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Learning from a Healthcare System Where Prevention Gets Priority

College of Public Health Dean Laura SiminoffLaura A. Siminoff, Dean of the College of Public Health and Laura H. Carnell Professor of Public Health, says there are lessons to be learned from a healthcare system that's designed with prevention in mind.

Often it is the unexpected that teaches us the most. On a recent trip to Japan I came down sick, and without a regular physician to see, I went to the central hospital in Hiroshima. My unforeseen visit offered a striking vision of what the United States’ healthcare system could be.

When I walked into the hospital’s waiting area I was startled: there was hardly anybody there. This was the primary hospital in one of the largest cities in Japan. Where were all of the patients?

The answer was simple: they were receiving prompt, efficient care in non-emergency outpatient settings. I was quickly seen by a physician, given outpatient treatment and prescriptions, and was on my way. A visit that in the United States would have cost thousands of dollars was instead the equivalent of less than $200. That’s because costs for healthcare services and drugs are set by the government, so no matter who or where you are, you get the same essential high-quality treatment, at the same price.

Another reason the visit was so affordable: all Japanese citizens are required to have health insurance coverage, which lowers costs for everybody. Because it is easy to access care,  the average person sees a doctor thirteen times each year. That’s thirteen opportunities to receive preventive care, and to address health issues before they become more serious and more expensive to treat.

In the United States, we attempt to discourage these visits through high co-pays and deductibles—that’s because any care received is expensive and specialists are overused.  In Japan, visits are used to maintain individual health. And this contributes to better population health: Japanese citizens have the world’s longest life expectancy and the world’s lowest infant mortality rate. But per capita the country’s healthcare costs are about half of those of the United States. By and large, this is a model that works.

To me, though, the most illuminating thing about healthcare in Japan is how the country is addressing the parts of the system that don’t work. Doctors are overworked, don’t spend enough time with patients, and over-prescribe medications. Meanwhile, the country’s aging population means that the system in its current form is at risk of becoming overburdened. Some of these issues sound strikingly similar to our own.

But the Japanese government is taking a proactive approach. Rather than treating their citizens’ health as a political football and scrapping the current healthcare system altogether, Japan is convening panels of health policy experts and using patient interests as a guide. The country is placing new emphasis on home care, integration of healthcare services, early intervention incentives for care providers, and other approaches whose effectiveness is backed by public health research.

In other words, Japan is implementing solutions that improve patients’ health and drive down costs, all while strengthening (rather than abandoning) the universal healthcare model. Perhaps it really is true that the best care is driven by research-based policy—and that an ounce of prevention is worth a pound of cure. The United States would be wise to take note.


Posted:  February 16, 2017