The Japanese healthcare system: an explanation

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The 101 for the Japanese healthcare system

Japan has had a universal health care system in place since the 1960’s and has enjoyed the benefits of such a system. Coming from another country with a health care system it is something I can appreciate and understand, not just the positives but also the negatives about it.

The problem with Japan’s health care system is 3 fold:

  1. an aging population
  2. low economic growth with high rates of unemployment
  3. a negative population growth i.e. low birth rate

There are plans to change the system into something more sustainable and allows more collective responsibility to ensure it remains stable and sustainable. But what about how the system stands currently?

A post-code lottery

There is an uneven distribution of health care providers in Japan as most clinics are private and it is down to the business to where it should open. As a general trend clinics are only found within built up areas and clinics that specialise in something are extremely rare outside cities. While researching this article, I came across a singular diabetes specialist in Nabari and Iga but there are many clinics that specialise in diabetes in Osaka.

Another example is palliative care which is expected to be the responsibility of the household. An advertisement on the train (of all places) gave commuters information about a palliative care clinic in Osaka and people were reading this and taking that information in.

Cost of healthcare for foreign nationals living in Japan

If you live in Japan, you are required to join the health care system and I will always say one thing: do it. The current system will cover 70% of the costs of any necessary treatment plan e.g. dentistry, internal and external medicine etc. A recent trip to the dentist should have cost me just offer 10,000 JPY but under this system I paid around 3000 JPY instead.

This has a few positives especially for Americans living in Japan. This is a form of insurance that everyone is required to have and if you’re filling US taxes, this does count in the eyes of the IRS.

My monthly cost is just under 2000 JPY and just one visit to the dentist or doctor would be the equivalent to 4 or 5 months work of insurance. It is brilliant for the end user but not for the system. The amount of money that the government spends under this system is astronomical. This is a better system than the UK as everyone has a more direct input into the running costs of health care in Japan, but there is still money being pumped into the system.

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Patient enpowerment

A patients choice is at the heart of the Japanese healthcare system and people are encouraged to give suggestions to policy makers in Tokyo. People have the right to chose which clinic, which hospitals they would like to go to regardless of insurance status, disease or background. There may be a fee incurred but people have that right.

Please note there is also voluntary private health insurance available which helps cover things that national health insurance dies not including: loss of income insurance, transportation, food etc.

Care

There is no difference between primary and secondary care in Japan, even historically. This means that you can go to a clinic or a hospital without a referral, a small clinic may be extremely specialized in an obscure disease but they are located in the smallest town imaginable or have no specialist available within a city.

In Japan there are over 8,400 hospitals and over 100,000 clinics and 80% are privately owned. The system is split into several major sectors: internal medicine, external medicine, dentistry, gynecology, emergency medicine, pediatric medicine and pharmaceutical.

Emergency care

Even emergency care is split into primary care (on call doctors and prefecture run care), secondary care (hospitalization is required) and tertiary care (advanced or more grievous care).

The general pathway for this system is 119 (ambulance) assistance, then hospitalization, the removal to a specialist facility e.g. ICU.

Where to go?

As a general rule of thumb, the guidelines about where to go are:

  • External medicine: injuries and problems of the limbs
  • Internal medicine: anything else e.g. vaccines, non-commutable diseases (cancer, COPD, cancer etc)
  • Dentistry: teeth….
  • Gynecology: females
  • Pediatric medicine: Children
  • pharmaceutical : drugs
  • Emergency medicine: ambulance

There is a lot more information about the Japanese health care system and I can, and really want to, go into so much more detail but this is an overview and a general guide.

Thank you for reading and happy exploring.

Advanced directives in Japan

Not an easy topic but a necessary one.

Please look at this beautiful picture, its nice and pretty and if you are squeamish please try to read this article- its important.

Anything that is in relation to end of life care or dying is NOT popular at all. To be perfectly honest, I do not expect this article to be read but this is (I hope) the start of a conversation, the start of an understanding that will be covered.

Please note, I have not studied Japanese law extensively and as this concerns Japanese law please do consult a lawyer or solicitor to ensure that the information you need is legal and correct. Additionally, at the end of this article and on the further information page of this blog is a like to Advanced directives and the actual form in English and Japanese from the university of Michigan. Let us begin.

What is an advanced directive?

Firstly you will die, one day. That is at the core of an advanced directive- one’s mortality but more importantly one’s choice. You have a choice to make to either have an input into your last days and your funeral or to see what life throws your way.

An advanced directive or living will is a written document that states your wishes regarding end-of-life care (from live extension to removal of support), pain management, organ donation, and postmortem options. The link to the document I have provided includes mental health options, life ending decisions, end of life plans and giving someone the durable power of Attorney of health care.

Why choose an advanced directive?

An example for this is extension of life or allowing one to die in cases of incurable diseases such as cancer, ALS, dementia etc. At this stage, do you want your life to continue regardless of the chance (or lack therefore of) of recovery or allow yourself to die.

What are your personal beliefs? Under what circumstances (or none perhaps) do you believe life is not worth living. What about your religious beliefs? What are your options regarding end of life care or postmortem options?

What about a DNR or DNACPR?

You may be wish to have a DNACPR or commonly called a DNR- do not resuscitate. To add a personal note to this, my mother had a DNR- it was a decision I did not agree with but I accepted her decision. When her time came, the wishes were respected. Additionally, my mother had planned her entire funeral and it progressed exactly as she wanted. Even if no-one were to be at her funeral, it would have progressed exactly the same.

What this comes down to is personal choice. In Japan 58% of Japanese nursing homes have advanced directives (but that is not to say they are filled out) and this allows a person a choice.

The choice is simple: do you want a say in what happens to you if you cannot?

The final note on this article will be a piece of advice from my company. If you die in Japan, all expenses will be your (or your families) problem not the companies. The words used were more of the idea that you don’t have a choice nor a say- live with it. But what happens if you want a say in it? Or want/need a choice.

This is a needed topic to cover in the month of awareness and while leading a health life is one of my core principles, dealing with difficult topics will help either mentally, spiritually, or emotionally. This topic cannot be ignored death is the end of the journey of life.

Thank you for reading and enjoy exploring.

Advanced directive resource https://medicine.umich.edu/sites/default/files/content/downloads/99-10048_AdvanceDirectives_Booklet%28Japanese%29.pdf – advanced directive document in English and Japanese

Final note.

If you are part of the LGBTQ* community an advanced directive allows you to, for example, keep your gender identity after death. There have been cases where trans women have been changed to show them as males rather than females.

Additionally, some countries do not recognize same-sex partnerships and thus, legally, have to follow the directive of the next of kin rather than their partner. An advanced directive and giving someone the durable power of attorney for health care allows their partners to be involved in the entire process and even if your partner does recover, it is a safety net that is necessary even in LGBTQ countries (the US, the UK etc). Please consider an advanced directive no matter where you live!

COPD in Japan

Idamichi

COPD is finally getting the awareness that it needs in Japan. It a problem that the rest of the world is aware of but Japan liked to bury its head. Quick note, why the pretty picture? You’ll need something nice to look at.

The lack of foresight about COPD within Japan was made apparent by the “COPD awareness campaign” advertisements that have appeared in my newspaper recently. What is strange about this is the Victorian impression Japan gives to “curing” diseases but nothing (much) on treatment or prevention.

When I say a Victorian impression- I do mean this literally. In all Japanese newspapers, there is at least 5 companies offering a special product that will help cure X, or help alleviate Y or further improve the quality of life regarding Z. A lot of this comes from the mix of eastern (or Chinese) medicine and western medicine.

I am aware that communities and tribes in Africa, in Asia and south America use traditional medicine. However, Japanese law requires companies to list the ingredients used in the ‘miracle cure’ and most ingredients are either common plant extracts or vitamins and minerals so are mostly useless.

COPD, however, seems to be an unknown concept as the newspaper gives not only the kanji (with the entire reading), not only the international name (COPD), not only some causes behind the disease but the effects it has and where to find additional information- highly unusual for Japan. Kanji reading, for example, are expected to be known by the reader as you are an educated, respected person of culture (again Victorian in attitude). Moving on.

COPD is 慢性閉塞性肺疾患 「mann/sei/hei/soku/sei/hai/shik/kann」. The kanji used (as a quick side note) is fantastic. The Kanji is literally:chronic (first 2 kanji), closed, obstruct, lungs, rapid, disease. But is this a good translation?

COPD 101

COPD is Chronic obstructive pulmonary disease- so the kanji use is quite good. I imagine it comes from either a translation of a western term either recently or just after the collapse of the Tokugawa shogunate. The term is used to describe multiple similar conditions that cause limitation in lung airflow- which is an extremely basic definition of COPD (but this is a blog about cultures not medicine) and even though I am studying medical science I’ll keep it there (which is extremely painful).

COPD is caused (primarily) by smoking, indoor pollutants (the main cause in low-economically developed countries around the world, and cleaning products. Japan has seemingly discovered that smoking is harmful and with the ease of getting cigarettes, there are waking up to a wider problem.

The current campaign is focused on awareness. The advertisements I have seen are the COPD awareness strategies which are ideas like: increasing the warning label on cigarettes, letting people know smoking causes COPD.

But why has Japan been forced to acknowledge this? According to a national survey on the http://www.copd-jp.com, there are over 5.3 million people aged 40 and over that have a COPD and 2.1 million of those are over 70.

People with COPD need to be aware of every activity they would like to do that day (especially in later stages) and elderly people that have advanced COPD may require more help and in a country that has a rapidly aging population, there is immense strain (already) on the health care system.

What can you do about it? Firstly be aware of what COPD is and how to reduce your change of contracting it. COPD is a progressive disease Daily management of the disease is ensuring that you lead a healthy lifestyle.

What does Japan need to do? Simply put, change its’ attitude. Japan is changing and some old culturally accepted practices (smoking for example) are no longer as acceptable as they once where. I just hope that Japan is able to change sooner and avoid a major future problem rather than face additional millions of suffers and try to find a care solution.

On the first day of December I talk about COPD morbidity. Merry Christmas?

Thank you for reading and happy exploring.


Final note, there are still adverts for cigarettes in Newspapers as well as the COPD awareness campaign. This is case and point why awareness in English as well as Japanese is needed and warranted.

Product: Plus Balance

A short review of the “plus balance” health drink

A short review of a new health drink that has hit the market

As I was travelling to work, I came across a new health drink while I was looking for a tasty protein shake. As this new one had a good amount (8 g), I decided to try it and I have to say, its not bad.

Firstly, this was bought from Lawson and they offer the drink in banana and strawberry flavors. When opening the product, it looks rather like a milky coffee but without the expected caffeine hit- I was only slightly disappointed.

Surprisingly, it actually tasted like real strawberries and not artificial strawberries- which was a win- with a slight soy taste. The drink also contains added vitamins and minerals which I did like the idea of.

A slight negative was the amount of sugar in the product but as it was part of my lunch, I didn’t mind as much.

If you can, please check it out- I recommend it (as long as your not allergic to anything in it).

Thank you for reading and happy exploring.

Another plague of Japan: litter

I wish this was a rare sight

As much as I love living in Japan, there are certain things which bug me at times- an example of this would be the cultural expectation to drink. An example of this would be the expression お神酒上がらぬ神は無い- which means even the gods drink sake (and thus you should too).

However, one of the more insidious plagues is the abundance of litter in Japan- which is a rather un-Japanese thing considering that there is a nationwide recycling and garbage disposal program.

The disposal program, looking at Iga specifically, was started in 1996 and the articles in the local paper explained how to separate garbage and what will be done with the garbage. To be put simply, in Iga, garbage is separated into burnable, non-burnable, paper and cardboard items, plastic waste, and pet-bottles and cans.

This is something even I understand. Additionally, if you refuse to take part, you may be fined- along with the shame aspect. But somehow, even with the amount of resources Japan has invested into recycling and waste management, litter is still an issue.

During my journey “the long walk”, and photographed above, litter was unfortunately a common site even in the most remote of locations. The discover of this, encouraged me to look into this further and I have since discovered that litter is not just common in remote areas but in built up cities as well.

While walking through Iga, cigarette ends are common along with plastic bottles, cans and other recyclable materials. The same can be said about Nabari, Tsu, Nagoya, Osaka etc but with one difference: high traffic areas such as tourist areas are extremely clean and without litter.

It seems as if Japan likes to give the appearance of being clean in small villages and around people’s homes, but a bit further afield, such as in the middle of the country or in non-popular areas in cities, less emphasis is given on its’ importance and thus its’ much more common to see.

Is this something you have experienced while visiting or living in Japan?

Thank you for reading and happy exploring.

Health food in Japan

The world of extreams

How long does it take to spot CC lemon?

I have talked about buying protein in Japan very recently, but what I have not yet mentioned is suppliemts, more specifically added vitamins and minerals.

If you were to go to a convience store and go to the drinks section, ignoring the sugar content, there would be quite a few healthy looking options. Admittedly one of my favourites is CC lemon which it’s selling point (on the front and highlighted) is that it contains the same amount of vitamin C as 60 lemons or 200 mg. The body cannot process this amount and a lot of it is lost via urination.

You may think that is a crazy amount, but it’s nowhere near the highest amount. Available at most stores are health tonics in small glass bottles that contain upto 2000 mg of vitamin C.

To put this into prospective, the daily recommended intake for most adults is upto 90 mg a day. If that is the case, does excess vitamin C cause any ill effects?

Yes! Regular amounts exceeding 2000 mg cause gastronomic distress i.e. Diarrhoea, vomiting, cramps etc.

However Japan doesn’t just have products with excess vitamin C, there are products with excess anything.

You may buy wafers with added calcium, wafers with added iron, wilk with added calcium, health drinks with collegen etc. It’s sometimes amazing what extras Japanese producers add to products.

It sounds a bit morbid but: health warming! Be aware of what you are consuming, an excess of a vitamin or mineral for you may have a completely unintentional side affect or may cause you harm. If in doubt either do further research (scientific papers etc), ask a doctor or dietitian or simply avoid it.

After all there’s only one you (and you read my blog, so stay safe)

Thank you for reading and happy exploring

Vending macines: a healthy choice?

Japan, the land of vending machines but is it a cause of ill health as well?

Kirin, one of the major vending machine operators

Japan is known as having a very high number of vending machines serving everything from snacks, drinks, alcohol to books, rice and ice cream. But just looking at 2 typical vending machines, are the choices they offer healthy or not?

The first thing to note about the kirin vending machine is that it offers both hot (red) and cold (blue) drinks, perfect for any season- so the temptation begins.

Of the hot drinks, 2 of the 6 are black coffee, no sugar nor milk so you’re looking at a calorie free drink. The other drinks ar standard hot drinks with milk and sugar so in the 100-200+ kcal range. The other drinks on the bottom row are the same but cold instead, so 3/12 drinks are very low in calories.

Starting from the top right, there’s green tea (few calories); an amino acid and vitamin drink- quite a bit of sugar but tastes good; a standard sports drink to replenish ions (salts); mets lemonade which has few calories and no sugar and tastes great; soda water with no sugar and added minerals; large black coffee–no sugar; large milk tea- with added sugar; oat tea- few calories; lemonade with added sugar and water.

Of that entire selection, the drinks that have sugar in for no purpose are the kirin lemon, and the tea. All the others, excluding the sports drinks, have little sugar. Additionally sports drinks are recommended for extremely hot weather in Japan-sugar and all (it didn’t drop below 30 degrees for 3 months!).

The count: healthy drinks 13/24. Now the last row- summary: there’s three drink with no added sugar/good for you: the fruit tea, the giant Yakut, and the Tropicana.

Final total: 16/36 or 44% of the selection consisting of health drink- that is not to say the others cannot be part of a healthy diet.

A smaller company with its selection

Itô is a much smaller company but I’ll quickly list this companies’ offerings in this vending machine:

  • 6 Japanese teas
  • sports drink
  • peach soda
  • sparkling water
  • water
  • 2 black coffees- no milk or sugar
  • green tea
  • 青汁 (Ao-jiru)- vegetable juice
  • tea
  • Peach soda
  • 2 yoghurt
  • soda
  • lemon soda
  • water
  • vitamin C drink
  • 5 milk coffees
  • 2 black
  • 2 coffees milk no sugar
  • 2 coffees
  • black coffee

This vending machine offers 21 healthier drinks out of a total of 36.

Please note this is a small survey of vending machines but out of a total of 72 drinks, 37 are ‘healthy’ drinks. This is a healthy total of 51%, a marginal majority.

Final thoughts: these vending machines offer some healthy drinks and can be handy if you’re in need in either summer or winter but do be careful. There are some good options but more unhealthy than healthy.

Note on this ‘investigation’

If I expanded this investigation for all the vending machines in Nabari or at least in a larger area for example, ensuring a representative sample (from each company), there would be a much clearer picture.

Thank you for reading and happy exploring.

Review: Axtos gym

A good gym for the price?

I will say I am a member of Axtos gym under the anytime plan with insurance. The reason why I say this is that it costs me just over 10,000 JPY a month to go (and I may have been quite bad in the last month…). But is Axtos worth it?

Axtos offers several levels of membership from daytime (mornings), anytime, professional, to evenings and weekends only. It is a strange system, but the most basic package is 7000 JPY (for daytime), and each additional time that you can go, increases the price. Insurance is an extra 500 JPY a month- but you do get a discount card for quite a few places across Japan.

Axtos in Nabari has a swimming pool, free weights, cardio equipment, Sauna, and general weight training equipment. But there is one VERY importance difference compared to western gyms- etiquette.

You arrive to the gym in whatever footwear you desire, then take them off, put them into a shoe locker and go to the changing room. You only put on your training shoes once you enter the exercise area- want to do yoga or use the mats? Take off your shoes. Forgot something in the locker room? Take off your shoes.

This is a classic example of inside and outside culture in Japan but more likely at Axtos is for hygiene reasons.

The last bit of etiquette is that you are expected to clean any equipment you use (and clean well). This is one policy I wish all gyms in the UK followed so strictly.

Do I enjoy going? Yes, I love it (I’m known as the foreigner who goes to Axtos). Do I think there could be more equipment and weights- definitely? Why haven’t I gone? Lazy/ I did not go with an injured foot (didn’t stop working out without the gym though). Is it the best gym in the world and 100% worth the money- I’ll use the German word Jein (yes and no). Why haven’t I changed gym then?

Nabari doesn’t have much choice and it is the best and most convenient gym in this area.

Overall, (this will sound strange) I would continue to go even if there was another gym. All the staff are professional, I have had some brilliant conversations with people- and seeing a 60-year-old do full on yoga when you cannot touch your toes is humbling. DO I wish it was cheaper, of course but the price ensures that I go (ignoring the last month).

My one word of caution, Japanese only. But if you do have a Japanese friend who’s a member and they refer you, you’ll get a 1000 JPY gift card- it’s a little something at least!

When will I go back? I’m there now- go health month!

Thank you for reading and happy exploring.

Dengue feaver drill: a month on

It just takes a bite……

Is this something that Japan and the world should be concerned with?

As the first global health blog this month, we will look at something that policy makers are panicking about internationally.

Overview of the disease

Dengue fever is a vector-borne infectious disease spread through the bite of a female mosquito. It is a viral infection, which is dependant on the bodies own immunity and possible antivirals to treat if infected.

Why that previous line? Simply put, anti-biotics would be as helpful as taking candy- it would do nothing.

The Drill

Why the panic and the drill in Tokyo? The incidence of Dengue has increased and due to poor health-care systems in LDCs (Least developed countries- the modernisation of 3rd world countries)  the actual numbers of victims (incidence) globally has increased bringing with this a higher morbidity and mortality rate (morbidity is the rate of disease in a population while mortality is the death rate).

There are incidence of Dengue in the Philippines and Thailand- whose populations share close political and economic ties with Japan. What has got Japanese policy makers worried is the world converging on Tokyo next year.

If a major outbreak were to occur, the response from Japanese preparations would be underwhelming. There is information in Japanese from the NIID (National institute of infectious diseases 国立感染症研究所 Koku-ritsu-kan-sen-shou-ken-kyuu-jou) about the principles of treatment for dengue (which is treatment of the symptoms with a 1% mortality rate).

The Japanese policy on dengue can best be summed up by:

“予防には流行地域において蚊に刺されないような予防対策をとることが重要である”

It is important to take countermeasures in areas where mosquito bites are common.

Translated by author

Or prevention is better than cure! There are no outbreak plans I have found- just use repellent and treat what we can.

So while nothing has been said on the Dengue fever drill in Tokyo, possible to keep people calm about the possibility of occurance, it is still important to keep in mind the possibility of occurance.

After all, Zika Virus (from the Rio Olympics) is still a major problem but it is no longer in the public’s mind. Out of site, out of mind after all.

Thank you for reading the first of my international health posts and happy exploring.

The best sources I have found for this is Japanese is:

Japan’s true plague: Alcohol

To drink or to drink, there seems to be no question

The alcohol section at a convince store

Today is the start of the consumption tax increase- which seems to have so many people worried, but I, personally, am wondering will there be an effect on Japan’s systemic drinking culture.

For those of you who were wondering, alcohol addiction is in Japanese (it has a word at least) and it’s: 飲酒癖 in-shu-heki or drink-alcohol-habbit- a 101 of word formation as it were.

The first thing to note about Japan is that it is NOT morally wrong to drink- there has never been a cultural nor religious argument against it, so it is accepted. This can be seen by the myriad of drunks getting on trains, drinking wherever they would like and the common availability of alcohol to those over 20 (we’ll ignore the alcohol vending machines where anyone can by unlike the cigarette vending machines that require a TASPO card).  

Please note, the following information has been taken from the 2016 WHO Alcohol consumption report on Japan with tourist figures removed from the final results.

In terms of pure alcohol Japan consumes the following per capita in drinkers only:

  litres
Males (15+) 19.0
Females (15+) 6.6
Both sexes (15+) 14.1

Please note that most beers in Japan are 5% per 500 ml- so each can has 25ml of pure alcohol. Therefore, if a male were to just drink beer, that equates to 760 beers annually or 63 a month or 16 a week or 2.2 a day. With beer set a about 700 JPY for a 6 pack, that is a massive 88,000 JPY a year or 815 USD.

But the WHO has an even more telling statistic: abstainers- those who have not drunk at all within a set time period. The following table shows the percentages of the entire population who did not drink in 2016:

  Males (%) Females (%) Both sexes (%)
Life Abstainers 4.3 13.7 9.1
Former drinkers* 24.4 42.6 33.8
Total 28.7 56.3 43.0

*’Former drinkers’ was defined by those who have not drunk within the last 12 months.

With a populate on 127 million in 2016, and 48.85% of that being males (world population review),

the total of males who drank alcohol in Japan (out of a male population of 62 million) was just over 44 million males, and 28 million female drinkers which is a total population of 72 million drinkers- more than the entire population of the UK in 2019.

Question 1: does Japan have a drinking problem just based on numbers?

Based on this number alone, it seems to be the case, but what about the numbers of heavy drinkers? There is one more statistic to look at and that is the prevalence of heavy drinking and I will only look at drinkers within the alcohol drinking population not the average for the population.

  Drinkers only (aged 15+) %
Males 53.0
Females 20.3
Both sexes 40.0

But what does this mean- this table looks at the percentage of the drinking population that have drunk more than 60 g of alcohol on at least one occasion in the last month. To use numbers to highlight this further:

Of the 44 million males that drink in Japan, over 23 million have drunk heavily within a month. Of females this is significantly lower at only 5.6 million heavy drinkers. This equates to 28.8 million people regularly drinking excess amounts of alcohol.

Out of the entire Japanese population, this is representative of 23% of the total population drinking excess amounts of alcohol.

What is Japan doing to compact this?

Firstly, drink manufactures like Suntory, Sapporo etc have pages on their websites dedicated to drinking smart. There are taxes on alcohols and government sponsored support available for those who seek it. However, alcohol is readily available and can be drunk wherever one pleases. There is no regal restriction on alcohol advertisement or placing and you can readily but 3 litre sake boxes at the supermarket.

It is a problem that will not disappear anytime time soon.

Thank you for reading and I hope you have a bit more knowledge on another of Japan’s plague.

Happy exploring.

One of the main sources for this article: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/jpn.pdf?ua=1