Comparison of healthcare in the United States and Japan
Anne Price
The healthcare availability and coverage is a fluid target in the United States, given the wide
availability of public and employer based insurance policies each covers. The United States has
both a private and public system to cover elderly and low income. Employer-based insurance is
available to most employees for themselves and their children often have benefits available
after retirement. Medicaid is offered for low income individuals (due to unemployment or
retirement) and every state offers insurance, like MediCal in California, cover pregnant women,
children, elderly and disabled (Admin, 2009). All these policies have varying annual premiums,
deductibles, co-pays and annual maximums as well as widely varying coverage and costs for
medications. All available health plans assist in paying the cost of certain prescription
medications. Specific medication coverages are listed on an individual’s insurance plan’s
approved (“Getting Prescription Medications” (n .d)), and usually a generic brand will have a
lower co-pay or no co-pay than a name brand.
Preventative services are usually covered and to see a specialist, in most Health Maintenance
Organizations (HMOs), a written order from your primary care doctor is normally required
before a covered individual can receive medical care from anyone except their primary care
doctor. If the referral is not received first, the plan may not pay for the services. However,
Preferred Provider Organizations (PPOs) a covered individual may go directly to a specialist,
although the covered amounts and co-pays will vary. (“Referral” (n.d))
Currently, insurance companies can no longer deny coverage to an individual for a pre-
existing condition. However, individual rates may vary through private and employer- based
programs based on any conditions. In prior years, they could deny coverage and the Pre-existing
Condition Insurance Plan (PCIP) program provided health coverage options to individuals who
were uninsured for at least six months, had a pre-existing condition, and had been denied
coverage (or offered insurance without coverage of the pre-existing condition) by a private
This study source was downloaded by 100000827506713 from CourseHero.com on 02-16-2022 02:27:32 GMT -06:00
https://www.coursehero.com/file/24872655/Comparison-of-healthcare-in-the-United-States-and-Japandocx/
, insurance company. This ended on April 2014 and now with the Affordable Care Act in place,
health insurance plans can no longer deny anyone coverage for their pre-existing condition.
Japan has a socialized healthcare system where everyone is required to have insurance
through their employer for themselves, their children or if they are retired. If they are
unemployed, disabled or retired without benefits, the Japanese national healthcare system
would be utilized to cover those individuals (Admin, 2009). Their healthcare system controls
costs by banning insurance company profits by limiting doctor fees (Anonymous, 2009) and the
government sets a national fee schedule lists all procedures and products that can be paid for
by health insurance and sets their prices. These prices apply to all Japanese citizens, regardless
of individual health plans or where they receive their care. Ikegami and Campbell, 1995).
Medications are purchased from wholesalers and dispensed to patients directly by providers.
The cost to providers is stated to be “on average 26 percent less than the reimbursement
specified by the fee schedule”, which is leaves an incentive to overprescribe. “Per capita
expenditure on pharmaceuticals ($116) is higher than in the United States ($109)”. (Ikegami and
Campbell, 1995). However, medications covered by insurance cost the same to everyone as set
by the national fee schedule which is negotiated every two years for review (Admin, 2009).
During this period, the costs for medications and treatments are fixed and do not fluctuate.
Japanese patients do not need a referral to see a specialist, individuals are allowed to seek
treatment from any provider they chose (Admin, 2009). However, they do suffer a shortage of
many types of specialists due to low pay, long hours and high stress. Japanese healthcare is
universal and mandatory, no Japanese citizen is denied coverage or given limited coverage due
to a pre-existing condition (“Japan’s Healthcare System Has Many Advantages, but May Not Be
Sustainable”, 2009).
United States healthcare facilities are mostly owned and operated by private
businesses, contrary to Japan where. The five largest insurance companies in the
United States “made a combined profit of around $12 billion in 2009”. (Gonzalez,
2013). Although the profits are substantial, patient fees continue to increase and
quality of care decreases. Japan in contrast has no insurance companies, and does
not make a profit in patient care. Patient costs stay low and affordable, and there is
This study source was downloaded by 100000827506713 from CourseHero.com on 02-16-2022 02:27:32 GMT -06:00
https://www.coursehero.com/file/24872655/Comparison-of-healthcare-in-the-United-States-and-Japandocx/
Anne Price
The healthcare availability and coverage is a fluid target in the United States, given the wide
availability of public and employer based insurance policies each covers. The United States has
both a private and public system to cover elderly and low income. Employer-based insurance is
available to most employees for themselves and their children often have benefits available
after retirement. Medicaid is offered for low income individuals (due to unemployment or
retirement) and every state offers insurance, like MediCal in California, cover pregnant women,
children, elderly and disabled (Admin, 2009). All these policies have varying annual premiums,
deductibles, co-pays and annual maximums as well as widely varying coverage and costs for
medications. All available health plans assist in paying the cost of certain prescription
medications. Specific medication coverages are listed on an individual’s insurance plan’s
approved (“Getting Prescription Medications” (n .d)), and usually a generic brand will have a
lower co-pay or no co-pay than a name brand.
Preventative services are usually covered and to see a specialist, in most Health Maintenance
Organizations (HMOs), a written order from your primary care doctor is normally required
before a covered individual can receive medical care from anyone except their primary care
doctor. If the referral is not received first, the plan may not pay for the services. However,
Preferred Provider Organizations (PPOs) a covered individual may go directly to a specialist,
although the covered amounts and co-pays will vary. (“Referral” (n.d))
Currently, insurance companies can no longer deny coverage to an individual for a pre-
existing condition. However, individual rates may vary through private and employer- based
programs based on any conditions. In prior years, they could deny coverage and the Pre-existing
Condition Insurance Plan (PCIP) program provided health coverage options to individuals who
were uninsured for at least six months, had a pre-existing condition, and had been denied
coverage (or offered insurance without coverage of the pre-existing condition) by a private
This study source was downloaded by 100000827506713 from CourseHero.com on 02-16-2022 02:27:32 GMT -06:00
https://www.coursehero.com/file/24872655/Comparison-of-healthcare-in-the-United-States-and-Japandocx/
, insurance company. This ended on April 2014 and now with the Affordable Care Act in place,
health insurance plans can no longer deny anyone coverage for their pre-existing condition.
Japan has a socialized healthcare system where everyone is required to have insurance
through their employer for themselves, their children or if they are retired. If they are
unemployed, disabled or retired without benefits, the Japanese national healthcare system
would be utilized to cover those individuals (Admin, 2009). Their healthcare system controls
costs by banning insurance company profits by limiting doctor fees (Anonymous, 2009) and the
government sets a national fee schedule lists all procedures and products that can be paid for
by health insurance and sets their prices. These prices apply to all Japanese citizens, regardless
of individual health plans or where they receive their care. Ikegami and Campbell, 1995).
Medications are purchased from wholesalers and dispensed to patients directly by providers.
The cost to providers is stated to be “on average 26 percent less than the reimbursement
specified by the fee schedule”, which is leaves an incentive to overprescribe. “Per capita
expenditure on pharmaceuticals ($116) is higher than in the United States ($109)”. (Ikegami and
Campbell, 1995). However, medications covered by insurance cost the same to everyone as set
by the national fee schedule which is negotiated every two years for review (Admin, 2009).
During this period, the costs for medications and treatments are fixed and do not fluctuate.
Japanese patients do not need a referral to see a specialist, individuals are allowed to seek
treatment from any provider they chose (Admin, 2009). However, they do suffer a shortage of
many types of specialists due to low pay, long hours and high stress. Japanese healthcare is
universal and mandatory, no Japanese citizen is denied coverage or given limited coverage due
to a pre-existing condition (“Japan’s Healthcare System Has Many Advantages, but May Not Be
Sustainable”, 2009).
United States healthcare facilities are mostly owned and operated by private
businesses, contrary to Japan where. The five largest insurance companies in the
United States “made a combined profit of around $12 billion in 2009”. (Gonzalez,
2013). Although the profits are substantial, patient fees continue to increase and
quality of care decreases. Japan in contrast has no insurance companies, and does
not make a profit in patient care. Patient costs stay low and affordable, and there is
This study source was downloaded by 100000827506713 from CourseHero.com on 02-16-2022 02:27:32 GMT -06:00
https://www.coursehero.com/file/24872655/Comparison-of-healthcare-in-the-United-States-and-Japandocx/
