Mark Wilson discusses the healthcare system in Japan and gives you some tips

Situated in the north Pacific, and composed of four main islands, Japan has a health care system to be proud of. Its success reflects its economic prosperity over the past 50 years. Despite this, Japan is not a popular elective destination (probably because of the language). This article gives a potted background to Japan's medical system and provides information on where to start looking if planning an elective.

Japan's healthcare system

Japan has a first class healthcare system, possibly because it is the second highest spender per capita on health care (8% of its national income). Infant mortality is one of the lowest in the world and longevity is one of the highest (77 years for men and 84 years for women).

In 1961, Japan set up the universal medical insurance system. This is four different insurance schemes, two of which are the employee's health insurance (covering the working population) and the national health insurance (covering unemployed people). These schemes are further subdivided but cover 99% of the population overall. All schemes entitle patients to hospital care at any centre they choose, but they still have to pay deductibles and copayments (a proportion of the total cost, usually 10-30%). This system works well; however, Japan's economic slow down and the rapidly ageing population may soon cause problems. Citizens outside of the universal medical insurance system are covered by a means tested welfare system. There are national hospitals and sanatoriums that cater for a limited number of conditions and cases.

There are 9400 hospitals in Japan of which 80% are privately owned but are run on a not for profit basis (they can make a profit but they cannot give it to shareholders). The remaining 20% of hospitals are publicly owned; they account for 34% of beds.

Interestingly, despite the high expense, Japan does not have a high doctor to patient ratio (1:600). Once admitted to hospital, however, patients tend to stay much longer than they would in similar Western hospitals.

In addition to the ageing population, Japan is also trying to tackle healthcare in remote regions, especially on smaller islands. An elective on one of these would be very different to one in a city teaching hospital, as described by Philip Alexander.

Visas and medical schools

For information on visas contact The Embassy of Japan, 101-4 Piccadilly, London W1V 9FN (tel 020 7465 6500; fax 020 7491 9347; email info@embjapan.org.uk; www.embjapan.org.uk).

A full list of medical schools is in The Medic's Guide to Work and Electives around the World and on www.medicstravel.com In addition http://dir.yahoo.co.jp/health/medicine/hospitals/directories lists hospitals with an internet presence. Another good place to start finding out about the Japanese healthcare system is the Japanese Ministry of Health at www.mhlw.go.jp/english

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