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Global Health Blogs with Professor Swahn

The U.S. Healthcare System vs. Japan

February 15, 2021 · 2 Comments · Health Care Systems, Uncategorized

What’s the DL on the US Healthcare system?

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The United States is known as the most powerful country in the world according to and The question however is not about how powerful the country is in terms of its strength or firepower, rather about its healthcare. Where does the US healthcare system rank? The United States is known to spend the most per capita (per person) on healthcare than any other country in the world and yet we have not seen the most patient-centric healthcare system. One of the most major impacts of our healthcare system was the enactment of Medicare and Medicaid in 1965 under President Lyndon B. Johnson, our 36th president. Why did Medicare and Medicaid make such an impact? Well, both systems allowed for more coverage of the American people. Millions in fact. You may ask, well if these systems are working to cover millions of Americans, why are people still not covered? The simple answer is money and freedom. How very vague, I know. Let me explain as best I can.

The arguments about universal healthcare include that the US government should ensure healthcare for all its citizens, that the government is already spending so much on emergency care for the people without insurance that if there’s a more formal system, perhaps it would reduce the strain of spending. Having a unified system would make it easier to bargain with big pharma companies who currently charge prices for medications based on their own discretion and would allow for shared costs of equipment and such that it may help lower the cost of care. But the argument against universal care typically entails the “wariness of federal power”. This wariness stems from the idea that the government controlling healthcare could lead to bureaucratic red tape or less freedom for the patients to make decisions regarding their own care. 

Besides the positives and negatives of the argument about universal care, the next important factor of the healthcare system is insurance coverage. The United States has various forms of healthcare coverage for its residents which include Medicare, Medicaid, HMOs, and various private insurance providers. What’s great about these options is simply having the options! That’s what makes Americans great. We get to choose who we want to cover our healthcare needs. Also pricing. We can compare one to the next and see what benefits we get based on how much we pay per month therefore if we want someone that is a little more expensive and has better coverage or if we want something that is not as expensive, but has more basic coverage, we can decide that. 

The Affordable Care Act (ACA) was established during President Barack Obama’s time in office. What was revolutionary about this coverage was that it was able to expand coverage to over 11 million more Americans, it helps people regardless of pre-existing conditions and there are minimal standards that must be met therefore everyone can be covered regardless of what their SES is. 


The Context Institute simplifies the US healthcare system’s strengths to:

  • The availability of high-quality care
  • The development of clinical research 
  • The technological development that has allowed for an understanding of diseases
  • The VAST variety of specialties available

The Institute continues to go into the weaknesses such as:

  • Cost of healthcare services per person 
  • 37 million people do not have health insurance
  • Better quality of care for people with higher SES or the ability to pay for services
  • Ranking lower in several categories compared to other countries

The last bullet point led me to peruse other countries’ healthcare systems and I got curious about Japan’s healthcare system.

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How does Japan compare to the United States?

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The above flowchart shows the organization of the healthcare system in Japan according to the Commonwealth Fund. Japan’s healthcare system is classified as statutory insurance which has mandatory enrollment in one of its 47 residence-based insurance plans or one of the 1400+ employment-based plans. It is financed through general tax revenue and individual contributions. 

Health Affairs broke down the similarities that the Japanese healthcare system has with the United States’s healthcare system which include values such as employment-based health insurance, free consumer choice of physician depending on the plan one decided to enroll with, and a delivery system that leaves a lot of the clinical decisions to the provider. The differences lie in the costs of care, the way it functions, and its services to the people using the system as necessary. The Japanese system works as a universal system that treats citizens, ex-pats, and foreigners with the same level of care and treatment. This specific point is very interesting because it respects the people that are interacting with the system and treating them with equitable care. How is culture or race treated in the Japanese healthcare system? According to The Lancet, care for foreign residents in Japan is much less than for original residents from Japan. Those that are foreign are likely to have more diseases and experience higher mortality rates. Compared to the US, there is no official language interpretation program or service available. Therefore, there is the fear that if one were to move to Japan, there would be the possibility of less effective care. It is curious that people who visit or are there for short term periods of time would get readily available care should they need it. 

There are various pros and cons that set this system apart from our own. One major difference is the per capita cost which ranges from around $4600 to over $10,000 in Japan and the United States, respectively. 

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After reviewing these systems and the major technical differences, it makes one wonder what of the ethical implications of treating people who may not look the same as you or speak the same language as you. It is hard to say that because of the low costs of the Japanese healthcare system, that it is better. Statistically, the numbers show it is, but the quality of treatment for everyone comes into question. The United States struggles to maintain the same level of care for everyone, everywhere but it seems to be more tolerant of the various groups that come through its hospitals’ doors. So who is really considered better? It’s safe to say that both systems need to work hard to be more inclusive and have equal levels of care for their patients. Some solutions could be to hold bias, sensitivity training with onboarding employees or incentivizing care based on the quality of treatment, or something like having diverse shared teams of providers working together to keep each other accountable for patient care. 



  • Mercedes Albanes

    I thought that the Japanese system would have been better than the USA system. In general they both are good but they have their own flaws. Japanese-treating non-Japanese different is something I never thought possible. I enjoy how you did the tables to make it very explanatory. It is true both countries need to improve a lot of different issues. One of them is how the USA expend a lot of money in emergency rather than improving the availability of care to all.

  • mwright106

    Very great blog. It gave me much insight. I have to start with the comparison “PwC SDoH Japan vs. the US, it was quite surprising to see the vast difference in life expectancy (65), and I wonder if it has to do with Japan’s healthcare system. Lastly, I would like to go in-depth with Lancets’ argument of “for foreign residents in Japan is much less than for original residents from Japan. Those who are foreign are likely to have more diseases and experience higher mortality rates”. I would have to disagree mainly based on previous work with the refugee community, yes interpretation services are provided, but the care they receive is sub-par; they are looked down upon and discriminated against again. But what more is to be expected in a society where African-Americans born on this soil are dying at a higher rate, especially about maternal morbidity and mortality. Therefore, I disagree; I do not believe they are more “tolerant” than Japan’s system.

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