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Japan's Health-Care System Has Many Advantages, but May Not Be Sustainable

"More than one-third of the workers' premiums are used to transfer wealth from the young, healthy and rich to the old, unhealthy and poor," Ikegami said.

Workers at major corporations pay about 4 percent of their salary to a company-based insurance provider. These premiums are limited to $6,000 a year, but the average salary worker pays $1,931, the government says. Job-based insurance in the United States costs the typical employee $3,354 a year, according to the U.S.-based National Coalition on Health Care.

In Japan, employers pay premiums that match each employee's contribution. In the United States, where health insurance is far more expensive, employers pay private insurers three or four times the amount contributed by each employee.

The self-employed and the unemployed in Japan must pay about $1,600 a year for insurance coverage. In addition, working-age patients are required to make a 30-percent co-payment for treatment and drugs -- the highest such fee in the world. But those payments tend to be relatively low because of the tight lid on costs. If the co-payment exceeds $863 in any month, it drops to 1 percent of additional medical bills.

Hana Mukai, a fashion merchandiser in Tokyo, said she cannot think of anything wrong with health care in Japan.

She takes her son Yugo, 4, to an ear, nose and throat specialist nearly every week during the cold and flu season. They go about 12 times a year, often when her son has a runny nose. She does not need to make an appointment, but has to wait about 75 minutes to see the doctor.

The doctor checks his ears, irrigates his nose and prescribes medicine. The visit usually lasts a few minutes, and it is free. There is supposed to be a co-payment, but Mukai's local ward government covers all medical costs for children, which is common in much of Japan. Mukai says she never buys over-the-counter drugs for Yugo, because prescribed drugs for children are also free.

As for her own health-care costs, she says they are either invisible or negligible. She has never checked to see how much she pays through payroll deductions for health-care premiums. The co-payment for doctor visits is insignificant, she says, since the total bill for most visits comes to less than $30, including drugs.

"I know my medical fee is going to be cheap, so I have never, ever thought about how much it will cost me to go to the doctor," said Mukai, 39.

The health of Mukai, her husband and her son -- and of nearly everyone in Japan -- also benefits from free annual checkups. Japan requires companies to pay for annual physicals for employees.

Local and national governments also push preventative care. Since Mukai is nearly 40, her local ward government has notified her that she can sign up for a comprehensive, and free, battery of tests. Doctors will examine her eyes and teeth, and they will test for colon, stomach and cervical cancer. She will also receive a free gynecological workup.

For her son, an internal medicine specialist and a dentist visit his public day-care center twice a year to conduct free examinations. Once a year at day care, he is examined at no cost by two other doctors for potential eye, nose and ear problems.


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