by liberal japonicus
Below the fold is post 2, about the Japanese medical care system.
The collarbone was a different matter. If you haven't broken your collarbone, it is several times worse. The break was clean, and I went to the clinic that served the HS I was teaching at. I stayed that night at the clinic and the plan was for me to live at the clinic until the bone healed. This was because I was a single foreigner with no family to support me. My Japanese was rudimentary, and so the head English teacher translated, explaining that normally, my family would bring a futon and visit me but because I was a foreigner, they were going to loan me a futon. I slept one nite there and then explained that I could get by, and asked to be released, which they did reluctantly.
This was over 30 years ago, so things have changed. I was asking my wife about this and she said that this sort of arrangment was common (and may still be) in Tohoku, where I was, but other places in Japan, not so much. However, that principle that the hospital is a place you stay and your family comes and visits is one of the first differences between the Japanese and American health systems. Hospital stays are much longer than in the US, and often for much milder aliments. But before explaining that, let's jump ahead 25 or so years to my next brush with the Japanese hospital system
About 5 years ago, one afternoon, I say white flashes in one eye and then suddenly, it was as if someone had dropped a dirty piece of clear plastic in front of my eye. It didn't hurt, so I went to bed and thought it might be better in the morning. It wasn't and because I didn't have classes that day, my wife said I should go and have the doctor take a look at it. I saw the doctor at 11 the next morning. The doctor looked and said, well, you have to go to the hospital. I said I had 3 more weeks of classes, but August, I could probably squeeze it in. He said, no, right now and I checked in to the hospital and was on the operating table having emergency surgery for a detached retina at 2 that afternoon.
Though a detached retina often happens with boxers, mine was the result of getting old. I've always had bad eyes, which is another risk factor, because the flattened shape of the eye causes the retina to be stretched, and the vitreous (the clear fluid in the eye) loses consistency and can pull the retina away from the back of the eye in your 50's.
There are a number of things people could complain about in the Japanese health system, set costs, lack of innovation, but had I not had that surgery, it would have been likely that I would have lost vision in my right eye. The surgery reattaching the retina, like a waterlogged tissue, to the back of the eye, and then removing the liquid from your eye and replacing it with oil. Because the retina floats, it is then necessary to keep your head down 24 hours a day and sleep on your stomach. Because of the possibility that I might turn over and lie on my back while I slept, I stayed in the hospital for 3 weeks and a nurse came by every hour during the night to make sure I hadn't turned over. I can't remember how much we paid (30% of total cost) which we deducted from our taxes. Google told me that it's usually a one night stay in the US and you are released with an admonition not to lift your head. From https://www.visionaware.org/info/your-eye-condition/guide-to-eye-conditions/macular-hole/macular-hole-surgery/suggestions-for-maintaining-face-down-positioning/12345
Unfortunately, Medicare (and therefore many health plans) considers face-down positioning equipment to be "comfort" and "convenience" equipment, and therefore does not provide reimbursement for rental as durable medical equipment.
LMG vitrectomy equipment FY. Then tell me how people without savings afford it.
So I'm pretty kindly inclined to the Japanese health system. But what is interesting is that while the US system is geared to 'efficiency', the Japanese system seems to be built to have you stay. However, in the US, this is a profit opportunity. Because the hospital provides everything, they choose to charge for individual items. Many have heard about wildly overinflated charges for patients in the US and these charges don't exist in the Japanese system. There are things that are charged for. At the beginning of my stay, I was told if I wanted to watch TV, I needed to rent it. I was given a list of supplies I needed to bring or buy and if I didn't have them, I could purchase them (at standard retail prices) at the hospital store. The things that I brought or bought probably didn't make a huge difference in cost savings, but it did underline that it is not the hospital that does everything, hospitalization is a shared burden.
If you know anything about Japan, you know that Japan is on the cutting edge of demographic trends. One example is that in 2013, the sale of adult diapers surpassed that of diapers for children. My most recent encounter with the Japanese health system was not emergency, but going thru the process of appointments, checking in, waiting. It seems that hospitalization in Japan has a secondary purpose to provide elderly with something to do. The waiting areas of the hospital, while allowing you to check in, give you a card if you need to come back so your records are immediately accessible, but this is not about processing as many people as quickly as possible. There is a lot of waiting time built in. The nurses come out, squat down next to the patient so they are lower than them and explain what they need to do. There is a constant flow of nurses coming out to talk to various people.
Recently, Japanese love the phrase omotenashi. No good translation, it is basically the 'over-offering' of hospitality. As bob mcmanus will point out, offering too much hospitality is a way of control. You reach a point where you don't want to say 'gee I don't want my steak pre-chewed, I actually like to chew it myself'. I exaggerate, but only a little. Japan is full of stories of taxi drivers running after you to return some change you forgot, lost wallets full of money turned in to the police koban, the offhand remark that then has the Japanese driving a couple of hours out of their way to get you to your destination. Japanese hospital culture is full of omotenashi.
Someone might go back and say, how can hospitals maintain a sterile environment if the family is toting in whatever they have at home. The other thing that happens, not just in the hospital system but in Japan society in general, is the ready adoption of techniques and procedures designed to deal with these sorts of things. A non hospital example is the Yubisashi kosho (finger pointing check system). These sorts of systems permeate Japanese hospital culture. Check offs to wash hands, requiring the patient state their name and birthdate to make sure that the right sample is coming from the right patient. Russell, I think, spoke of a doctor acquaintance who balked at asking patients he had known for years to tell him their name and birthdate. Japanese don't balk at this. Also death due to medical error is often treated as a criminal offense. While the question of what constitutes medical error is fraught, systemic causes are targeted aggressively in the Japanese system.
A lot of ink goes into comparing national health systems. Japan spends far far less than the US, but gets much better results. I don't think this is something to dismiss out of hand. However, one reason it gets better results is that many things in the health care system are based on the cultural norms and expectations. As I have mentioned, I'm in the process of taking Japanese citizenship. However, I'm very cognizant of the fact that this is a terrible country if you don't have family. 30 years ago, when I was lying in a dingy clinic with virtually no Japanese, I was young, it was a broken bone and I knew that I was going to recover. When you are young, you think you are indestructible. Now, I wonder how I could have ever been that stupid.