TABLE OF CONTENTS
Acknowledgments
Introduction - David A. Wise
DOI: 10.7208/chicago/9780226903248.003.0001
[health care systems, Japan, United States, economic incentives, health care costs, medical practice]
This book investigates the structural characteristics of the health care systems in Japan and United States, the economic incentives underlying the systems, and how they operate in practice. The rising cost of health care presents important financial challenges in both countries. It is divided into three major sections. The first includes studies of the health care systems in Japan and the United States and how those systems are evolving with the financial pressures of rising health care costs. The second major section addresses studies on the variations in medical practice patterns and quality of care in the two countries. The final section evaluates selected other health care topics in Japan and the United States. The ten chapters in this book provide valuable insight into the differences in the health care systems in the two countries. (pages 1 - 16)
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Evaluating Japan's Health Care Reform of the 1990s and Its Efforts to Cope with Population Aging - Naohiro Yashiro, Reiko Suzuki, Wataru Suzuki
DOI: 10.7208/chicago/9780226903248.003.0002
[health insurance reform, Japanese medical care system, Japan, health insurance, copayment rate, sharing revenue, population aging]
This chapter explores the basic structure of the Japanese medical care system, primarily addressing recent policy issues. It is observed that various policy reforms introduced in the 1990s did not effectively solve Japan's fundamental health care system problems. The rate at which Japan's population was aging was accelerating in the 1990s, far exceeding that of the United States. The price elasticity of demand for medical care was very small, generally around -0.1. A variety of policies were implemented in order to control health expenditures by means of the efficient use of resources. Increasing the copayment rate and mechanisms for sharing revenue among health insurance providers, however, were not sufficient to attain a sustainable fiscal balance in the long run. The 2003 health insurance reform was a first step toward a more comprehensive reform of the health care services sector. (pages 17 - 42)
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The U.S. Medical Care System for the Elderly - David M. Cutler, David A. Wise
DOI: 10.7208/chicago/9780226903248.003.0003
[elderly, American medical care system, coverage rules, reimbursement system, access rules, Medicare, Medicaid, United States, private insurance policy]
This chapter investigates the structure of the American medical care system, especially the system of care for the elderly. It concentrates on three sets of interactions: coverage rules (how people get health insurance and who pays for it), the reimbursement system (how providers are paid), and access rules (what are the financial and nonfinancial barriers to receipt of care). Medicare is significantly less generous than the typical private insurance policy. The various reimbursement systems differ enormously in the incentives they provide. The United States' medical care system has become substantially less generous in payment for care in the past two decades, and this has affected the care provided. About three-quarters of the elderly have some supplemental insurance, through Medicaid or private supplements. In general, the coverage in the United States is spotty—quite good for the elderly, especially those with supplemental insurance, but not guaranteed for the nonelderly. (pages 43 - 68)
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An International Look at the Medical Care Financing Problem - David M. Cutler
DOI: 10.7208/chicago/9780226903248.003.0004
[medical spending, populations age, medical systems, financing, medical costs, gross domestic product, medical care, tax]
This chapter emphasizes that, as populations age and medical spending rises, medical systems will account for an increasing part of economic activity. It is noted that demographic change will present a financing hurdle for all developed countries. It is also assumed that medical costs increase at all ages by 1 percent per year above the rate of per capita gross domestic product (GDP) growth. Continued increases in costs result in disproportionately large increases in the size of the medical sector. There are three possible ways to pay for the coming medical care burden: firstly, increase revenues from people currently alive to pay for medical care in the future; secondly, wait until the future and then tax working generations to pay for the increased medical care burden that future elderly will incur; and, finally, make people pay more for medical care when they use services, especially at older ages. (pages 69 - 82)
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Removing the Instability and Inequity in the Japanese Health Insurance System - Seiritsu Ogura, Tamotsu Kadoda, Makoto Kawamura
DOI: 10.7208/chicago/9780226903248.003.0005
[health insurance system, Japan, elderly, National Health Insurance, consumption tax, medical costs, medical services]
This chapter compares Japan's current public medical insurance to an unstable two-story building, whose second floor (health insurance for the elderly) is becoming heavier each day, while its first floor is losing strength. It evaluates the weaknesses in the current health insurance system: the insurance of the elderly, or the second floor of our insurance system; and the National Health Insurance (NHI) system. It is observed that a switch to a consumption tax is a reform that brings the burdens of households who are raising families more or less in line with their medical costs. The rich are paying more than they consume under the present system and under any reform plan. In the 1996 health insurance system, it is shown that an imbalance of the benefits and burden of medical services was created across generations and that the imbalance was growing rapidly due to the aging of the population. (pages 83 - 112)
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The Volume-Outcome Relationship in Japan - Koichi Kawabuchi, Shigeru Sugihara
DOI: 10.7208/chicago/9780226903248.003.0006
[percutaneous transluminal coronary angioplasty, acute myocardial infarction, hospital volume, health care, physician, risk adjustment]
This chapter explores the link between the number of percutaneous transluminal coronary angioplasty (PTCA) procedures performed and negative medical outcomes among acute myocardial infarction (AMI) patients in Japan. A physician in a high-volume hospital does not necessarily perform a large number of PTCA procedures. One possibility is that hospital volume has a significant effect on physicians' outcomes. The other possibility is that unobserved common factors affect hospital- and physician-level mortality rates while physician-level mortality is independent of hospital volume. Moreover, it is found that hospital volume does not seem to be an additional contributing factor to the higher quality of health care. The volume effect operates not at the hospital level but at the physician level. Risk adjustment is important for the assessment of the quality of health care. No spillover effects nor organizational skill are observed as represented by hospital volumes. (pages 113 - 146)
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Market Concentration, Efficiency, and Quality in the Japanese Home Help Industry - Yanfei Zhou, Wataru Suzuki
DOI: 10.7208/chicago/9780226903248.003.0007
[market concentration, service quality, cost savings, home help services, Japan, care providers, elderly, market-oriented reforms]
This chapter addresses the influence of market concentration on the quality and cost of home help services in Japan. It employs cross-sectional data to examine the effect of market concentration on the quality and cost of home help services. Care providers in highly competitive markets are providing better services. The impact of market concentration on service quality, if one exists, was quite limited in 2000. The statistically significant negative coefficient on the market concentration index indicates that the number of care providers per thousand elderly is negatively associated with cost. Market competition induces cost savings in the home help care market. It is generally suggested that there are no foundations for the concern that market-oriented reforms will sacrifice quality in the name of cost savings. (pages 147 - 164)
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A Comparison of the Quality of Health Care in the United States and Japan - Haruko Noguchi, Yuichiro Masuda, Masafumi Kuzuya, Akihiko Iguchi, Jeffery Geppert, Mark McClellan
DOI: 10.7208/chicago/9780226903248.003.0008
[treatment patterns, health care quality, acute myocardial infarction, United States, Japan, elderly, high-tech treatments, Cooperative Cardiovascular Project, intensive procedure]
This chapter evaluates the differences in treatment patterns and the relationship between treatment patterns and health care quality among acute myocardial infarction (AMI) patients in United States and Japan. The Cooperative Cardiovascular Project (CCP) patients tend to be more aggressively treated by beta-blockers than Japanese patients, and it is observed that collaborative medical centers in the data tend to perform intensive procedures more often. There is significant heterogeneity among patients and in treatments that could influence the quality of care among elderly AMI patients. It is also found that high-tech treatments would significantly enhance patient outcomes and would increase hospital expenditures. CCP patient who undergoes an intensive procedure tends to stay in a hospital longer compared to the one who does not, while a patient who undergoes an intensive procedure in Japan is inclined to stay in the hospital for a shorter period. (pages 165 - 194)
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Geography and the Use of Effective Health Care in the United States - Jonathan Skinner
DOI: 10.7208/chicago/9780226903248.003.0009
[medical practice patterns, acute myocardial infarction, financial incentives, Georgia, Atlanta, Macon, beta-blockers]
This chapter describes the variation in medical practice patterns across geographic regions of the United States. There appears to be a missing link between the potentially large benefits of effective care for heart attack patients and financial incentives to pay for them. At least in Georgia, the use of beta-blockers in a community is not positively linked with the presence of a medical school. Atlanta and Macon display beta-blocker use well below the state average. The supply of cardiologists appears to be weakly connected with the use of beta-blockers, but not with an average of four quality measures. Regions with a higher prevalence of cardiovascular disease are more likely to adopt the use of beta-blockers and to experience higher average rates of effective care for acute myocardial infarction. (pages 195 - 208)
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Does Caregiving Affect Work? Evidence Based on Prior Labor Force Experience - Kathleen McGarry
DOI: 10.7208/chicago/9780226903248.003.0010
[caregiving, labor force behavior, women, leisure, employment, elderly]
This chapter explores the influence of caregiving on the labor force behavior of women. Little relationship between previous employment and later caregiving is found. Caregiving seems to be a relatively temporary state for many women. The sex distribution of siblings does not affect work behavior. It is noted that women seem to reduce on leisure rather than work when providing care to an elderly parent. The results of a multivariate analysis similarly fail to support a strong relationship between labor market ties and caregiving later in life. In addition, having a parent who needs care does not influence employment behavior, and lagged labor force participation does not affect current caregiving. The task of providing care to an elderly parent may have large negative effects on caregivers in terms of emotional well-being. (pages 209 - 228)
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Conjoint Analysis to Estimate the Demand for Nicotine Replacement Therapy in Japan - Seiritsu Ogura, Wataru Suzuki, Makoto Kawamura, Tamotsu Kadoda
DOI: 10.7208/chicago/9780226903248.003.0011
[nicotine gum, Japan, smoking cessation, nicotine replacement therapy, cigarettes, medical insurance, health capital accumulation]
This chapter addresses the demand for nicotine gum in Japan. It explores the smoking cessation assistance policy with nicotine replacement therapy (NRT) using original survey data gathered in late 2001. A high price is preventing the diffusion of nicotine gum. The price of nicotine gum had a negative effect on nicotine gum purchasing, the price of cigarettes had a positive effect, and access to the gum had positive effects on nicotine gum purchasing. The benefits associated with the subsidy for nicotine gum are a decrease in smoking-related illnesses through successful smoking cessation. This would make annual medical insurance payment fall by 67.6 billion yen. When the change in the lifetime medical insurance payments and health capital accumulation are taken into account, 3,300 billion yen should be added to the benefits in the long run. (pages 229 - 246)
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Contributors
Author Index
Subject Index
