Japan as a model

The cost of in home long-term services continues to rise and the future costs are only expected to increase at an even higher rate. Several articles have looked to robotics as a way of taking care of the elderly and disabled and profiled Japan recently.  This weekend, the New York Times had an interesting piece:

Last year in Japan, where robots are considered “iyashi,” or healing, the health ministry began a program designed to meet work-force shortages and help prevent injuries by promoting nursing-care robots that assist with lifting and moving patients.

Robots are fascinating and while this technology continues to develop, it reminds us that Japan has innovated beyond mechanically in their health care system. Japan uses all payer rate setting to control the cost of health care and for all intensive purposes, their system has maintained a low rate of growth.  See below:

Country Health Care Percent GDP in 2000 Health Care Percent GDP in 2008
Japan 7.7 8.5
US 13.7 16.4

Naoki Ikegami and Gerald F. Anderson wrote an interesting Health Affairs article in 2012 about their rate setting policies. While the health care system in Japan has a fee-for-service model which typically drives usage, the rate setting is keeping costs down. In order to revise the fee schedule the government looks at overall rate of increase paying special attention to drugs and devices then takes into account item by item revisions. The government doesn’t do global rate decreases because that would be politically impalpable. Interestingly, Japan combines their hospital and physician fees for inpatient care which makes sense and reduces overbilling.


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