Containing Health Care Costs in Japan

16 Waiting Lists in Japanese Hospitals

CHAPTER 16 Waiting Lists in Japanese Hospitals Naoki Ikegami and Shunya Ikeda SUM MAR Y A survey of the waiting period for inpatients was conducted in two hospitals in Tokyo. In K Hospital, a I,061-bed private university medical center, the average waiting period was thirty-one days. Fifty-two percent of those classified as "urgent" and 39% of those with cervical cancer waited for more than one month. [n S Hospital, a 450-bed, quasi-public hospital, it was fifteen days. No one waited more than one month if classified as "urgent." In both hospitals, the waiting period lengthened when the level of urgency became less and for patients requesting rooms with no extra charges. The current situation is very difficult to change as long as the principle of unlimited access to all health care facilities is upheld in Japan. Background Under the Japanese health care system, patients may visit any health care facility they wish. Most of the hospital visits are made without a referral and virtually all inpatients are admitted from the outpatient department. The copayment rate and the fee schedule are the same no matter where the patient chooses to go. Even if a private room is requested, extra charges will only apply for the room, and health care will be fully covered by insurance. Since there are no formal gatekeepers nor economic disincentives, queueing is an inevitable result in facilities that enjoy a high reputation. These are usually large hospitals in the metropolis that can provide tertiary care. While much attention has been drawn to the long waiting time and the inadequate attention in the outpatient department (it is popularly said that one waits three hours and then is seen for three minutes), since very few hospitals limit their intake by appointment systems, patients are at least seen on the same day that they choose to visit the hospital. The problem, in fact, is more serious in inpatient care because the number of patients who can be admitted is severely limited by the hospital's bed capacity. Grave consequences may arise from delayed admission, especially ifthe required treatment is of a nature that can be provided only in a tertiary-care setting. However, this issue has never been researched in Japan. It is for this reason that a survey of the waiting period for inpatient admissions was conducted in two hospitals in central Tokyo that can provide tertiary care. 176 CHAPTER 16 Waiting Lists in Japanese Hospitals Naoki Ikegami and Shunya Ikeda SUM MAR Y A survey of the waiting period for inpatients was conducted in two hospitals in Tokyo. In K Hospital, a I,061-bed private university medical center, the average waiting period was thirty-one days. Fifty-two percent of those classified as "urgent" and 39% of those with cervical cancer waited for more than one month. In S Hospital, a 450-bed, quasi-public hospital, it was fifteen days. No one waited more than one month if classified as "urgent." In both hospitals, the waiting period lengthened when the level of urgency became less and for patients requesting rooms with no extra charges. The current situation is very difficult to change as long as the principle of unlimited access to all health care facilities is upheld in Japan. Background Under the Japanese health care system, patients may visit any health care facility they wish. Most of the hospital visits are made without a referral and virtually all inpatients are admitted from the outpatient department. The copayment rate and the fee schedule are the same no matter where the patient chooses to go. Even if a private room is requested, extra charges will only apply for the room, and health care will be fully covered by insurance. Since there are no formal gatekeepers nor economic disincentives, queueing is an inevitable result in facilities that enjoy a high reputation. These are usually large hospitals in the metropolis that can provide tertiary care. While much attention has been drawn to the long waiting time and the inadequate attention in the outpatient department (it is popularly said that one waits three hours and then is seen for three minutes), since very few hospitals limit their intake by appointment systems, patients are at least seen on the same day that they choose to visit the hospital. The problem, in fact, is more serious in inpatient care because the number of patients who can be admitted is severely limited by the hospital's bed capacity. Grave...