Japan has a universal healthcare system funded by insurance on a
co-payment scheme. The two broad categories are employee insurance
and national health insurance (a third, elderly health insurance is
being worked up). All citizens have to be enrolled on one of these
insurance schemes.
It is not cheap. If you go to hospital, you pay 20% of the medical
fee from your pocket and the remainder comes from the national
medical insurance. On top of that, you pay premiums for the
national medical insurance, the amount varies according to your
location and annual salary, up to a maximum cap of 530,000 yen per
year or about S$7,329 per year. You also need to co-pay medication
costs and this insurance excludes fees for normal baby delivery and
injuries caused by a third party. However, you are free to go to
any hospital in Japan for your treatment. The hospitals are paid a
fixed fee for the services and that is capped by the
government.
A universal health insurance system like in Japan sounds great but
when you look into it further, we see that they are suffering from
escalating deficits because of an aging population. As a result,
they had to raise the amount of co-payment (ie, cash up front from
your pocket). Increasing premiums for all is not acceptable to the
electorate and so the move will be towards increasing the
co-payment amount and in keeping with our government's argument
about personal responsibility. I agree there is a limit to
everything but I feel that smokers and drinker should have to pay
more health insurance premiums if we have a universal medical
insurance plan.
A universal health insurance system is in line with socialist
values like having the rich pay more to support the poor but of
course, this might encourage the rich to set up shop in places like
Hong Kong. This may erode our economic competitiveness....are we
prepared to accept that?
What I think we can learn from the Japanese is the removal of all
distinctions between public and private hospitals because with a
universal healthcare system private hospitals will not have any
customers apart from foreigners. As a result, they have bought into
the national healthcare system too and accept the fixed rates
prescribed by the government. The huge discrepancy in pay between
doctors in the private and public sectors has resulted in a
situation where two-thirds of our doctors are over-servicing just
one-third of the population in the private sector.