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Health Care Issues in the United States and Japan

Recent data show wide disparity between Japan and the United States in the effectiveness of their health care systems. Japan spends close to the lowest percentage of its gross domestic product on health care among OECD countries, the United States spends the highest, yet life expectancies in Japan are among the world’s longest. Clearly, a great deal can be learned from a comprehensive comparative analysis of health care issues in these two countries.

In Health Care Issues in the United States and Japan, contributors explore the structural characteristics of the health care systems in both nations, the economic incentives underlying the systems, and how they operate in practice. Japan’s system, they show, is characterized by generous insurance schemes, a lack of gatekeepers, and fee-for-service mechanisms. The United States’ structure, on the other hand, is distinguished by for-profit hospitals, privatized health insurance, and managed care. But despite its relative success, an aging population and a general shift from infectious diseases to more chronic maladies are forcing the Japanese to consider a model more closely resembling that of the United States.

In an age when rising health care costs and aging populations are motivating reforms throughout the world, this timely study will prove invaluable.


"This joint study of Japanese and U.S. health care issues provides insightful perspectives."

Satoshi Shimizutani | Journal of Pension Economics & Finance

Table of Contents

Acknowledgments  ix

Introduction  1
David A. Wise

1. Evaluating Japan’s Healthcare Reform of the 1990’s and Its Efforts to Cope With Population Aging  17
Naohiro Yashiro, Reiko Suzuki, and Wataru Suzuki

2. The U.S. Medical System for the Elderly  43
David M. Cutler and David A. Wise

3. An International Look at the Medical Care Financing Problem  69
David M. Cutler

4. Removing the Instability and Inequity of the Japanese Insurance System  83
Seiritsu Ogura, Tamotsu Kadoda, Makoto Kawamura

5. The Volume-Outcome in Japan: The case of Transluminal Coronary Angioplasty (PTCA) Volume on Mortality of Acute Myocardial Infarction (AMI) Patients  113
Koichi Kawabuchi and Shigeru Sugihara

6. Market Concentration, Efficiency, and Quality in Japanese Home Help Industry  147
Yanfei Zhou and Wataru Suzuki

7. A Comparison of the Quality of Health Care in the United States and Japan: Treatment and Outcomes for Heart Attack Patients  165
Haruko Noguchi, Yuichiro Masuda, Masafumi Kuzuya, Akihiko Iguchi, Jeffery Geppert, and Mark McClellan

8. Geography and the Use of effective Health Care in the United States  195
Jonathan Skinner

9. Does Caregiving Affect Work? Evidence Based on Prior Labor Force Experience  209
Kathleen McGarry

10. Conjoint Analysis to Estimate the Demand for Nicotine Replacement Therapy in Japan  229
Seiritsu Ogura, Wataru Suzuki, Makoto Kawamura, and Tomatsu Kadoda

Contributors  247
Author Index  249
Subject Index  253

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