---

---

---

---

---

---

---

---

---

---

---

---

---

Not all smiles
Japan’s health-care system is the envy of the world. It is also in crisis

---

---

“The system’s inefficiencies could be tolerated in a period of high growth, but not in today’s climate of economic stagnation.”

Doctors are too few—one-third less than the rich-world average, relative to the population—because of state quotas.

The Japanese are only a quarter as likely as the Americans or French to suffer a heart attack, but twice as likely to die if they do.

Some doctors see as many as 100 patients a day. Because their salaries are low, they tend to overprescribe tests and drugs. (Clinics often own their own pharmacies.) They also earn money, hotel-like, by keeping patients in bed. Simple surgery that in the West would involve no overnight stay, such as a hernia operation, entails a five-day hospital stay in Japan.

Emergency care is often poor. In lesser cities it is not uncommon for ambulances to cruise the streets calling a succession of emergency rooms to find one that can cram in a patient. In a few cases people have died because of this. One reason for a shortage of emergency care is an abundance of small clinics instead of big hospitals. Doctors prefer them because they can work less and earn more.

The system is slow to adopt cutting-edge (and therefore costly) treatments. New drugs are approved faster in Indonesia or Turkey, according to the OECD. Few data are collected on how patients respond to treatments. As the Lancet says, prices are heavily regulated but quality is not.

---

---

---

---

---