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| My national health insurance card and clinic ID card, center, surrounded by my prescription drugs |
For any reader not familiar with US-style clinics/hospitals/Doctor's offices, almost all of these facilities have a waiting room, a reception desk staffed by a secretary, and walls and a door that separate the waiting/reception area from the exam rooms. An appointment is necessary. After sitting in the waiting room (usually at least 15 minutes) and being processed, the patient is called by a nurse and escorted to a private room for an interview. The nurse conducts the medical history interview, checks the patient's blood pressure and heart rate, and gathers all information about the reason for the visit. After this, the nurse asks you to wait in the room for the doctor. Again, the patient must wait for the doctor to come and ultimately provide a diagnosis after further consultation. The file containing all the information gathered from the nurse hangs outside the door until the doctor reviews the information, sometimes consulting with the nurse before meeting the patient. Alas, the doctor provides a diagnosis and the appropriate treatment is recommended. In my experience, I've never gone in and out of the door quicker than 1 hour for common illnesses like influenza or ear infections.
Here is my experience in Japan: After taking note of my insurance information, I answered (with the help of Yuichi) my medical history and explained my ailment to the nurse. This conversation happened in the open waiting room, which could be embarrassing if I had a more private health issue. From this area, I could also see the doctor examining patients as they sat on dentist-like chairs in the exam room. This clinic had two main rooms --the waiting room and the exam room, separated by a wall but still open to one another. The exam room had 3 or 4 chairs each surrounded by their own medical equipment and supplies. Once in the exam room, I shared the room with other patients, with each of us having our own chair. The doctor quickly began examining me and the two nurses in the room looked on while a second patient waited for his turn with the doctor. It didn't take but five minutes for the doctor to explain the cause of my ear pain and he also explained what he would prescribe to tackle the infection. I walked back to the waiting room where I was asked to pay my 30% share of the office visit, 1,800 Yen (about $20 US), and I took my prescription note to the pharmacy next door. At the pharmacy, I again presented my national healthcare insurance card and paid my share of the prescription costs (about $25 US).
You can quickly see the difference. The Japanese system uses a first-come, first served (FIFO) work pod setup which focuses on time, efficiency, and quality. The famously efficient manufacturing processes and techniques pioneered by Toyota automobile manufacturing have been successfully translated to service industries. Personally, I love this system for healthcare. Time is money but, national health insurance aside, I strongly suspicion that having this system in a health environment actually increases the quality of care because more of the physicians time is spent directly with the patient rather than communicating with nurses and reading files. If anyone wants to provide me with a sizable grant, I'll prove that this system will work for the US.
Many debate about the probability of national heath insurance plan would work in the US (as much as I would like it to), but national health insurance itself offers ENORMOUS efficiency here in Japan by completing eliminating the need to bill patients and their private insurance providers. How much in salaries would that save US healthcare providers? In turn, those savings could be passed on to the customers (patients) to further reduce the cost of providing them healthcare. America is a capitalistic society, but when are we going to stop letting for-profit health insurance companies and for-profit pharmaceutical companies strip our wallets when we get sick?
