With the COVID-19 continuing to spread like wildfire worldwide, it is not surprising that foreigners living in Japan who have never even visited a doctor here have begun to wonder what it is like to be hospitalized in Japan.
Having just returned home from a two-and-a-half-week stay at one of Kyoto’s major hospitals for an ailment unrelated to the coronavirus, I think my personal story might be of some interest to Japan healthcare neophytes.
A Trip to the Hospital
One morning during the first week of February, I woke up as usual and was sipping my starter cup of coffee after booting up my computer. However, I suddenly felt a bit odd, and started experiencing a pain deep in my stomach. So I went back to bed and stayed there all day without eating anything.
In the middle of the night, I suddenly started vomiting repeatedly. I stayed in bed until the second evening, when my wife finally convinced me to go to an emergency ward.
We made it by taxi to the nearest general hospital, which was more or less closed down. They did take an X-ray, though, which showed that I had a serious obstruction of the lower intestine, an ileus in medical terms. In other words, anything I ate had no way of getting out. The doctor on duty at that hospital said they could not do anything at that time and said we should go to the Kyoto Daini (No. 2) Red Cross Hospital not far away in the Marutamachi district. So we were off by taxi once again.
More tests and consultations. Then, after about an hour, it was decided that since someone else was already in emergency surgery, I would have to go to the main Kyoto Daiichi (No. 1) Red Cross Hospital near Tofukuji. This time, my wife and I were sent by ambulance with a doctor along. Funny enough, I still did not feel particularly nervous.
It was only when we got to the emergency room and someone asked about my religion — Was I a Protestant, Catholic, Jewish, Buddhist, or something else? — that it began to dawn on me that I was in a proper fix.
But for me that question was a real curveball. Although I would vehemently deny being an atheist, how could I describe my religious orientation? A fallen-away Catholic with deist characteristics? A philosophical Buddhist? A would-be Taoist adept? A born-again Manichean? A 21st-century seeker?
My wife answered in my stead, “He’s nothing.”
So be it, I thought.
Dust to dust. A proper state of mu.
A Hospital Week to Think and Observe
Well, to dispense with the drama, let me just say that in the emergency room they stuck a tube through my schnozz to drain my stomach and hooked me up to an intravenous drip — my bosom buddy for the next couple of weeks. The doctor quickly determined that I would have to be operated on to clear the obstruction.
Luckily, although I had also suffered an intestinal hernia, nothing had burst. However, the sides of the intestines were adhering and my guts had gotten all tangled up.
Because of a backlog of patients waiting to be operated on, and an intervening weekend and national holiday, I could not be operated on for roughly a week. So for that week I sat in my hospital bed, feeling no pain but getting all my nourishment through the IV drip.
One factor that alleviated the tedium was the fact that attached to the hospital was a nurses’ school. So I enjoyed a seemingly unending cavalcade of friendly young nurses taking care of me. I was also ambulatory, so I got to walk around the halls quite a bit.
Now, it just so happened that my hospital stay coincided with the spread of the coronavirus to Japan and the Diamond Princess saga that played out on television. It was a strange, almost out-of-body sensation indeed to be in the hospital for something totally unrelated and observing with dispassion a global epidemic increasingly threatening to become a pandemic.
But it gave me a good deal of time to consider the advantages of the Japanese health insurance system as compared to my native United States.
Comparing Healthcare Systems in Japan, U.S., China
I do not know the intricacies of the Japanese national insurance system. As the spouse of a Japanese, I am covered by the basic form of the insurance, under which the patient pays a certain percentage of the medical bills, with personal circumstances being taken into account.
The Japanese system admittedly does face serious financial problems, especially as the population ages. But all residents of Japan are required to have insurance, and the government vigorously tries to keep a lid on costs, including for prescriptions. Everyone is covered, regardless of preexisting conditions or economic status. Perhaps most important, for-profit corporations are not allowed to operate hospitals; they are managed by doctors themselves.
Japan ranks first in the world for life expectancy and is among the healthiest countries in the world. It is the only nation with a population of over 100 million in the top 10 for healthcare systems.
Contrast that with the scandalous situation in the United States, where tens of millions of people lack any health insurance, and in the worst cases the size of your bankroll determines whether you live or die. Of course, the rich can get high quality medical care anywhere in the world, but shouldn’t a society be judged by how it treats its citizenry as a whole? The United States, in fact, is the only high-income nation lacking a universal healthcare insurance system.
In 2016 the United States spent $3.3 trillion USD, or 17.9% of GDP, on healthcare, yet studies consistently show that the U.S. healthcare system is among the least efficient in the world. It has the highest per capita healthcare expenditures of any country, yet ranks last among developed countries in terms of outcomes. In addition, an estimated 27.5 million Americans, or roughly 20% of the workforce, have no health insurance or poor health insurance with astronomical deductibles. Many of them are food service workers or drivers who constantly come into contact with the public.
Recently, the Miami Herald reported the case of a Florida man with insurance, who, upon returning from a recent trip to East Asia, went to a hospital to make sure he had not been infected by the coronavirus. He opted for a simple blood test and nasal swab, since he feared the cost of further testing. His bill came to $3,270.
Most Americans do not have funds set aside for an emergency. And the many involved in the gig economy and service industry who lack sick leave have no option but to go to work even when they are sick. Heaven only knows what will happen if the spread of COVID-19 gets out of control.
According to a report from the Federal Reserve Board, only 61% of Americans would be able to cover a $400 unexpected emergency with savings. Tellingly, polls show that Americans are more afraid of being saddled with huge medical bills than actually becoming seriously ill. Hospitalization can destroy a family’s finances, deplete savings, reduce retirement savings, necessitate borrowing — often in the form of high-interest credit card debt — and destroy a person’s personal credit rating. Those who cannot pay are routinely handed over to the tender mercies of collection agencies.
As a result, sick individuals do not take prescribed medicines and view seeing a doctor as a last resort.
I lived in China for three years and heard many horror stories about hospitals refusing to treat patients unless they paid cash up front. But is the U.S. system really much better?
Putting the Japanese Healthcare System Into Perspective
I don’t want to give the impression that Japan is a healthcare paradise, however. Having lived in Japan for roughly 30 years — although not continuously — this was hardly my first encounter with the Japanese medical care system.
Most of my experiences have been good, and I would not hesitate to visit a Japanese doctor. [RELATED STORY: All Eyes on Japan’s Long-term Health Care Innovations]
However, any nation is made up of individuals, and any profession anywhere has its dullards and sluggards as well as top-notch professionals. And it is rare to find anyone without his or her own preconceptions or prejudices.
Therefore, in writing this column, I feel I would be remiss if I did not note a couple of my less agreeable experiences. When I was living in Tokyo decades ago, I fell and cut my elbow rather badly, and the wound subsequently became infected. The young doctor I saw at a major university hospital did not really seem to have his heart in the job and more or less went through the motions. Initially, he prescribed antibiotics, but when they did not work, decided to operate to clean out the wound, using a local anesthetic.
The only problem was he did not give a strong enough dose, so I definitely felt the scalpel incision. I still remember one of the nurses scolding that doctor, “You went and did it again!”
Not very reassuring to a patient.
Then there was the time, also in Tokyo, when I took up scuba diving. After a practice session in a pool, I became totally disoriented. I went to see an ear, nose, and throat specialist — a cool, young guy who frequently went diving in Hawaii, where I was from. His examination found that I had acute sinusitis and nose polyps that could be corrected through surgery.
When I was going through the pre-op tests, the head nurse in the department — who seemed just like a Japanese version of Nurse Ratched from One Flew Over the Cuckoo’s Nest — loudly demanded that I be given an AIDS test. (It was at the time of the worldwide AIDS scare). The doctor laughed and said it was not necessary, but she insisted, bellowing, “Gaijin dakara (Because he’s a foreigner).”
(Now, I fully realize the term gaijin is not necessarily derogatory, but the way that Florence Nightingale spat it out left no doubt in my mind that in this case it was meant to be.)
So my conclusion is: medical care in Japan is among the best in the world. But when you get down to it, life is a crapshoot, isn’t it?
Author: John Carroll