page_title: Health care system in Japan
section_title: Access
hierarchical_section_title: Health care system in Japan / Access
caption_attribution_description: スーパーアンビュランス。東京消防出初式にて撮影。 Deutsch: Großraum-Rettungswagen English: Ambulance bus
context_page_description: The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered by a universal health care insurance system that provides relative equality of access, with fees set by a government committee. All residents of Japan are required by the law to have health insurance coverage. People without insurance from employers can participate in a national health insurance programme, administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians.
  Medical fees are strictly regulated by the government to keep them affordable. Depending on the family’s income and the age of the insured, patients are responsible for paying 10%, 20%, or 30% of medical fees, with the government paying the remaining fee.
context_section_description: In Japan, services are provided either through regional/national public hospitals or through private hospitals/clinics, and patients have universal access to any facility, though hospitals tend to charge more to those patients without a referral. As above, costs in Japan tend to be quite low compared to those in other developed countries, but utilization rates are much higher. Most one doctor clinics do not require reservations and same day appointments are the rule rather than the exception. Japanese patients favor medical technology such as CT scans and MRIs, and they receive MRIs at a per capita rate 8 times higher than the British and twice as high as  Americans. In most cases, CT scans, MRIs and many other tests do not require waiting periods. Japan has about three times as many hospitals per capita as the US and, on average, Japanese people visit the hospital more than four times as often as the average American.
  Access to medical facilities is sometimes abused. Some patients with mild illnesses tend to go straight to hospital emergency departments rather than accessing more appropriate primary care services. This causes a delay in helping people who have more urgent and severe conditions who need to be treated in the hospital environment. There is also a problem with misuse of ambulance services, with many people taking ambulances to hospitals with minor issues not requiring an ambulance. In turn this causes delays for ambulances arriving to serious emergencies. Nearly 50% of the ambulance rides in 2014 were minor conditions where citizens could have taken a taxi instead of an ambulance to get treated.
  Due to the issue of large numbers of people visiting hospitals for relatively minor problems, shortage of medical resources can be an issue in some regions. The problem has become a wide concern in Japan, particularly in Tokyo. A report has shown that more than 14,000 emergency patients were rejected at least three times by hospitals in Japan before getting treatment. A government survey for 2007, which got a lot of attention when it was released in 2009, cited several such incidents in the Tokyo area, including the case of an elderly man who was turned away by 14 hospitals before dying 90 minutes after being finally admitted, and that of a pregnant woman complaining of a severe headache being refused admission to seven Tokyo hospitals and later dying of an undiagnosed brain hemorrhage after giving birth. The so-called "tarai mawashi" (ambulances being rejected by multiple hospitals before an emergency patient is admitted) has been attributed to several factors such as medical imbursements set so low that hospitals need to maintain very high occupancy rates in order to stay solvent, hospital stays being cheaper for the patient than low cost hotels, the shortage of specialist doctors and low risk patients with minimal need for treatment flooding the system.
caption: Japanese Super Ambulance, Tokyo Fire Department
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