section of hospital medicine the health care system of japan gregory ruhnke, md, ms, mph section of...

SECTION OF HOSPITAL MEDICINE

The Health CareSystem of Japan

Gregory Ruhnke, MD, MS, MPH

Section of Hospital MedicineUniversity of Chicago

Lancet. 2011 Sep 24;378(9797):1174-82

Cost containment and quality of care in Japan: is there a trade-off?

Hashimoto H1, Ikegami N, Shibuya K, Izumida N, Noguchi H, Yasunaga H, Miyata H, Acuin JM, Reich MR.

• Excellent health status• >= age 65 from 9% in 1980 to 23% in 2010• Nationally uniform fee schedule• 3500 insurers (majority private)• Fee schedule adjusted based on volumes• Prices for services are low• Frequent outpatient physician visits• Reliance on the family

Key Components


# surgical procedures requiring general anesthesia per 1000 population

Japan 18USA 39


# MDs and nurses per hospital bed

MDs NursesJapan 27 117OECD 100 249


Specialization of physicians:

Physicians can proclaim any subspecialty at their discretion.

General practice has not been recognized as a specialty.


Quality of Care


Low post-surgical mortality rates

Consolidation of services to maximize volume

81% of surgical procedures at hospitals with >200 beds, which comprise only 17.5% of hospitals


39% among time-limited cert MDs

23% among time-unlimited cert MDs


Thank You

section of hospital medicine the health care system of japan gregory ruhnke, md, ms, mph section of...

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