SECTION OF HOSPITAL MEDICINE The Health Care System of Japan Gregory Ruhnke, MD, MS, MPH Section of Hospital Medicine University of Chicago

Lancet Sep 24;378(9797): 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

SECTION OF HOSPITAL MEDICINE # surgical procedures requiring general anesthesia per 1000 population Japan18 USA39

SECTION OF HOSPITAL MEDICINE # MDs and nurses per hospital bed MDsNurses Japan27117 OECD100249

SECTION OF HOSPITAL MEDICINE Specialization of physicians: Physicians can proclaim any subspecialty at their discretion. General practice has not been recognized as a specialty.

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Quality of Care

SECTION OF HOSPITAL MEDICINE 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

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 39% among time-limited cert MDs  23% among time-unlimited cert MDs

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Thank You