Doctors in Japan

Stippy.com posted an article about Japanese medicine horror stories the other day. The comments have been humorous and frightful. Below is my recent comment regarding some problems with the Japanese medical system:

A few institutional problems with Japanese medicine:

There is no national accreditation for doctors, rather a system of cronyism. I don’t know what universities have medical schools, but, for example, if you graduate from Toudai or Keio, you have the ticket to job as a doctor - no matter what. Even if you are a lousy doctor or have numerous malpractice claims or a high patient mortality rate, you will be able to continue to practice. Just like anything else in the Japanese system, a person’s pedigree and education connections are what count.

Another problem with Japanese medicine is rather simple: socialized medicine. Doctors in high-rent Tokyo are paid the same rate by the government as low-rent doctors in Shikoku. This puts some customers at a disadvantage simply because of economics realities. In order to make sufficient money to pay the light bill, doctors in high-rent districts have to keep costs down and one way to do so is to funnel the patients through as quickly as possible. That is, unless he can get them into the hospital (more below on hospitals).

These two factors are significant disincentives for doctors to provide excellent service. Add to the mix sub-standard medical training and you get the current Japanese medical system. I think good Japanese doctors are anomalous. Those that do provide good service are probably either highly self-motivated individuals or trained in the West or both.

A couple other interesting facts:

Japan’s sharei system is rather simple. If you want good service or the hoped for outcome of your surgery, you pay the doctor a bribe (sharei). Sharei is the incentive not provided by the official system and apparently can be an effective means of ensuring good care.

Japan has one of the longest average hospital stay lengths in the world – seems like it’s close to a month. When I was in Japan, I recall people staying in the hospital for ridiculous lengths of time – weeks at a time for minor illnesses or a month before childbirth with a normal pregnancy. I suspect from the doctor’s point of view, if he can keep them in the hospital, he can keep billing.

I recall Tim Clark and Carl Kays’ excellent tome, Saying Yes to Japan, explores the problems with and potential solutions to Japan’s troubled healthcare situation.

Finally, the US has plenty of healthcare problems too. Usually, at least in my case, the problem is more with the insurance side of the equation, but I’ve had my share of incompetent doctors too. But here, terrible doctors are the anomaly – the reverse of Japan.