Please respond in a discussion board post format to the below text: Short Paper

Please respond in a discussion board post format to the below text:
Short Paper #2
There are four components worth considering when analyzing how effectively a health system offers access to care. According to the Agency for Healthcare Research and Quality, these elements include coverage, services, timeliness, and workforce. Inequities arise when a health system does not perform well in any of these categories. In Japan, the health insurance system provides universal coverage for a wide range of services. Although this may seem desirable, the nation has struggled to contain costs, thus producing a system that is both overutilized and unsustainable (Elements of Access to Health Care).
The average Japanese citizen visits the doctor 12.8 times a year, which is three times as much as Americans (Matsuda, 2019). There were 1.7 billion claims from all medical facilities last year for a population of 130 million (Matsuda, 2019). Some patients come into the office for something as simple as a blood pressure read (Reid, 2008). In Japan, there is no system of gatekeeping, therefore the patient can go in to see any specialist of their choosing without needing a referral from their primary care physician. Additionally, the government sets the fee schedule for the entire country and does not charge specialists at higher rates (CNN, 2009). In addition to an overuse of outpatient care, Japan has longer hospital stays relative to the U.S. As a result of this overutilization, 50% of hospitals are going into debt (Palfreman).
Japanese health system receives a considerable amount of tax subsidy. As such, it is dependent on a strong workforce. Unfortunately, that is not the case. The population in Japan is rapidly aging, with those over the age of 65 accounting for 27.4% of the population. As the distribution of the elderly population increases, the social security expense also rises. The workforce, on the other hand, is shrinking. Japan is experiencing a negative growth rate of -1.06%. Additionally, the fertility rate has dropped from 1.75 in 1990 to 1.43 in 2017. A few stipulations for this decrease are from fewer people getting married or getting married at an older age, as well as more women having their firstborn child at an older maternal age. In essence, the increase in users coupled with a decrease in taxpayers makes for an unsustainable system (Reid, 2008).
Japanese Statutory Health Insurance System (SHIS), offers coverage to 98.3% of the population. The remaining 1.7% are insured under the Public Social Assistance Program for low-income residents. Under this system, there is minimal cost-sharing. Although there are no deductibles, enrollees do pay a coinsurance of 30% for all health services and pharmaceuticals. The only members except paying coinsurance are children, adults age 70 and older, and low-income individuals. There is, however, a monthly out-of-pocket maximum for services. Providers are also prohibited from billing above the national fee schedule set by the national government. As a result, no one in Japan becomes bankrupt over paying off medical bills (Tikkanen,, 2020).
The Japanese government mandates that all SHIS plans offer the same benefits package. This includes hospital visits, primary and specialty care, mental health care, prescription drugs, home care services, hospice care, physical therapy, and most dental care. The Japanese do not face an issue with accessing care, whether for preventative or specialty services. In fact, the Japanese can see a specialist without the need for a referral. The fee to see a specialist is comparable to seeing a primary care provider, therefore the Japanese can demand services without the presence of a gatekeeper. Additionally, unlike in America, the Japanese prioritized preventative care. Under the SHIS, preventative services such as screenings and health education are all covered. This emphasis on preventative care explains how Japan ranks competitively in various health indicators including life expectancy and infant mortality (Tikkanen,, 2020).
In summation, Japan is arguable the healthiest nation in the world, surpassing all developed countries in health indicators such as life expectancy and infant mortality. One could argue that this is because, unlike the U.S., Japan prioritizes preventative medicine. The SHIS insures enrollees seeking screenings and health education, as well as a variety of specialty care. The nation controls costs by setting a national fee schedule that providers must adhere to. All health care systems, however, are not without flaws. The health care system is burdened by unnecessary office visits. The average Japanese citizen visits the doctors three times more than the average American. This is because the health insurance system allows the Japanese to visit the doctor with financial ease. There are no constraints to accessing a primary care provider or specialty physician, given that the national fee schedule is comparable for both. This overuse burdens an already unstable system, as the SHIS is heavily subsidized with taxpayer dollars. The workforce in Japan is shrinking and the elderly proportion of the population is growing at a rapid rate. With age comes chronic disease that requires expensive treatment as well as social security expenses. When considering the components of accessing health care, the Japanese excel at both coverage and services. However, the growing cost of medical care will be harder to cover when there is a greater need for insurance among the elderly and fewer reinforcements made by the workforce.

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