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Saturday, September 25, 2004

Comments

Joe Adkins

Hey, I just stumbled across your page. Anyway, I've only been in hospitals here (in Tokyo) as a guest and I have to agree with your assessment of the cleanliness. I thought the same about the dentists and only went when I was in excruciating pain (lost a filling). Subsequently, my opinion of Japanese dentists improved. When you finish the whole experience please tell us how/if your view (not that it was negative in the post) have changed/improved/whatever.

p.s. I thought that childbirth was almost an outpatient procedure in the US these days? 2.9 days?

jarred

I just hope you are doing okay or on the mend.

Karla

lasttbronx, I appreciate your comments, but I just want to clear up a couple things I may not have communicated well. First of all, I did NOT say, "My god, how cruel US hospitals must be," when citing those statistics; what I actually said was, "Japanese people spend on average a whole lot more time in hospitals than Americans." My real statement on the subject was far less profound and much more obvious than the one you gave me credit for. You did make a valid point nonetheless; in case anyone were to approach the figures from the "cruel US hospital standpoint", there are other sides to the story. There are quite a few factors at work in these statistics -- let's not forget that most Japanese homes do not have the space to spare a sick room for a recently discharged patient, but that most American families do not have an extra member of the extended family to spare for nursing said patient either. There's a big difference on ideas about total dependence vs. relative independence too, especially in regard to families. There are differences in the employment environment and company/employee relationships that affect or allow such decisions. There's a lot going on here, but I never said the reason was cruelty.

I don't know about the role doctors in Japan play in peddling medicine, and it seems that you do, and I respect that. Just from my personal experiences here though, I've felt that doctors here have been much LESS inclined to push unnecessary drugs on me. Something about how their offices are never decorated with drug company paraphenalia, drug logo-emblazoned clocks and pens and calendars and whatnot, inspires more confidence in me. I'm always prescribed only a small amount of medicine if any, in low dosages and minimal amounts. I've heard the reason doctors give only a few days' worth of prescription is to monitor its effectiveness, your own illness and its progress and any changing needs, and the presence of any side effects, and to make adjustments accordingly, and that's always how I've felt I've been treated. There may be other reasons, but I feel the benefits balance them out. Even if doctors are making money off the drugs here, the prices for drugs are so low, and the ones in America so disgustingly, embarrassingly, scandalously high, and their offices so boldly ad-plastered, that I don't feel it to be a particularly great worry here. If your statement that prescription drug use is twice that of the US, I wonder if other factors shouldn't be looked at -- what kinds of drugs are these, what are their strengths, what isn't available over the counter here because people in a lower-cost healthcare system are less likely to self-medicate, things like that. People seem to almost always be given a mild antibiotic, but even if two people are given that for every one American given an overly strong, debilitating thing with strong side effects and an absurdly high price, or something from the company that furnished his nice wall clock, I'm not worried.

I'm sure you're right about numbers for average stays being skewed by the absence of nursing homes, but without even getting into the fact that care for elderly here is usually taken on by the person's own family, let's look at an independent figure, not skewed by the elderly. Like post-childbirth hospital stays, we know that's not the elderly. Putting a new mother out of the hospital only 2-3 days after she gives birth hasn't always been US policy, and I don't see how it can be argued to be a good one. The longer stay in Japan is allowed, sure partly by sexist employment practices, but also by supportive extended families and a greater respect by bureaucrats of that new mother's time. Japan also has an extremely low infant mortality rate, and if the longer stay has ANY role in that no matter how small, it should be respected.

Yes, of course there are problems with Japan's healthcare system. I could list off about 10 of those right now based on my past month's experience. But I think any large system that administers to so many people with so much regularity must have some kind of problems. Under these criteria though, I think the US could learn something from Japan: in Japan, regular people can afford to see doctors when they need them, regular people can afford and obtain preventative medicine, regular people are easily able to get yearly complete physicals, and regular people can afford prescription drugs. You definitely can't say that about America. It's not perfect, but at least it's available, which is more than I can say about where I'm from.

lasttbronx

Well I was sorry to read that you were ill and I am glad you are doing better, but you might want to step back and actually do some research on a topic rather than merely assuming that the J version healthcare is less corrupt/unfair than the US version. Like many things in Japan, the corruption is just up at a higher level and/or is just less transparent than it would be in the US (look at the recent scandal involving the Japanese Denial Society).
http://www.japantimes.com/cgi-bin/geted.pl5?eo20040907kn.htm


Average hospital stay: Japan 37 days; U.S. 6.4.
For normal childbirth: Japan 8.3 days; U.S. 2.9
Diabetes: Japan 53.4 days; U.S. 7.1
Asthma: Japan 31.5 days; U.S. 4.5
Cancer: Japan 57.1 days; U.S. 9.2

Rather than looking at these stats and saying,” My God, how cruel US hospitals must be!”, I look at these and say, “Damn those Japanese hospitals are slow to fix people up!”. Life expectancy issues are more likely a result of diet, genetics, relative lack of firearms, signficantly fewer cars/miles driven per capita than in the US and super tough drunk driving punishments, not hospital stays. Given the chances for secondary infections, you can probably draw a correlation between longer hospital stays and higher mortality rates. Also influencing these stats is that fact that Japan doesn’t really have nursing homes like they do in the US, so when old people get too hard to handle or become ill, they go to a hospital and stay for a long time. I also look at these numbers and say, Hmmm, I wonder if doctors get paid by the length of a patient stay. And the fact that the doctor only gives you 3-4 days worth of medicine (which, unlike in the US, historically the Japanese doctor is the one SELLIING it, which helps explains why Japan’s usage of prescription drugs is TWICE that of the US), gives him/her the opportunity to have you come back again so he/she can ring up the gov/insurance company for another visit and maybe sell you some more drugs (although the J Gov has been taking steps to separate doctors from the prescription dispensing role, with variable results in different prefectures).
http://www.ims-global.com/insight/news_story/0212/news_story_021211.htm

And it certainly helps that people pretty much have to pay their bills here in Japan, unlike the US. Death doesn’t even get you out of debt here…they’ll just track down your survivors and shake them down for the money you owe. And malpractice lawsuits, while increasing in Japan, are minuscule by US standards.

There are lots of problems with the US healthcare system but don't think there aren't a ton of problems with Japan's as well. And with Japan's ageing population, these problems are going to become much more eveident pretty soon.

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