Containing Health Care Costs in Japan

13 Afterword: Quality and Cost in Japanese and U.S. Medical Care

CHAPTER 13 Afterword: Quality and Cost in Japanese and U.S. Medical Care John M. Eisenberg with Nancy Foster The chapters by Hasegawa, Hisashige, and Ikegami offer important insight into the practice of medicine in Japan and how it differs from medical practice in the United States. Following some preliminary comments, we will tum to the broader question of whether Japan has paid a price in quality for the lower costs of its medical system. Hasegawa has presented fascinating information on rates of surgery that might help to explain the differences in costs between the Japanese and American systems. The same percentage of gross domestic product (GDP) is spent in Japan on ambulatory care as is spent in the United States, but there are dramatic differences in expenditures for inpatient care. About half of this difference is attributable to differences in surgical utilization rates. These differences in utilization rates and surgical expenditure are striking and may help us to understand the differences in health care costs between the two countries. It is not clear, however, why these differences exist. A number of possibilities have been proposed, some by Hasegawa, and others might be suggested as well. For example, some of the difference may be due to the disease burden in the two populations, either because of a different endogenous frequency of diseases that would be treated surgically or because of a difference in preventing these diseases from developing to the surgical stage. However, because Japanese rates ofcancer tend to be higher than those in the United States, one would anticipate, if anything, that surgical rates would be higher rather than lower. Hasegawa suggests that early detection of disease may prevent surgery, and this postulate could be tested by evaluating the stage of disease at the time of detection. However, in many instances surgery would still be required even for disease at an earlier stage. Another possibility is that the surgical rates are different for the population as a whole but not on a per-surgeon basis. Thus, it would be interesting to determine what the surgical rates are per surgeon to determine whether a limit on the capacity of the system to provide surgery is one of the explanations for the lower utilization rate in Japan. Also, even when individual physicians have been trained to perform surgery, they may not be able to do so in Japan because of the 143 CHAPTER 13 Afterword: Quality and Cost in Japanese and U.S. Medical Care John M. Eisenberg with Nancy Foster The chapters by Hasegawa, Hisashige, and Ikegami offer important insight into the practice of medicine in Japan and how it differs from medical practice in the United States. Following some preliminary comments, we will tum to the broader question of whether Japan has paid a price in quality for the lower costs of its medical system. Hasegawa has presented fascinating information on rates of surgery that might help to explain the differences in costs between the Japanese and American systems. The same percentage of gross domestic product (GOP) is spent in Japan on ambulatory care as is spent in the United States, but there are dramatic differences in expenditures for inpatient care. About half of this difference is attributable to differences in surgical utilization rates. These differences in utilization rates and surgical expenditure are striking and may help us to understand the differences in health care costs between the two countries. It is not clear, however, why these differences exist. A number of possibilities have been proposed, some by Hasegawa, and others might be suggested as well. For example, some of the difference may be due to the disease burden in the two populations, either because of a different endogenous frequency of diseases that would be treated surgically or because of a difference in preventing these diseases from developing to the surgical stage. However, because Japanese rates ofcancer tend to be higher than those in the United States, one would anticipate, if anything, that surgical rates would be higher rather than lower. Hasegawa suggests that early detection of disease may prevent surgery, and this postulate could be tested by evaluating the stage of disease at the time of detection. However, in many instances surgery would still be required even for disease at an earlier stage. Another possibility is that the surgical rates are different for the population as a whole but not on a per-surgeon basis. Thus, it would be interesting to determine what the surgical rates are per...