Country : Hong Kong
Assignment Task:

Every resident of Japan is required, in principle, to take out public health insurance. The system is heavily regulated and there is a combination of semi-private and public health insurance. Regular employees are typically covered by a work scheme and are required to pay 20 per cent of their total medical costs at the point of use (McCurry, 2016).  

Those not covered by their employer – mainly the self-employed and unemployed – must join the national health insurance scheme. Fees are based on salary, the value of a property and the number of dependants, and members pay 30 per cent of the cost of inpatient or outpatient treatment – including emergencies – with the government paying the remainder. People over 70 pay 10% of costs (McCurry, 2016). A typical visit to a GP will cost approximately AU$60 and double this for accident and emergency and patients will pay a percentage of this according to their level of cover (The Commonwealth Fund, 2017). Out-of-pocket spending is 13.45% of total health care spending (The World Bank, 2019). However, the government places a ceiling on the yearly total cost that a person will pay for their medical care, which di?ers based on a person’s wealth. This ensures that medical bills will not be ?nancially crippling (The Commonwealth Fund, 2017).   


Fees are waived for uninsured people on low incomes who receive government support. Public insurance plans cover a range of services, including hospital care, mental health care, prescription drugs, physiotherapy and, significantly, most dental care. The Commonwealth Fund (2017), describes the system as well funded, well-resourced and generous with some of the best medical facilities in the world. The role of the government in providing healthcare services is greater than in many other developed countries. In 2012, 82% of health spending was publicly funded, compared with an OECD average of 72% (McCurry, 2016). Universal health coverage has been credited with contributing to Japan’s impressive longevity statistics, but as in many developed countries, the growing elderly population is adding to healthcare costs. Life expectancy in Japan is 84 years - the highest in the world excluding Hong Kong (World Bank, 2017).   Due to the large elderly demographic, the length of hospital stays is almost twice as long as in other countries (The Commonwealth Fund, 2017). Accordingly, the total amount spent on health care is rising.

Japan spent 8.6% of GDP on healthcare in 2008 and by 2014 this had risen to 11%, largely because of the ballooning cost of caring for older people (OECD, 2015). Some politicians in Japan believe that the current system is not sustainable and that insurance premiums and taxes will need to rise in order to pay for increasing healthcare costs. Despite this, at $4592 per capita, PPP healthcare spending in Japan is not excessively high compared to other developed nations (The World Bank, 2019). On the positive side, Japan has very little regional difference in health care quality and outcomes compared to other nations (Fullman et al, 2018). The part of Japan a person lives in seems to have little effect on their health outcomes. It also has a very low rate of deaths that could have been prevented with adequate basic care, ranked 12th in the world by the Health Care Access and Quality Index. 
System 

Guiding questions for the seminar. 
1. Should access to health care be a basic human right?

2. Why does the World Health Organisation consider Universal Health Care to be such an important issue?  

3. Some lower-income countries such as Cuba achieve comparable health outcomes as higher-income countries such as the USA. What is a valid explanation for this?

4. Which model do you think is the fairest on

(i) the taxpayer

(ii) the patient out of the three systems (single user, two-tier, insurance mandate)? 
 

5. Should health care be rationed or stopped for people who have unhealthy lifestyles such as smokers, illicit drug users and the obese? 
6. Which countries in the examples given have the worst health care? Explain why. 
7. Which countries in the examples given have the best health care? Explain why. 
8. Explain what health care is like where you are from in the context of the issues discussed in the article. 
9. Is there any perfect system of healthcare? Explain your ideas. 

 

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