4 ms·

This gave me the strong desire to learn a lot more about how the Japanese manage health care.

patio11 17y ago
In Japan, waiting times are so short that most patients don't bother to make an appointment. At my local hospital they stop taking new appointments for the day at 10:30 in the morning, sharp, because they're booked by that point. I got myself there at 11:00 while severely ill, was told by the receptionist to come back tomorrow, stupidly decided to walk home rather than protesting or calling a cab or ambulance, and very nearly passed out in the middle. A coworker wondering why I didn't come into work dropped by my house, found me, and took me across town to a different hospital. Aside from nearly dying in the street despite having both insurance and ample means to pay for treatment, my experience with Japanese healthcare has been mostly positive. P.S. Don't get me started on dentistry, though.
- abalashov 17y ago
  Dentistry's pretty bad anywhere.
  - dflock 17y ago
    I have noticed this too - does anyone know why? In the UK, the NHS provides excellent healthcare for everything except dentistry, which is noticeably poorer in both availability and (arguably) quality. As far as I can see, dentistry has seen very little innovation since the invention of pneumatic drills and amalgam filling by the Victorians over a century ago - 'modern' dentistry is basically just an electrified version of that. The only other noticeable improvements, except fluoride toothpaste, are slightly updated versions of those same basic technologies, or have just been borrowed directly from general medicine, where all the research and innovation seems to take place. Given that, even on subsidized NHS rates, dentistry is expensive (and massively so without) - why is this?
    - patio11 17y ago
      dentistry has seen very little innovation I'm only 27, but I've seen significant innovation in my lifetime. In America at least, they've made the filling of cavities less time consuming, stressful, and painful. (They have this little das blinkenlights contraption that can auto-harden a paste in your mouth.) They've also got some real improvements in cosmetic dentistry -- invisi-braces, for example. Retainer technology is apparently getting better, too. In Japan, they have the tech but the payment system is severely borked, so getting a routine teeth-cleaning takes four days, one per quadrant, because they get paid based on patient-days not based on procedures performed. I had to have 3 cavities filled and a routine cleaning. I was quoted 6 visits, and bargained him down to merely 4. I still have to go to the last 2, because I can't justify that much time off of work when its a simple in-and-out anywhere in the US. (Paying cash, naturally.)
      - dflock 17y ago
        Yes, there is UV hardening resin - but this is just a slightly improved version of the old amalgam fillings - and does the same job: drill hole, fill with stuff. It's considered better in that it doesn't contain heavy metals, but worse because the silver in amalgam prevents bacterial growth under the fillings and the resin is harder to apply properly. Maybe the issues with dentistry are just because of the financial incentives. The UK NHS used to pay dentists per treatment course but have recently changed to some kind of per patient/treatment hybrid system (http://news.bbc.co.uk/1/hi/health/7485012.stm http://news.bbc.co.uk/1/hi/health/7485012.stm). The old pay-per-treatment system was a) complex and b) unsurprisingly, led to a 'drill and fill' culture of lots of treatments, most of which tended to be fillings. Things have changed and got much simpler, but it's arguable if it's 'better' overall. Maybe it's just because dentists are on piecework? If A&E/ER/emergency medicine departments were paid so much per stitch, then I guess everyone would come out looking like Frankenstein's monster.
- davidw 17y ago
  Sounds (but is not clear) like maybe you were trying to get 'regular' care rather than emergency care, and that the receptionist didn't bother trying to check whether the latter might indeed have been needed, and you thought "well, I guess I can wait..." or something like that. That sort of thing can happen anywhere, I think. Or are the Japanese so organized that they make appointments for emergency care?:-) Medical care is not bad here in Italy, but has some drawbacks compared to the US. On the other hand, you really have "peace of mind" in the sense of not having to worry about it at all. You go to the doctor and you get fixed up, end of story. Austria's system seemed a bit more complex (mostly because I never learned the language very well, I suppose), but better than Italy's. I think it's a German/Swiss style system with non-profit insurers that everyone has to have, which seems to be a bit roundabout, but apparently works well. Padova is a bit of a special case, because there's a big medical University, so there are actually some very good doctors in certain fields, it's just the "extras" aren't nearly as good in the US: more people per room, shoddier looking stuff. And a final note: I walked into our local doctor's office this morning because of a bad cough, and the guy didn't have time to see me because I got there near the end of his office hours, but I think that's less of a system thing than this guy being a dick (my wife didn't like him either), so we'll change doctors if the local Death Panel lets us. In reality, we don't have to ask anyone, we can just switch.
- jhancock 17y ago
  interesting story. Do you think it would have made a difference if they felt your illness was an "emergency"? Even in the U.S. paying out of pocket for a well respected doctor, you still have to wait for an appointment. The only way you really get immediate treatment just about anywhere is to go to an emergency room and let them prioritize based on who's there at the time.

In Japan, waiting times are so short that most patients don't bother to make an appointment. At my local hospital they stop taking new appointments for the day at 10:30 in the morning, sharp, because they're booked by that point. I got myself there at 11:00 while severely ill, was told by the receptionist to come back tomorrow, stupidly decided to walk home rather than protesting or calling a cab or ambulance, and very nearly passed out in the middle. A coworker wondering why I didn't come into work dropped by my house, found me, and took me across town to a different hospital. Aside from nearly dying in the street despite having both insurance and ample means to pay for treatment, my experience with Japanese healthcare has been mostly positive. P.S. Don't get me started on dentistry, though.

abalashov 17y ago
Dentistry's pretty bad anywhere.
- dflock 17y ago
  I have noticed this too - does anyone know why? In the UK, the NHS provides excellent healthcare for everything except dentistry, which is noticeably poorer in both availability and (arguably) quality. As far as I can see, dentistry has seen very little innovation since the invention of pneumatic drills and amalgam filling by the Victorians over a century ago - 'modern' dentistry is basically just an electrified version of that. The only other noticeable improvements, except fluoride toothpaste, are slightly updated versions of those same basic technologies, or have just been borrowed directly from general medicine, where all the research and innovation seems to take place. Given that, even on subsidized NHS rates, dentistry is expensive (and massively so without) - why is this?
  - patio11 17y ago
    dentistry has seen very little innovation I'm only 27, but I've seen significant innovation in my lifetime. In America at least, they've made the filling of cavities less time consuming, stressful, and painful. (They have this little das blinkenlights contraption that can auto-harden a paste in your mouth.) They've also got some real improvements in cosmetic dentistry -- invisi-braces, for example. Retainer technology is apparently getting better, too. In Japan, they have the tech but the payment system is severely borked, so getting a routine teeth-cleaning takes four days, one per quadrant, because they get paid based on patient-days not based on procedures performed. I had to have 3 cavities filled and a routine cleaning. I was quoted 6 visits, and bargained him down to merely 4. I still have to go to the last 2, because I can't justify that much time off of work when its a simple in-and-out anywhere in the US. (Paying cash, naturally.)
    - dflock 17y ago
      Yes, there is UV hardening resin - but this is just a slightly improved version of the old amalgam fillings - and does the same job: drill hole, fill with stuff. It's considered better in that it doesn't contain heavy metals, but worse because the silver in amalgam prevents bacterial growth under the fillings and the resin is harder to apply properly. Maybe the issues with dentistry are just because of the financial incentives. The UK NHS used to pay dentists per treatment course but have recently changed to some kind of per patient/treatment hybrid system (http://news.bbc.co.uk/1/hi/health/7485012.stm http://news.bbc.co.uk/1/hi/health/7485012.stm). The old pay-per-treatment system was a) complex and b) unsurprisingly, led to a 'drill and fill' culture of lots of treatments, most of which tended to be fillings. Things have changed and got much simpler, but it's arguable if it's 'better' overall. Maybe it's just because dentists are on piecework? If A&E/ER/emergency medicine departments were paid so much per stitch, then I guess everyone would come out looking like Frankenstein's monster.
davidw 17y ago
Sounds (but is not clear) like maybe you were trying to get 'regular' care rather than emergency care, and that the receptionist didn't bother trying to check whether the latter might indeed have been needed, and you thought "well, I guess I can wait..." or something like that. That sort of thing can happen anywhere, I think. Or are the Japanese so organized that they make appointments for emergency care?:-) Medical care is not bad here in Italy, but has some drawbacks compared to the US. On the other hand, you really have "peace of mind" in the sense of not having to worry about it at all. You go to the doctor and you get fixed up, end of story. Austria's system seemed a bit more complex (mostly because I never learned the language very well, I suppose), but better than Italy's. I think it's a German/Swiss style system with non-profit insurers that everyone has to have, which seems to be a bit roundabout, but apparently works well. Padova is a bit of a special case, because there's a big medical University, so there are actually some very good doctors in certain fields, it's just the "extras" aren't nearly as good in the US: more people per room, shoddier looking stuff. And a final note: I walked into our local doctor's office this morning because of a bad cough, and the guy didn't have time to see me because I got there near the end of his office hours, but I think that's less of a system thing than this guy being a dick (my wife didn't like him either), so we'll change doctors if the local Death Panel lets us. In reality, we don't have to ask anyone, we can just switch.
jhancock 17y ago
interesting story. Do you think it would have made a difference if they felt your illness was an "emergency"? Even in the U.S. paying out of pocket for a well respected doctor, you still have to wait for an appointment. The only way you really get immediate treatment just about anywhere is to go to an emergency room and let them prioritize based on who's there at the time.