• Takaoka, Toyama

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Regarding the Nov. 28 article reprinted from Sentaku magazine, “Existential fear stalks M.D.s“: To promote high-quality and cost-effective care, Japan needs to set clear targets for cost efficiency in health care services. A fee-for-performance reimbursement system could make the current universal system more sustainable.

Japan delivers effective health care services at a surprisingly low cost of around 8.5 percent of GDP. The Japanese government curbs soaring medical expenditures every other year by strictly controlling fees to health care providers.

The current fee-for-service reimbursement system, however, inevitably leads to over-delivery of health care services because it lacks incentives to improve the quality of care and does not cap the supply of services.

Some economists insist that Japan should introduce “capitation,” in which doctors are paid a fixed fee per patient. Medicine, however, is not that simple because many patients with chronic diseases have uncommon and complex conditions.

As a professional medical writer, I have translated a number of medicine-related articles since I was certified as a fellow of the Japanese Society of Internal Medicine and the American College of Physicians. And I have noticed that more and more attention is being paid to the value in health care services: the ratio of outcomes to long-term costs.

Thanks to the universal health care system, many Japanese people do not care so much for the clinical performance given by their health care deliverers. But they need to pay more attention to how doctors extend specialist education, which areas of medicine their doctors are certified in, which hospitals provide clinical practices consistent with the most recent science, and which hospitals design clinically efficient health care infrastructure.

It’s time to facilitate health care innovations and system improvements by nurturing a culture that encourages people to learn principles for improving the value of care.

The opinions expressed in this letter to the editor are the writer’s own and do not necessarily reflect the policies of The Japan Times.

hajime ichiseki

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