Posts Tagged ‘gynecology and obstetrics’

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...

Will the ‘morning-after pill’ make gynecologists obsolete?

Thursday, May 26th, 2011

In February, the health ministry approved the “emergency contraception” drug NorLevo, which was developed in France and is being distributed in Japan by the pharmaceutical company Sosei. It went on sale this week. Often called “the morning-after pill,” the drug was first marketed in 1999 and since then has been approved for sale in 50 countries. Sosei first applied for approval in 2001. The reason it took so long has something to do with Japan’s sclerotic drug testing system, but probably more to do with bureaucratic queasiness over the idea of women being able to prevent pregnancies unilaterally. After all, it took more than three decades to get the low-dosage birth control pill approved, and less than a year for Viagra to receive the go-ahead.

Preemptive: Condom vending machine

NorLevo should not be confused with the so-called abortion pill, RU486. Emergency contraception is supposed to be taken within 72 hours following intercourse to prevent conception, with a second pill taken 12 hours after the first one. The effectiveness is said to be more than 80 percent. It will be available by prescription (in some countries, like Canada, it can be bought over the counter), but users cannot use national health insurance to pay for it. The internet import price is anywhere between ¥2,500 and ¥6,600 for one dosage, meaning two pills. So far the domestic price hasn’t been made public, but it is probably in that range.

It’s expensive, but still much cheaper than an abortion, the vast majority of which are performed on married women. Young, unmarried women tend to have the baby and marry the father. The average cost of an abortion is around ¥100,000. The procedure is basically illegal in Japan but there’s a loophole that allows gynecologists to perform them on women who have “economic issues.” In 2009, about 220,000 were done, or one-fifth the number of live births that year. Because of the unavailability of the low-dosage birth control pill until recently and the paucity of sex education classes in public schools, abortion was for many years considered a form of birth control. So despite its high price, NorLevo could very likely cut the number of abortions significantly in the future, which is a good thing for women’s reproductive rights but not necessarily good news for the obstetrics-gynecology profession.

For a while now ob-gyns have had to contend with falling incomes due to the declining birthrate. Abortions became a larger part of their livelihoods. When abortion becomes less of an option for women, gynecologists will have less to do. Fewer medical students, thinking it not a lucrative field, will choose gynecology and obstetrics as a course of study.

In the past, emergency contraception in Japan was carried out with the mid-dose birth control pill, which was approved many years ago ostensibly to treat menstrual disorders though mostly they were used as de facto birth control pills. Taken right after intercourse, the mid-dose pill will prevent pregnancy, though its effectiveness is not as high as NorLevo’s and the side effects are more noticeable. The police also distributed the mid-dose pill to rape victims free of charge, though, obviously, that meant the victim had to come to the police and file a rape report. Such victims may have preferred going to a doctor, who would have kept the incident confidential. But then they’d have to pay for the full treatment.

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