How Does Japan Do It - Doctors and Hospitals in a Universal Health Care System Health Care Symposium 3 Stanford Law & Policy Review 1991

3 Stan. L. & Pol'y Rev. 111 (1991)
How Does Japan Do It - Doctors and Hospitals in a Universal Health Care System

handle is hein.journals/stanlp3 and id is 113 raw text is: How Does Japan Do It?
Doctors and Hospitals in a
Universal Health Care System
by
Aki Yoshikawa

As the sobering realities of
spiraling medical care costs and a
large number of un- or under-in-
sured Americans gain more atten-
tion, American policymakers,
businesspeople and citizens are
looking to see how other coun-
tries manage health care. Most of
their attention has focused on the
Canadian and British experiences.
However, Japan, the second larg-
est industrialized democracy in the
world, has embraced an approach
to health care that differs from
that of the U.S., Canada, and
Britain by incorporating fee-for-

Norihiko Shirouzu
Matthew Holt
The greatest virtues of
Japan's medical care

system are i
and its pm
guarat
uninhibite
comprehens
care for vii
entire cc
popul

service medical care into a non-discriminatory univer-
sal health care system.'
Three features stand out in the Japanese model of
Dr. Yoshikawa is the Deputy Director of the Comparative Health Care
Policy Research Project at the Northeast Asia-United States Forum
on International Policy at Stanford University. Mr. Shirouzu and Mr.
Holt are research fellows at the project.

I o s health care provision: the system
ts OW costs of Universal Health Insurance, the
avision of fee-for-service/unit price reim-
bursement system, and the so-
nteed, called free medical practitioner
d access to system in which physicians are
given total freedom to choose lo-
ive medical cations of practice or employers.
These three features embody the
principles that underlie Japanese
iuntry's health care policy: uninhibited
access to medical care, equity in
ation. care delivery, and cost-contain-
ment. We feel that analysis of the
low costs and universal coverage
of this system provides important
insights into the ongoing U.S. health care debate.
After a brief introduction of the Japanese experi-
ence, Sections Two and Three of this article focus on the
Japanese Universal Health Insurance system, its reim-
bursement mechanisms, and their effects on medical care
provision. Section Four examines the supply side of medi-
cal care, with special attention to the roles of hospitals and
doctors. Section Five compares medical care provision in

FALL 1991

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