HEALTH CARE A Year of Smoke and Mirrors

Back to Contents of Issue: January 2003

-- John Wocher, executive vice president of administration at Kameda Medical Center

THE YEAR 2003 WILL most likely be a transitional one for health-care reform in Japan, as diagnostic related groups (DRGs), mandatory internships and specialty certification for physicians loom on the horizon in 2004 and beyond. With the deregulation initiatives (iryo tokku) solicited in October of this year getting severely watered down, I don't expect any major breakthroughs to occur. It seems clear that the issues of for-profit health-care delivery, emergence of a competitive private health insurance market and the commingling of charges between patient and national health insurance have a chance between slim and none. Giving the nonprofit health-care sector a modified tax exempt status seems to be impossible.

I also see very little meaningful deregulation efforts to allow hospitals to import medical supplies and devices directly from the country of origin. The current practice of sole source (exclusive distribution) for most key medical equipment made abroad is still monopolistic and will probably continue.

I anticipate no changes to physicians being licensed for life, no mandating of a third-party accreditation of hospitals based on an evaluation system, no mandatory continuing medical or nursing education requirement (except for an initiative to be introduced in 2004), no widespread adoption of giving medical staff credentials and privileges (except in progressive hospitals), and little legislative support for letting patients have mostly unrestricted access to their medical records.

However, the good news might be in the IT sector. Electronic medical systems are proliferating, helping to prevent medical errors. But in short, 2003 will be a year with more bark than bite, and a year of more uncertainty regarding health-care reform. Hoping to be wrong on all counts.

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