PEDIATRICS Vol. 86 No. 3 September 1990, pp. A44
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JAPANESE EURYTHMY

Edgar K. Marcuse MD

The organization and operation of Japan's health system reflects the quest for harmony and balance, or eurythmy, of Japanese culture. While Japan's economic success has attracted considerable attention among management scientists, the health care system that fuels and nurtures the health status of its hyperproductive workforce has not been a topic of much interest...At a time when American policymakers are paying considerable lip service to the notion of "universal" health benefits, it is wise to look beyond Canada and Europe for examples of practices that work...

Some Facts About Japanese Health Care

• In less than 40 years, Japan has achieved the world's lowest infant mortality rate and the highest longevity figures.

• Japan spends only about 6.5 percent of its gross national product on health.

• The average hospital stay is more than 35 days, and the average person visits a physician 15 times or more each year.

• More than 25 percent of all health care expenses are for drugs.

• Solo private practice physicians generally do not have hospital privileges.

• Groups of either single- or multispeciality (physicians) do not exist.

• All medical services are fee-for-service with nationally set charges and no prepayment.

• Physicians own and run most of the nation's hospitals.

• Health maintenance organizations (HMOs) and prepaid care do not exist.

• Japan has the fastest-aging population in the world.

Japanese health care is delivered, financed, and managed in a sociological environment in which excellence is expected, harmony cultivated, and conflict resolved through negotiation.