Posts Tagged ‘elderly’

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...

New stats about old folks

Wednesday, September 19th, 2012

With the rapid aging of society it pays to pay attention to all the latest economic statistics regarding old people, and lately we’ve come across quite a few. Here are some new numbers about households in which the designated head-of-household is 65 or older, carried in the Asahi and Tokyo Shimbuns.

Keep on pushin’

  • The average monthly income in 2011 was ¥185,000, which is about ¥3,000 less than the average in 2010.
  • About 90% of total income is in the form of government and company pensions.
  • Average spending is ¥221,000 month, meaning that the average household is ¥36,000 in the hole.
  • However, in 2011 average savings for households when there are at least two people stood at ¥22.57 million. Savings among seniors has been increasing gradually since 2008, but the statistic may be misleading since it is heavily weighted toward upper income households newly entering the senior demographic. Median savings is ¥14.6 million.
  • 5.44 million people over the age of 64 worked in 2011, which represents 27.6 percent of the nation’s population over that age; 46 percent of men and 26 percent of women between the ages of 65 and 69 worked.
  • Total number of people over 64 exceeded 30 million in 2011, with 50,000 over the age of 100.
  • As reference, in 2005, when the number of elderly was slightly over 26 million, about 2.2 percent were collecting welfare. The average monthly welfare payment for two-person elderly households in Tokyo was ¥122,000 and for outside of Tokyo ¥94,500. About 47 percent of elderly who received welfare also received some sort of government pension, at an average of ¥46,000 a month.

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 →

Can financial incentives put a brake on senior driving?

Tuesday, January 24th, 2012

Two weeks ago a lawyer in Chiba was cited for leaving the scene of an accident. He had hit a pedestrian with his car but later told police he didn’t notice anything odd at the time the accident occurred. The police believe him because he’s 81. The victim was also “over 60.” This may be a pattern we have to get used to. According to the transport ministry, more than 6,000 traffic accidents a year involve a driver confusing the brake for the accelerator. Though the ministry doesn’t break this particular statistic down into age groups, it does report that in 2010 there were 0.5 traffic accidents per 10,000 drivers between the ages of 25 and 54, and 3.3 accidents per 10,000 drivers over the age of 75. In the same year 106,000 of the 724,000 traffic accidents were caused by drivers over 65, while 50.4 percent of the people who died in traffic accidents were over 65, both new records.

Caution, geezer on board: ochiba (fallen leaf) car decal identifying elderly driver, now replaced with a more ambiguous design

Consequently, a number of local governments have been trying to convince elderly residents to surrender their drivers licenses, and have turned to financial incentives to do so. Ichihara city in Chiba Prefecture will launch a program in February wherein “old people” (no actual age is designated) who voluntarily give up their licenses will receive in return an identification card that allows them a 10 percent discount with 17 taxi companies operating in the city. Normally, municipalities offer discounts for bus rides, which may not sound like much of a trade-in considering that, traditionally, many local governments actually subsidized public transportation for elderly riders, in many cases giving then free passes. That time-honored practice started disappearing as the percentage of elderly, especially in rural areas, steeply increased over the past two decades. Local governments just couldn’t afford to pay for all those fares.

But driving could become even more dangerous as the baby boom generation enters its twilight years. Among previous generations, the driving population was mostly limited to men, but among boomers there are just as many women behind the wheel, which means there will soon be a sudden steep increase in the number of elderly drivers. In addition, insurance companies want to increase premiums for older drivers. Many of these people consider their drivers licenses more than a necessity, so local police departments issue unten keireki shomeisho, or “certificates of driving history,” a form of ID that looks just like a drivers license but isn’t. The psychological effectiveness is questionable, but in any case it is this card that can be used for discounts when using taxis or public transportation. To make the card more attractive, local merchants in Shizuoka Prefecture have agreed to offer discounts to anyone who produces one (rather than a bona fide drivers license). Last year in Kagawa Prefecture, 976 people gave up their licenses, a threefold increase over the previous year owning to a new discount service provided by the local taxi union and a special low-priced IC bus card especially for older patrons.

A university professor who specializes in “traffic sociology” told Nishi Nihon Shimbun that local government’s face a very real problem of guaranteeing old people mobility in the future. If public transportation isn’t available and affordable, then the elderly are going to drive as long as they possibly can, a possibility some carmakers are trying to take advantage of. It’s basically up to friends and relatives, and not just the local authorities, to convince them to give it up “without hurting their pride.” Economic incentives may be a good way to convince them, but first bus and train lines have to be substantialized and taxi service increased.

Grandma got game: More elderly patronizing arcades

Wednesday, September 7th, 2011

Not-so-heavy medals

A recently released report by the Japan Productivity Center noted a steady decrease in leisure expenditures. In 2010, the Japanese public spent ¥67.97 trillion on recreation, a 2.1 percent decrease from the previous year and the second year in a row that statistic registered a deficit. Certain activities, however, have posted increases. Driving and eating out remain the most popular things people spend money on during their free time. They also spent about 1 percent more on theatrical films, tourism and amusement parks in 2010; and expenditures for activities “promoted on television” saw a 6.2 percent increase. The pastimes that contributed to the minus figure were mainly sports (except for bicycling and running) and goraku (distractions), a euphemism for what are generally considered non-constructive pleasures, such as gambling, pachinko and computer or arcade games.

Spending on goraku, in fact, was down by a whopping 4.7 percent, a reality that has prodded the arcade industry, both operators and game producers, to concentrate promotion on a demographic that they previously ignored: the elderly. As reported in this space last year, pachinko has become more popular in recent years among retired people who have nothing better to do and few opportunities for social interaction. However, the majority of older folks are on fixed incomes, and pachinko can be expensive. According to the Asahi Shimbun many are now turning to game arcades, or “game centers” in the Japanese parlance, and the arcades themselves are bending over backwards to accommodate them.

(more…)

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