Archive for the ‘Healthcare’ Category

Diaper manufacturers get them coming and going

Tuesday, May 8th, 2012

Checking out the merchandise

Ever since Japan emerged as a manufacturing giant it has concentrated a great deal of sales efforts on exports, but in the past decade or so, as the country’s population has begun to contract, foreign markets have become even more important to sustain corporate growth. And nowhere is this dynamic felt more acutely than in the disposable diaper business. Japanese are having fewer babies. In 2011 the domestic market for disposable baby diapers was about ¥140 billion, but according to one major manufacturer, Unicharm, that market is shrinking at a rate of about 2 percent a year. However, in many other Asian countries,  population is increasing along with average living standards.

Whether it foresaw these changes or not, Unicharm entered the foreign market early and started selling diapers in Taiwan in 1984. It now has a presence in 80 countries and territories, in the form of factories or sales channels. This summer the company plans to open a plant in Egypt, its first on the African continent. Unicharm’s strategy is to adjust quality and price for specific local markets. For instance, it offers three price grades of diapers in Thailand and Malaysia, each price targeted at a specific income group; while in Indonesia it sells diapers individually rather than in packs since that is the way most retail sales work in the country.

Japanese disposable diapers are generally considered to be of high quality, and many manufacturers, such as Kao, which makes Merries, the best-selling diaper in Japan, simply target parents in foreign countries who can afford to pay a little more for diapers. Merries is quite popular among middle class parents in China, where they are 20 to 30 percent more expensive than “regular” disposable diapers. Meanwhile, Daio Paper, which is also considered high quality and sells 40 percent of its disposable diapers outside of Japan, seems to be particularly popular among the well-to-do in Shanghai.

But the real news in the diaper business is at the other demographic end. In 2011, for the first time, sales of adult diapers in Japan exceeded sales of baby diapers. According to Yano Research, sales of adult diapers in 2011 increased by more than 100 percent from 2010, with revenues topping ¥160 billion. Unicharm alone recorded sales of ¥60 billion. Growth in the adult diaper market is propelled by more than just the aging of the population. Purchases of adult diapers can be subsidized in part by the Long-term Nursing Care Insurance system (kaigo hoken), and while babies usually need diapers for three years, four at most, older people could conceivably need to use them longer. And as advertising becomes more widespread the hazukashii (embarrassment) factor will continue to abate.

Putting the ‘fortune’ back in fortune telling

Sunday, March 18th, 2012

For more than a month the tabloid press has been obsessed with comedian Tomoko Nakajima, who apparently has squandered her career and whatever money it made her on the services of a self-styled fortune teller who effectively commandeered her life. In Japan, fortune tellers, or uranai-shi, do pretty much the same thing that fortune tellers do everywhere else in the world. They use supposedly timeless, spiritual or other non-scientific techniques to predict an individual’s future. Uranai-shi have more of an accepted social position Japan than they do in a lot of other developed countries. A few, in fact, are bona fide stars whose advice is sought by the rich and famous, thus making them rich and famous, too.

You will meet a tall, dark stranger: Fortune teller's sign in Ginza

A recent article in Asahi Shimbun discussed people who, like Nakajima, have become “addicted” to fortune tellers. About 80 percent of the people who patronize uranai-shi are women, the majority in their 30s. One told the newspaper that she first turned to uranai-shi when she needed advice about becoming a freelance writer. A fortune teller told her to get married instead, and she did, but the marriage didn’t work and she divorced.

Despite what turned out to be bad advice she continued seeking counsel from fortune tellers, obsessed with what would happen to her in the future. She paid upward of ¥20,000 per session for two years and eventually amassed a debt of more than ¥3 million. In the end, she kicked her habit by studying the psychology of addiction, and now makes a living counseling fortune telling addicts like herself. Nice work if you can get it. She points out that the act of “regurgitating” emotions to a fortune teller is what makes the process so habit-forming. It’s like a “tranquilizer” to ease the fear of the unknown, but since the fear is never directly dealt with it never goes away, and so the patron has to continue seeking advice.

Money is an integral component of the addiction, since it clarifies the relationship. Traditionally, one finds fortune tellers on the street, sitting in front of little stands, handing out advice in ten-minute blocks of time, and ten minutes is never enough. More successful practitioners work out of offices. But growth in the industry is now in fortune telling over the phone and on the Internet. One entrepreneur told the Asahi that he runs 20 fortune-telling hotlines that charge ¥9,000 for 30 minutes, and candidly admits that his main mission is to listen to people’s problems and “cheer them up.” And though many of his customers are repeat users, he insists that if he or his staff suspect anyone of being an addict, they “reject” them.

Like all consumers, people who use fortune tellers insist on getting their money’s worth. Asahi reported that one site received a lot of complaints, not so much for its exorbitant fee — several thousand yen per minute — but because the advice didn’t work. One has to wonder if the degree of dissatisfaction has a direct correlation to the dearness of the charge, but as fortune telling becomes more of a legitimate commercial enterprise it also becomes more of an issue. The National Consumer Affairs Center of Japan reports that formal claims against fortune tellers have increased over the past decade. In 2001 the center received 871 complaints for the whole year. As of March 2, it’s already received 1,801 since Jan. 1. The complaints are about not fees but rather the product. People demand predictions that work out.

Asahi says that DoCoMo’s goo website survey found that the starting price for fortune tellers is about ¥5,000 for 30 minutes, which is about the same as the consultation fee you’d pay to a psychiatrist or a lawyer. It makes sense. All three specialize in giving advice with no guarantee of results.

Hospitals redefine the meaning of ‘weekend getaway’

Tuesday, February 7th, 2012

As the government continues looking for ways to reduce expenses in the face of the world’s biggest debt burden, every ministry is expected to pitch in. The Health, Welfare and Labor Ministry has probably the biggest job in this regard since it is responsible for the primary drain on future fiscal resources, namely all those old people on the horizon. We’ve already talked about the ministry’s attempt to make elderly patients pay a little bit more for their care, a scheme that was shot down by doctors who say such a move would discourage older people from seeking the help they need, though critics suggest the doctors are worried more about their own bottom lines.

In light of the health ministry's plan, patients looking to save on healthcare would do well to fall ill early in the week (Kyodo photo)

Now the ministry has come up with another money-saving plan that will likely irk the medical profession. Starting in April, the ministry will start withholding reimbursements for basic hospitalization fees if the hospitalization is deemed to be “unnecessary.” At issue is weekend hospital stays, which the ministry believes are wasteful. When the length of a hospital stay was measured against the day that the hospitalization began, the longest ones were found to start on Fridays, with an average of 18.14 days. In contrast, hospitalizations that begin on Wednesday average three days less. The ministry concludes that Friday-start hospitalizations are longest because nothing is really done over the weekend, and that whatever treatment is involved begins in earnest on Monday. However, the patient has to pay for the weekend hospitalization and national insurance will reimburse him or her for much of that payment. Hospitals can charge the full amount for the stay even though their personnel and overhead costs over the weekend are less than they are during the week.

The health ministry’s plan is to pay less for weekend hospital care. The point is to dissuade hospitals from starting patient stays on Fridays, but the ministry also wants to persuade them to discharge patients before weekends as well. The basic hospitalization fee (nyuin kihon ryokin) that the ministry now pays is between ¥9,340 and ¥15,550 per day, and no matter what time of day the patient is discharged, the hospital seeks payment for the full day, so theoretically a hospital can discharge a patient early on Monday morning and receive three extra days of fees without doing much of anything except feed the patient. Hospitalizations that end on Monday last for an average of 17.9 days, while those that end on Saturdays last three days less. Consequently, the ministry will not reimburse payments for a full day when the patient is discharged before lunch.

Japan is famous for its long hospital stays, which critics say have more to do with Japan’s national health insurance system than it does with quality of care. Hospitals want to make as much money as possible from patients and so are believed to “recommend” long hospitalizations. It’s why old people in Japan invariably die in hospitals rather than at home or in hospices and nursing homes.

So far, private insurers haven’t commented on the ministry plan. Since private medical insurance is mostly supplemental in that it provides subscribers with cash depending on how many days one is hospitalized, these private insurers should also be concerned if hospitals are keeping patients for unnecssarily long stays, but then again the whole idea of long hospitalizations is what makes their insurance policies attractive. If hospital stays were significantly shorter, most people wouldn’t see the need for supplemental insurance in the first place.

Are poorer families succumbing to the American lifestyle?

Friday, February 3rd, 2012

Big in Japan (Kyodo photo)

We’re not sure why this is coming out right now, but Sankei Express is reporting the results of a survey conducted in November 2010 by the Health, Welfare and Labor Ministry on the correlation between income level and lifestyle. The ministry divided respondents into three different groups according to household income: ¥2 million a year or less, between ¥2 million and ¥6 million, and over ¥6 million. The survey found that smoking was more prevalent the lower the annual income among both men and women. About 27 percent of men and 7 percent of women in the highest income group smoked, while 37 percent of men and 12 percent of women in the lowest income group did. Nationally, 32 percent of men and 8 percent of women smoke in all income categories.

In terms of being overweight, which the survey defined as having a BMI (body mass index) of over 25, there was found to be no significant difference between men among the three income groups, but among women the difference was stark. About 13 percent of the women in the highest income group were overweight, and the portion rose to 25.6 percent for women in the lowest group. Also, people of both genders in the lowest income group eat less vegetables regularly than people in higher income brackets, and low-income men tend to not eat breakfast.

If this doesn’t seem surprising it may be due to the fact that in the United States and the United Kingdom it’s been known for years that lower income people have poorer diets, higher rates of obesity, and smoke more than richer people do. Without going into why that is, it seems Japan is catching up with this trend, thus further undermining one of the country’s most beloved self-images of being a classless — or, more precisely, a uniformly middle class — society. If the trend continues along with the recession, it could mean even more of a crisis for social insurance schemes since it can be expected that more people will require health services in the future.

Competition taking a bite out of dentistry schools’ tuition schemes

Monday, December 5th, 2011

Drive 'n' drill: Former convenience store turned into dentist's office

Recently, the Japan Medical Association protested the government’s desire to increase the number of medical schools as a means of solving the doctor shortage. The JMA says that more physicians will undermine the pay potential of all doctors and points to the situation of dentists, whose average salaries have decreased markedly in recent years due to a glut.

In a society aging as rapidly as Japan’s is, you can never have too many doctors, but dentists? As a medical practice, dentistry tends to be self-defeating. The better job dentists do in promoting oral hygiene, the less there is for them to do. Like America in the ’50s and ’60s, Japan became more aware of dental health in the ’80s and ’90s and people spent more money on their teeth and those of their children. Such a development had two outcomes: More young people turned to dentistry as a career, and people’s teeth became healthier. Since the latter meant that people required less capital-intensive dental work in the long run, dentists on the whole made less money, especially since their numbers grew as the years progressed.

Consequently, fewer students are opting for careers in dentistry, which is bad news for dentistry schools, especially private ones. According to a recent article in the Asahi Shimbun, the number of university students who said they “wanted to enter dentistry” dropped below 10,000 for the first time in 2008. A year later that number had plummeted to less than 5,000. This year, the number of applicants to the nation’s 17 private dentistry schools is less than the number of openings.

Continue reading about dentistry in Japan →

Doctors afraid new fee will reduce customers … er, patients

Sunday, October 30th, 2011

At the end of September the Ministry of Health Labor and Welfare released figures for medical care expenditures in fiscal 2009. Based on national insurance records, Japanese people spent ¥36.67 trillion on medical care that year, a 3.4 percent increase over 2008. That boils down to ¥282,400 for each man, woman or child, which is a 3.6 percent increase over the previous year. Broken down demographically, patients between the ages of 65 and 74 accounted for 55.4 percent of money spent (¥19.94 trillion) and patients 75 and over 32.6 percent (¥11.73 trillion). Per capita, Japanese under 65 spent ¥163,000 for the year, those between 65 and 74 ¥687,000, and those 75 and older ¥855,800. In terms of sources of revenue, 48.6 percent (¥17.5 trillion) came from premiums for both the Kokumin Kenko Hoken (National Health Insurance) and the Kenko Hoken (Employees Health Insurance) systems; 37.5 percent (¥13. 49 trillion) came from national and local taxes; and the remaining 13.9 percent (¥4.99 trillion) came from patients’ pockets.

The kid stays in the picture: JMA ad against proposed ¥100 fee

These amounts were the highest since MHLW started keeping track. Japan’s Gross Domestic Product went down in 2009, but the portion of GDP accounted for by medical care, 7.6 percent, was higher than the previous year’s portion, which means that not only is more money from premiums being spent, but more people are paying out-of-pocket for medical care, since 10-30 percent of a doctor’s and pharmacist’s bill is paid for by the patient. This portion can be extremely large when hospitalization or special treatments are involved, and in many cases where patients’ expenses are exceedingly high (kogaku iryohi) the government will reimburse them depending on their individual incomes. The MHLW has decided that the current pay schedule for this excessive medical expense system is obsolete, and has restructured it to allow more income brackets and higher reimbursements. The problem is that as the population ages revenues from premiums are going down since people over a certain age pay less, even as they use more insurance. So where are they going to get the money to fund this new excessive medical expense system?

The provisional answer is something called the madoguchi futan (literally, “window burden”), a ¥100 fee that will be added to every doctor’s visit and paid by the patient. The Japan Medical Association has roundly condemned this fee, saying that it penalizes older people and others on fixed incomes, effectively widening the gap between rich and poor. In the long run, it will discourage lower income people from seeking medical help.

Continue reading about bump in doctots' fees →

Local governments crack down on health insurance scofflaws

Sunday, September 11th, 2011

Enough to make you sick: monthly Kokuho payment schedule

According to an article in the Aug. 29 Asahi Shimbun, the number of asset seizures initiated by local governments in an attempt to recoup delinquent national health insurance payments has increased startlingly in the past four years. Asahi asked the pertinent sections of all 23 wards in Tokyo, as well as those in 19 major cities about seizures. They received responses from 37 local governments in all, and the data indicates that between fiscal 2006 and fiscal 2010, the number of delinquent payments that led to actual seizures of assets increased by almost sixfold.

In this case, we’re talking about Kokumin Kenko Hoken, or National Health Insurance, which is paid by anyone who is not a member of the Shakai Kenko Hoken system, which is paid for by contributions from employers. Traditionally, National Health Insurance, known as Kokuho for short, was carried by people who are self-employed. And that’s still true. However, the ranks of Kokuho carriers has increased greatly over the past two decades as the employment situation has changed. With more people out of work and even more changing over from so-called lifetime employment to so-called non-regular employment, the number of people who are compelled to pay into the Kokuho system gets larger and larger. Kokuho is administered by local governments, and national insurance, whether paid for by the individual or by his/her employer, is mandatory in Japan. If the individual is too poor to pay the premiums, he or she should go to the local government office and tell an official. The only real way to get out of the system and still have insurance is to qualify for welfare. Other than that, in principle everyone has to pay. Some local governments have a system wherein someone who has not paid because of financial difficulties but needs medical care can pay the full amount of that care up front and receive at least partial reimbursement later, but those are exceptional cases.

Continue reading about health-insurance crackdowns →

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