I’ve been living in Germany and Japan, let’s look at some aspects of the health systems.

Rundown of a typical doctor visit

I’m entering the doctors office at 10:30 on a weekday. The naming is already interesting: in Japan, the normal places where doctors investigate and treat patients are called clinic (クリニック), which sounds like the German “Klinik” - but in Germany these are big complexes to treat patients, so in English “hospitals”.

This doctor is for generic health issues, also Japan has of course all the specializations of doctors into teeth, eyes, and so on. Most doctors receive patients over the week, some additionally on Saturday or Sunday. This is to give more flexibility to Japanese who simply do not find the time to see a doctor under the week. The worktimes in Japan are not as focused on Monday-Friday as in Germany: stores are also open on weekends, construction works on roads are often done in the night to not interrupt traffic.

So I enter the doctors place, and 4 people are already waiting. Some doctors accept no appointments and their patients simply appear - most of the patients of this doctor come without appointment. In contracst, I had also visited an ear doctor, with just people with appointment waiting - so I had to wait 2.5h until examination.

I go to the reception desk, nurses greet me and ask for my “customer card” and “health insurance card”. Employees at medical institutions in general wear face masks, and also patients are asked to do so - just now I remember and put on a face mask. These “customer cards” are handed out by each doctor or hospital. They have the same size as a credit card, and are used to identify me - basically just assigning a number to me. The cards are made from plastic on paper, and can also be machine readable via bar-code or magnetic stripe. The pursue is full of these, as each doctor or hospital is handing out such a card to you.

I am sitting down, and other patients get called into the doctors examination room. Some of them arrived after me - and when these are called into the doctors room also a “by appointment” is added. With that, us patients without appointment clearly understand that the order is arranged to accomodate here someone with an appointment. Clearly better for the doctor to state this, instead of having patients on the internet complain “that others, who arrived after me, were examined before me”.

After 30min I get called to the doctor. He measures blood pressure, we have a 5min chat where I report on the results of blood pressure measurements I do every morning, then he prescribes me again 2 months of blood lowering medicine. I’m also asking about a ‘clogged nose’ which I experience recently at night. I have ruled out that it’s a plain cold by myself already. He prescribes a nasal spray, to be inserted into the nose before sleeping.

Than I’m sitting down in the waiting area again, after 5min I’m called to the reception, I pay 1000yen (~6eur) for the consultation. The actual price is 3 times of that, but the other part is payed by health insurance. Then I leave.

Receiving the medicine

The doctor just gave me the prescription - like in Germany, most medicine requires prescription. I enter a pharmacy, in Japanese 薬局. I hand over the prescription from the doctor, the health insurance card, and the medicine book (おくすり手帳). The medicine book contains a list of all medicine I receive - so even if I was visiting the whole country, receiving medicine from various places, this book would still allow to have an overview of what was received at which date, to check for conflicting medicines and so on. Such a handbook is just fantastic - not storing the data in a central place, and keeping the data in the patients hands!

I sit down, and see how employees take the medicine out of cupboards, count the medicine, and use small stamps (hako) to mark on the paper that they verified the kind and amount of medicine. I also had instances of medicine not available, where staff asked me to return later again, or did calls to pharmacies in the neighborhood, to find out who had the medicine. The pharmacy will also ask you if you are ok to use generica, so medicine produced with the same ingredients but by a different company.

After 10min I receive the medicine, along with the instructions on how to take it. I’m again paying around 1000yen, also here the other 2/3rds payed by the health insurance.

The health insurance system in Japan

8 years ago, when I arrived in Japan, I had to register as resident (住民) at the local townhall. As it was the default, I entered then the ‘public health insurance’. Some weeks later, when I started to work, I changed into the company provided health insurance. So like in Germany, there are 2 basic kinds of health insurance:

• public
• via the company

The one related to the company is providing slightly different services and is usually preferred. Like in Germany, the health insurance pays a share of medical costs like doctor visit or medicine.

One really nasty thing about Germany is that there are 2 kinds of health insurances: ‘private health insurance’ and ‘compulsory health insurance’ (“Gesetzliche Krankenversicherung”).
The kinds of services included in both are different, but the biggest difference: the ‘private insurances’ are preferrable for doctors - so in some cases patients in need of diagnosis ask for appointment and the type of health insurance decides then between having to wait 2 days (private insurance) and multiple months (compulsory insurance).

Digitilization of the Japanese health system

People living in Japan get a unique ID assigned, the ‘my number’. I also got one, the ID is used for example when paying taxes, and recently also under some circumstances as replacement of the health insurance card.

I like the “medicine handbook” as a method to keep an overview of medications, while keeping the data in the users hands. For exachanging data of one patient between multiple doctors and hospitals, Germany is right now trying to install the electronic patiens file (“elektronische Patientenakte”), but they struggle to get this setup in ways which protect the patients data. In Japan, you mostly get the data in your hands, so you can then take it to the doctor. So when I had headache and an MRT-scan of my head was done, I received that scan data as compact disk (CD), to take it with me to the doctor.

Quality of the service

The quality of the medical services in Japan is considered high, about the same level as in Germany. There is one piece though: the language barrier leads to Japanese in average not speak English well, and it is rumoured that’s also delaying medical news/developments/studies to doctors in Japan.

Interestingly, the German language is playing a big role in Japans health sector. Many terms come from German, sometimes with different meaning. For example, the patients file in Japan is called “Karte”.

Further health impacting details

• Yearly health check: Japanese employers have to dedicate one day for employees per year for a health checkup. The company also pays for the check. It includes examination of blood and stool samples, xraying the chest, ultrasound examination, search for cancer in the stomach and much more.
• Generic health awareness: Being surrounded by people who are in general not overweight is also setting the standards for yourself. Japan has fewer overweight people than Europe, and Europe has less than America.
• Tax: When payments for medicine and doctors reaches a certain amount per year, Japanese can use the bills to lower the taxable income when doing tax declaration.
• Stress test: Government regulations dictate that yearly stress questionaires are done, to prevent people from overwork. Employees also have to fill in sheets with their daily work time, another counter measure to prevent overwork.

Corrections? Questions? -> Mastodon thread

Last modified on 2025-01-19