Though many of the doctor offices and their small hospitals have acquired a significant array of equipment, and some high-tech equipment, patients increasingly are bypassing them to seek treatment at the larger public and private hospitals. There have been efforts by government and the Japan Medical Association to change the practice of excluding private doctors from public hospitals but bringing about change will take considerable time. Japanese public hospitals and university hospitals are found throughout the country and are staffed by full-time, salaried doctors. Hospitals are paid fees by the insurance companies for the services they provide. Typically, premiums are paid partly by the employer and partly by the employee.
Special provisions provide insurance coverage for the self-employed, elderly and unemployed.
Coverage is for medical care both in and out of hospital, dental care, drugs, and long-term care. Patients will also have additional payments to make if they want a single or double-bedded room in hospital and if they choose to go to a highly specialized or university hospital without a referral. Private supplementary insurance to cover the additional costs is not common. Health costs are rising in Japan, as elsewhere, and the government is exploring ways to control those costs. While medical care in Japan is good, English-speaking physicians and medical facilities that cater to Americans expectations are expensive and not very widespread.