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Containing Health Care Costs in Japan
Naoki Ikegami and John Creighton Campbell, EditorsThe Japanese health care system provides universal coverage to a healthy but aging population. Its costs are among the lowest in the world and have remained nearly constant as a share of the economy for more than a decade. Americans concerned about runaway medical spending need to know about the successes that Japan has experienced and the problems the country has encountered in its effort to control costs while maintaining quality of care.
Offered here is an analysis of the key issues of cost-containment by specialists followed by reactions from some of America's best-known experts on health care delivery and finance. Topics include the macro-and microeconomics of health care, technology and costs, institutions and costs, attitudinal and behavioral aspects, and the politics of health care.
This collection provides an authoritative study of successful cost-containment in the Japanese health care system---a chronicle of success that is neither a statistical illusion nor a result of sociocultural factors. Detailed here is information on the key mechanism of cost constraint: a fee schedule that covers virtually all medical services and rewards inexpensive services while making expensive services unprofitable. This system has resulted in the provision of quality health care to the entire population at roughly half the cost of American health care. Is it a single-payer system? Would the United States have to introduce a dramatically altered health care structure to benefit from the Japanese experience? No. Japan relies mainly on fee-for-service medicine financed by multiple insurers---a system familiar to Americans and one from which many lessons may be learned.
Based on conferences held in Washington, D.C., and Izu, Japan, this volume collects original chapters on the overall cost structure, how the negotiated mandatory fee schedule works, specific mechanisms for cost control, the politics of health care financing, and the impact of cost cutting on quality, among other topics. These pathbreaking studies will be a significant resource for policymakers and scholars interested in comparative health care systems as well as those interested in health care reform in the United States.
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Cover
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Title
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Copyright
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Contents
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Introduction
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Conventions and Usages
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1 Overview: Health Care in Japan
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Section I: The Macroeconomics of Health Care
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2 Comparison of Health Expenditure Estimates between Japan and the United States
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3 Factors in Health Care Spending: An Eight-Nation Comparison with OECD Data
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4 Afterword: Costs—The Macro Perspective
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Section II: The Microeconomics of Health Care
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5 The “Natural Increase” and Cost Control
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6 Comparison of Capital Costs in Health Care between Japan and the United States
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7 Comparison of Administrative Costs in Health Care between Japan and the United States
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8 Afterword: Costs—The Micro Perspective
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Section III: Technology and Costs
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9 Comparison of Hospital Admission Rates between Japan and the United States
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10 High-Cost Technology in Health Care: The Adoption and Diffusion of MRI in Japan
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11 Comparison of Pharmaceutical Expenditure between Japan and the United States
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12 Sales, R&D, and Profitability in the Japanese Pharmaceutical Industry, 1981-92
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13 Afterword: Quality and Cost in Japanese and U.S. Medical Care
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Section IV: Institutions and Costs
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14 Comparison of Long-Term Care for the Elderly between Japan and the United States
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15 The Impact of Financing Reform: Inclusive Per-Diem Reimbursement in Geriatric Care
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16 Waiting Lists in Japanese Hospitals
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17 Comparison of Hospital Length of Stay and Charges between Japan and the United States
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18 Afterword: Implications for U.S. Health Care Policy Reform
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Section V: Health Behavior and Attitudes
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19 Paradoxical Comparison of Health Care Needs, Utilization, and Costs between Japan and the United States
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20 Keeping Pressures off the Japanese Health Care System: The Contribution of Middle-Aged Women
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21 The Three-Minute Cure: Doctors and Elderly Patients in Japan
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22 Over My Dead Body: The Enigma and Economics of Death in Japan
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23 Afterword: Social, Cultural, and Behavioral Factors
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Section VI: Politics and Health Care
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24 The Egalitarian Health Insurance System
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25 The Evolution of Fee-Schedule Politics in Japan
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26 The Japan Medical Association and Private Practitioners’ Income
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27 Afterword: National Health Insurance, Cost Control, and Cross-National Lessons—Japan and the United States
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Contributors
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Index
- 978-0-472-02413-1 (ebook)
- 978-0-472-10538-0 (hardcover)