When Health is Literally Wealth

In a few days, we come up to the fourth anniversary of our daughter’s open heart surgery. Her health always tops our list of things we are extremely grateful for. Every time I watch her run, jump, climb, bounce and do all the things healthy, active children do, I thank Japan and the National health care system. This essay first appeared in the now defunct Eco+Waza webzine.

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“支払いございません,” said the woman behind the counter of the Accounts section of the Todai Byoin, as she returned our baby’s hospital card and printed out the next appointment. Shiharai gozaimasen… You owe us nothing. My husband said thank you and quietly walked away with tears in his eyes.

Five days ago when I was going to check out of the hospital, the attending staff presented me with our bill. It says ¥5,200. I could not believe my eyes. Is it missing three zeroes? Is this just a downpayment? Is this just for the IV fluids and gauze pads? We went to the cashier and indeed, I got change for my ¥10,000 bill. I burst into tears right in front of the cashier and the attending staff and kept saying “Kansha…kansha…”. My husband could not believe the bill and fully expected to be presented with the “real bill” when we went for a check up five days later. There was none.

When our baby Ruby was born, she was diagnosed with Tetralogy of Fallot, a congenital heart problem that manifests itself in cyanotic episodes due to low blood oxygen levels.  In Ruby’s case, her condition was not too severe — in fact, most people who meet her see a perfectly healthy and thriving baby. For several months after she was born, we only occasionally saw tinges of blue on her nose, gums, hands and feet whenever she was upset or cried too hard. Still, the doctors told us that her condition would worsen and be potentially fatal as she grows bigger. They advised for Ruby to undergo total cardiac repair, i.e. open heart surgery, as soon as she is physically ready.

Ruby’s surgery was scheduled on her eighth month birthday. We stayed at the hospital two days before for the requisite preparations and during which the surgeons also briefed us on the risks of the procedure (a 2% mortality rate and a host of other serious complications). On the day of the surgery at 8:00 a.m., we brought Ruby to the operating room. Eight excruciating hours of nauseating worry later, the surgeons met us and told us that the operation went smoothly and that Ruby was being cared for at the pediatric intensive care unit.

As my husband and I walked home that night, we thoroughly understood what it meant to have a huge weight lifted off one’s shoulders. Our steps were light as we recounted the events of the day and were finally able to talk about the things we dared not speak of hours earlier. We were rendered speechless by the miracle worked through the surgeons’ hands (What does one say to the people who just saved your baby’s life? “Thank you” just seems so inadequate.). We shared our amazement of looking at pictures that most kids will probably never have — close ups of Ruby’s exposed heart when her chest was cut open. Yes, we were so grateful that our precious baby’s life is out of danger, but we were also extremely grateful that we can enjoy the walk home together without worrying about whether we would have to give up our house, or be burdened by our hospital bill for the rest of our lives.

Looking closely at our hospital bill, our total medical charges is ¥4,694,520. The ¥5,200 that we paid was the Patient Copayment (30%) of Ruby’s hospital meals only. In short, the Japanese National Health Insurance covered 100% of the medical charges and 70% of the meals. When we inquired in the United States, the surgery alone for Ruby’s condition could cost as much as $114,000. It is no surprise that 62% of personal bankruptcies in the United States are due to medical expenses, even though 78% of these have some form of medical insurance (data from Forbes). We felt like we had won the lottery.

Our journey with Japan’s national health care system began when I learned that I was pregnant. This was also about the time when there was talk about foreign residents being required to enroll into the National Health Insurance program in order to renew their visa. We visited a birthing center early in my pregnancy and the midwife encouraged us to get insurance. She said our hospital bill can be as expensive as  a million yen if our baby had even a simple and common condition like jaundice. And so we enrolled and what a huge blessing it has been.

In various rankings, Japan consistently stays in the top ten countries with the best health care in the world. Perhaps most Japanese take this for granted, but we who come from other countries with less than optimal health care systems can feel and appreciate the huge difference. When I went to apply for National Health Insurance, I was surprised not to be asked whether I smoke, drink, or have pre-existing conditions. The insurance premiums are based on income, not on the state of your health. I cannot even begin to imagine how much we would have to pay in insurance premiums for Ruby in other countries with her pre-existing condition. You also do not have to worry about insurance companies finding a reason not to cover you or reject your claims. Another thing I appreciate is that ambulance service in Japan is free. When I stayed in the US with Ruby when she was about two months old, I was so afraid of her having an anoxic spell that would require medical emergency services. We cannot afford to get sick. We have a friend in the US whose mother thought she was having a heart attack. Her mother called for an ambulance and stayed overnight in intensive care under  observation, racking up a bill of $17,000. As expected, this free ambulance service has been subject to abuse by people who just want a free ride to the hospital. Nonetheless, the service is invaluable for people who truly need it.

In the Japanese socialized medical model, health care is not for profit. In a good way, the doctors here do not want to see you again and I believe this is one of the reasons why people have a longer life expectancy in Japan. In other countries like the US or the Philippines, health care, in general, is for profit. Doctors are paid per procedure. The more difficult the procedure, the more income they receive. Herein lies a conflict of interest. Are doctors completely objective? Can they truly care for what’s best for the patient when their income depends on the patient being unwell? Do they recommend procedures unnecessarily because insurance companies are going to pay them anyway for it? More concretely for example, when they recommend a caesarian section, is it because you truly need it or because they get paid more than when they have you give birth to your baby normally?

Health care systems can reasonably be conceived of as not only supporting the general well-being of the people but also as a way to prevent poverty. The freedom from health-related worry, anxiety and stress is just priceless.

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