made everyday life difficult. A-san’s mother is on a fixed income and not tech-savvy, so A-san Googled the name of her condition and the first clinic that came up in the search said it had experience treating elderly women for that particular condition and happened to be not far from her mother’s home. She made an appointment.

The clinic’s owner and only doctor was quite chatty, and, after examining her mother, he told A-san that she needed an operation, and that because she had special insurance for elderly people she would only pay 10 percent of the surgery cost. In addition, since the surgery was expensive, she could apply for the kogaku iryo (high cost medicine) system, which would refund most of the 10 percent she would normally have ended up paying. In the end, she would only have to pay ¥44,400 for the actual operation.

But there was a catch. The clinic, which mostly catered to expecting mothers, only offered private rooms for ¥16,900 a night. The doctor said that following the operation, A-san’s mother would need to remain in the clinic for 10 nights, so altogether the operation would cost more than ¥200,000, not counting transportation to and from the hospital and whatever medication she would have to take. An interesting justification for extra charges...

Poorer people passing up cancer screenings

Friday, August 24th, 2012

As long ago as the early 1980s the health ministry made it a priority to get more people to undergo cancer screenings in order to detect the disease at its earliest and easiest-to-treat stages. By 2009, the goal was to have 50 percent of the targeted adult population receive annual tests for five types of cancer — colon, stomach, breast, uterus, lung — by 2012. That goal was not reached, so they moved it back another five years, but since the overall screening rate at present is still somewhere between 20 and 30 percent, it doesn’t appear the ministry is going to achieve that goal either.

Cancer screening menu

I’ll take one from column A, and…: Cancer screening menu distributed by local government (click to enlarge).

According to an article in Asahi Shimbun, the main obstacle is income. A center for adult diseases in Osaka analyzed surveys carried out by the health ministry and found that the higher a person’s income is, the more likely he or she is to undergo cancer screenings. In fact, screening rates have a direct correlation to the public health insurance program a person is enrolled in. For instance, 48 percent of males enrolled in the Kyosai Kumiai insurance program receive colon cancer screenings. The rate drops to 38 percent for a man in the Kumiai Kenpo program, 27 percent for one in the Kyokai Kenpo program, 19 percent for those who use regular kokumin hoken (national insurance), and only 13 percent for people on public assistance, who get their insurance free.

Kyosai Kumiai members are national and local civil servants, including public school teachers, whose average income in 2009 was ¥2.36 million. Kumiai Kenpo is insurance for companies with 100 or more companies, of which the average member makes ¥1.95 million. Kyokai Kenpo is for companies with less than 100 employees. Their average salary is ¥1.39 million. Regular kokumin hoken is for part-timers, pensioners and the self-employed, who average ¥910,000 a year. People on welfare, of course, don’t have income.

Cancer checks are managed by local governments, who set up screenings at public facilities or cooperating hospitals and clinics, usually for limited periods at specific times of the year. The Osaka center found that part-timers, the self-employed and workers at smaller companies usually cannot take time off whenever they want to, and thus are less likely to be able to go to the facility when the screenings are being conducted, usually on weekdays. Moreover, they may not have the money to pay the nominal fees for the screenings, which can cost anywhere from a few hundred yen to ¥2,000 or more. Even though welfare recipients get free insurance, they have to pay these fees as well. And there’s a fee for each screening, so if you are a woman and undergo all five of the tests recommended it could cost as much as ¥10,000. And there are lots of tests for other types of cancer, each of which requires a fee.

Continue reading about cancer screening →

Vitamin drinks demonstrate their stamina in the market

Wednesday, August 15th, 2012

I feel better just looking at them

The marketing firm Fuji Keizai reports that the eiyo inryo (nutrition beverage) market is one of the few consumer sectors that has performed spectacularly in the past few years. Often referred to as “stamina drinks” since they are typically bought by salarymen who need a boost of energy to get them through the work day, eiyo inryo saw its market balloon from ¥114.8 billion in 2010 to ¥121.7 billion in 2011. And if sales so far this year are extrapolated, revenues should increase significantly again in fiscal 2012.

Stamina drinks usually come in two sizes: mini (less that 50ml) and regular (50-100ml). They also fall into two general categories: iyakuhin, meaning they are considered “medicinal” and thus can only be sold in drug stores; and shiteii yakuhin bugai, which do not contain controlled active ingredients and thus can be sold anywhere.

The most expensive of the four general types is mini iyakuhin, and one of the biggest sellers in this category is Yunker Koteieki, made by Sato Pharmaceutical, which retails normally for ¥840 for only 30 ml. It contains lots of herbs but also extract from the gall bladders of cows. The Yunker series also boasts the most expensive stamina drink: Yunker Star, which costs ¥4,078 for 50 ml. It contains a whopping 20 herbs. According to a Sato publicity person interviewed by the Asahi Shimbun, people buy Yunker Star “when they feel tired and know they have to do something important.”

Continue reading about energy drinks →

How to keep your health insurance when you can’t pay for it

Saturday, July 14th, 2012

The damage: bill for national health insurance

Last week, the Ministry of Health Labor and Welfare released the results of a survey of about 60,000 households regarding the government-run basic pension plan. The ministry found that about one-fourth of the people who are supposed to be paying into the plan had no income in 2009. In addition, 38 percent of participants made less than ¥500,000 for the year, and 54.7 percent made less than ¥1 million.

The basic pension, kokumin nenkin, is for people who don’t work for companies or organizations that contribute to their employees’ government-run pensions, meaning they are either self-employed, part-timers or unemployed (and not wives of salaried workers). In 2011 only 58.6 percent of people who were supposed to pay into the basic pension plan actually did. The obvious conclusion the ministry drew from these numbers is that the ranks of the poor are growing.

These findings are sobering, but one should keep in mind that while not paying one’s pension contributions certainly undermines the system it doesn’t affect the person in a direct way, since he or she does not benefit from those contribution until he or she is old. In any case, if a person can’t pay the monthly ¥14,980 basic pension contribution because he or she is unemployed, the person can apply for an exemption.

Continue reading about national health insurance →

Tattoos are forever, which is why they cost so much to remove

Thursday, June 28th, 2012

On second thought…

The weekly magazine Aera recently discussed tattoos, which became a contentious issue in Osaka after Mayor Toru Hashimoto not only prohibited city employees from gettting them but suggested that any who already had tattoos resign. Hashimoto believes that Osaka citizens are offended by tattoos, which tend to be associated with gangsters and other lowlifes. Many young people get tattoos for reasons having to do with fashion, but the majority of citizens don’t make such a distinction. Public baths and onsen (hot springs) tend to prohibit patrons with tattoos, even if it’s just a tiny reproduction of a butterfly.

The mayor’s pronouncement met with complaints from some corners, which grumbled about personal freedom and human rights, but the Aera article implies that it had the desired effect. One young man in his late 20s told the magazine that after high school he became a construction worker and got a fairly large tattoo on his back because all his construction worker friends had tattoos. But now he wants to take a test to become a civil servant and wonders if having a tattoo will be a liability, and is therefore seriously thinking of having it removed. When told that no one can notice the tattoo when he has his shirt on, the young man says that he figures if he does get a public job he will have to undergo a physical examination, and so the doctor will see the tattoo and may report it to his supervisor.

In the context of the article, this isn’t presented as paranoia but more like common sense. In any case, tattoos are painfully permanent, and having them removed involves a hefty investment and even more pain. Aera says that you can assume that whatever your tattoo cost to apply, it will cost 10 times as much to erase. The magazine reports that the number of people in Osaka who are having tattoos removed has increased noticeably since Hashimoto made his stand. But it’s not just in Osaka. One Tokyo cosmetic surgery service, Isea Clinic, says that since the beginning of the year the number of inquiries it receives about tattoo removal has gone from about 100 a month to 125. Most are from the people who have tattoos themselves, but quite a few are from people whose children have tattoos. The reason isn’t just employment. Some parents think their children have less of a chance of finding a marriage partner if they have a tattoo.

There are three removal methods: laser, surgery and skin grafting. The laser method is the cheapest, at about ¥10,000 per square centimeter of skin. However, depending on the tattoo, it is likely that a shadow of the original pattern will be left behind, so others will know that the individual used to have a tattoo. Surgery, which means basically gouging out the skin and then sewing up the wound, costs about ¥30,000 per sq. cm. The tattoo is gone completely, but a scar remains. A skin graft, which involves cutting a chunk of flesh from another part of the body and using it to cover the tattoo, runs anywhere from ¥700,000 to ¥1,000,000. As the Isea doctor says, it’s too easy to get a tattoo, which is why so many people regret it in the morning, so to speak. In the end they want it removed regardless of the cost. “They always tell me it’s OK to leave a scar,” he says. The price you pay is more than just money.

Photo courtesy of Joshua Noblestone

Is nursing care insurance making nursing care recipients worse?

Friday, June 15th, 2012

Killing with kindness? Caregiver helps elderly woman into her apartment

Ever since the government launched the kaigo hoken system in 2000 to provide nursing care services for seniors, the health ministry reviews revenues and expenditures every year and adjusts them accordingly. What this means is that every year premiums go up, which makes sense since the number of seniors is increasing while the population in general remains static or shrinks. In 2000, 15.6 percent of the population was 65 or older. In 2011 the same demographic accounted for 21.4 percent of the population.

Starting at age 40, every resident of Japan pays kaigo hoken premiums, the amount determined by age and income. Even seniors who are eligible for and receive kaigo (nursing care) services pay premiums. They also bear 10 percent of the cost of their care. As each year passes, the burden gets heavier. In 2000, the average monthly premium for people 65 and older was ¥2,911. This past April, that amount breached ¥5,000, and it’s sure to go up. The baby boom generation will turn 75 in 2025, when it is estimated that the cost of kaigo hoken services, including the 10 percent that seniors bear, will total somewhere between ¥19 and ¥23 trillion. That’s twice the cost of such services in 2012. Consequently, average premiums for seniors will be more than ¥8,000.

Continue reading about kaigo hoken →

Japanese laws make abortion an economic issue

Sunday, May 13th, 2012

Women’s clinic in Chiba Prefecture

Contrary to what most people believe, abortion in Japan is not legal. The reason abortions are performed freely in Japan — 210,000 were reported in 2010, but the number is probably higher — is that shortly after the war the dataizai (illegal abortion) law was exchanged for the Eugenics Law to address the population boom. This law allowed for a pregnant woman to abort her child only if the pregnancy threatens her life or health, or if the woman is financially unable to raise the child. It did not make abortion a right available to any woman who wanted one.

It is thus assumed, for legal purposes, that the vast majority of women who undergo abortions do so for economic reasons. However, since there is no real provision for having women state their reasons when seeking abortions, and no woman in Japan has been prosecuted for aborting a fetus since World War II, abortion is considered effectively legal. It is also quite expensive. Unless the procedure is being carried out specifically for health reasons, national insurance will not cover it. This situation has lead to a paradox: Most women in Japan who seek abortions ostensibly do so because of financial hardship, but are nevertheless forced to pay a great deal of money to have those abortions performed.

According to our own Internet survey of gynecology services and comments on various blogs and websites, the cost of an abortion up to the 12th week of pregnancy ranges from ¥80,000 to ¥150,000, which is only the cost of the procedure and does not include consultation fees and medication. However, after the 12th week of pregnancy, the cost increases considerably. Abortions performed between the 12th and 22nd week of pregnancy are between ¥300,000 and ¥500,000. Also, if the patient suffers from a chronic condition that could complicate the procedure, such as asthma, she is required to undergo the procedure at a general clinic, which tends to be more expensive than a women’s clinic or a gynecology office.

Of course, if a physician concludes that the pregnancy threatens the woman’s life or health, insurance can be used for the abortion; and if the cost of the operation goes above a certain level, she can receive a refund for any money she pays out of pocket. Even if the cost does not rise above that designated level, if she files an income tax return she can deduct the cost of her abortion on her return, including money she paid for sanitary napkins and even the taxi fare to the clinic. But this is only if the procedure was done for health reasons. Other costs that apply but usually aren’t mentioned have to do with the aborted fetus. If an abortion (or miscarriage) takes place after the eleventh week of pregnancy, the attending physician has to fill out a death report which the mother then files at the local city office. After that she has to pay for cremation. There is also mizuko kuyo, or memorial services for aborted babies, which are completely optional, though some parties have tried to make a business out it.

Continue reading about the price of abortions in Japan →

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