Archive for the ‘Healthcare’ Category

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 →

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 →

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