Seeking for medical treatment in Japanese Hospital

Gunma University Hospital in Gunma Prefecture. One of the hospital belong to national medical school. (c) Wikimedia commons.

This is my first blog post, so this post might not be able to express the whole real idea. Feel free to drop critics or comment below. よろしくお願いします!

I am an Indonesian MD, living in Japan as PhD fellow in medical science. Until this post, I have lived in Japan for two years. At first, living here was challenging for me, you need to learn and adapt with culture and customs. Now, I started to enjoy Japan, everything has policy and rules that made to ease its residence. The people also tend to obey the rule, in order to honour other people right, not to disrupt the order of living. Even though sometimes instead of ease it become a troublesome, you’ll know once you live here.

In this post, I want to describe about medical systems in Japan. I had some experiences as patient  while I am living here. From sinusitis, knee problem, even a surgery caused by sports injury. ACL reconstruction surgery to be precise. All the insurance related information is refer to government insurance, not 社会人/employee insurance nor private insurance, except noted otherwise.

Types of doctors:
Lets start with medical specialists. MD in Japan is always a specialist, different from Indonesia where specialist training is an options. The clinic also based upon specialty, you won’t find a clinic that treat every patient. There are a specialist clinic or small/big hospital. So for example if your son has an allergic reaction, just go to paediatrics clinic, one of your family got a sprain/bone problem happened, go to orthopaedics clinic and so forth.

Referral system
In Japan health referral system, unless you have already been examined for your particular problem in the hospital, you have to come to clinic around your residence before of to a big hospital. A visit without referral will cost you a penalty, an extra ¥3150 in Gunma University Hospital or ¥5000 in The University of Tokyo Hospital. It is a part of distributing the patient load policy among hospital and clinic.  If you are a researcher in a hospital environment, you may ask a referral letter from your professor, it should help you to alleviate the extra cost.
a bit more about Japan – Health Care System Structure and Organization

Outpatient:
If you have a medical problem, make sure the cause of the problem and try to assign it to medical specialty. Some problem is easy to differentiate, some is difficult. For example rash and pain in elbow, depend on the extent and characteristic of the problem, you could go to internist, dermatologist, or orthopaedics. For safe, you could go to an internist, and the MD will either treat/refer you to other medical specialist.

To get a treatment, you need to bring your hokenshou/保険証/insurance card and visit the designated clinic near your residence. No need of hanko(stamp) or passport. Some clinics need an appointment, but most of it you could just show yourself and get treated. Some specialty like dentistry will make whole tooth and gum cheek up on our first visit, this will cost you more, however will make problem clear, and the treatment plan clear.

In Japan all clinic and hospital (in my knowledge) are using digital medical record. So you do not need to wait for x-ray film, or blood work result paper, or even ECG result. Everything will be recorded online. If you need to change hospital/being referred for some special diagnostic/treatment you will get a disc instead of paper/film.

The amount you should pay relied on the diagnostic and treatment you got. Basically for healthy adult and work as student with government insurance you will get 70% discount. If you have children, some treatment are free until certain age (differ between city/prefecture), including vaccination and hospitalization. Parturition/childbirth usually covered not by NHI but other government scheme(around ¥450-500.000), I heard that the doctor here prefers normal birth to caesarian section. Explantation of National Health Insurance in Japan.

In 2012, a CT Scan / MRI will cost around ¥6000-9000. A first visit to dental clinic will cost around ¥3500, for panoramic, hygiene photo as diagnostic/treatment base. Following visit to dental clinic will cost ¥200-1000 for exam and scaling and around ¥7000 for a regular implant crown.

Hospitalisation and Surgery:
If you need to be hospitalised, in non emergency basis, for any reason, the clinic will make you a referral for the hospital. Depend on the bed available, you might not be able to get your hospital of preference. If you get diagnosed in a hospital, you might directly hospitalised or choose a date(for elective problem).

The surgery will take place on the date you decided with the MD. A bunch of documents and lab works needed, including chest x-ray (lung/heart problem), urine sample (for kidney problem), ECG (heart problem), and blood works (hematologic/metabolic problem) and particular diagnostic exam depend on the disease.

Before hospitalisation you will discuss the duration of your hospital stay. However after the surgery it might be change, extent or shortened a certain days/weeks, according to your severity and progress of disease. My stay was extended due to severity of the injury. From 3 weeks become 5 weeks.

Emergency service:
Unlike in Indonesia, emergency service here could not be obtained in every hospital. You need to know which hospital is receiving emergency patient on that particular week. The hospital for paediatrics, internal medicine, and surgery problem might also different. For this schedule city office will send you a monthly bulletin, including information of emergency hospital schedule.

(c)Gifu prefectural medical service

Helicopter emergency medical system (HEMS) is one medical evacuation option for fast transport.

For emergency case, you might call an ambulance (free for low income people) and probably helicopter ambulance that available in some prefecture.

Payment of hospital bill, usually done at every beginning of the month. So, for long hospitalisation you ought to pay the bill every month. If you hospitalised at the end of June, early august you ought to pay your bill for the month of June.

The amount of payment relied on your salary and type of insurance. In my case because I am a student with income from scholarship and other income lower than the decided amount, I just need to pay less than ¥50.000 for each month of hospitalisation. No matter what kind of surgery and drugs that I need. I am entitled to a waiver. Lets say that the limit is ¥50.000, so If the bill rising above ¥50.000, even ¥1.000.000 for that particular month, I just need to pay the limit ¥50.000 for that month plus additional cost of clothing (if your rent) and food. note: some drugs and medical device might not be covered by insurance, or need to be paid full in advance and be reimburse later from the insurance office).

Cosmetics? 

For cosmetics treatment like dental brace, cosmetic surgery, and other cosmetic problem, you would not get insurance coverage. However, problems like dental decays, odontectomy, and acne/pimple considered as primary need, and will be covered by government insurance.

So keep your condition. Hopefully you won’t need to check yourself to a doctor.