RE: Japan

I recently started practicing on a military base in Japan and refer US patients to Japanese clinicians. Additionally, I myself now have a primary care doctor in Japan and anecdotally experience it through my Japanese family here.

Based on these findings, these results are not very surprising that Japan scores are low. The idea of primary care or a 'primary medical home' seems early here. Subspecialty referrals for things that can be handled in primary care (ie: hypertension to cardiology, asthma to pulmonology, endocrinology for uncomplicated diabetes) are common and expected. The onus is on the patient to track lab results/imaging and return to clinic for those results, track referrals and often wait 4-5 hours to see physician. This is no small feat given much less consolidation and integration in Japan. The independent practitioner is very much alive and well in Japan. Systems are not very integrated so paper is king.

Furthermore, medical litigation / malpractice claims are not at all common. No expectation that a patient should be able to reach their PCP 24/7. Many primary care doctors were former internal medicine or pediatric subspecialists who worked in hospitals and then transitioned to clinic-based medicine after they had saved enough money to open their own clinic or wanted better working hours. This means they did 1-2 years of internship (many years ago) and don't necessary have training the specialty of primary care.

That being said, Japan spends much less on healthcare and has a very healthy population because of the investment in meeting basic needs like access to good education, transportation, food and safety-net systems. Walking down the street, it is not very common to see obesity or homelessness. Opioids are basically used if someone is dying for palliation. Had a patient who had a lap chole at a local hospital recently and was sent home with only Tylenol. He did just fine. And Japanese seem relatively content with the system because they don't have to worry about insurance, are used to waiting for things, and have many independent doctors within walking distance should they need something. I paid $30 for an out-of-pocket PCP visit that included labs and medications. With Japanese insurance it would have been less than $10.

Very interesting study that brings up even more interesting questions to dive into that I'm sure colleagues in Japan are wrestling with.