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Michigan Universal Health Care Access Network

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Japan has a population of 126,550,000 people. The American South, as defined by the Census Department, is just over 100 million, so we would have to add California's 33,871,648 to that region to make up a comparable section of the US. The infant mortality rate in Japan is 3.91 deaths/1,000 live births, far superior to our 6.82. In Japan, life expectancy at birth is at 77.51 years for men and 84.05 years for women, 3-1/4 and 4 years longer, respectively, than in the US.

Japan's per capita GDP is $23,400, so the US is clearly the wealthier country, by over $10,000 per person. Approximately 7.4% of Japan's GDP is spent on health care, making the per capita expense $1732, or just under 40% of what the US spends. The pattern of equal or better results in health care for about half of the US cost is by now becoming crystal clear.

Japan's current system of universal health care was initiated in 1958. The Employee's Health Insurance System is financed by compulsory payroll contributions (8% of wages), equally shared by employers and employees, and covers employees and their dependents. The National Health Insurance System covers the self-employed, pensioners, their dependents, and members of the same occupation. The local governments act as insurers, and premiums are calculated on the basis of income, the number of individuals in the insured household, and assets. Premiums account for 57% of health expenditures. The federal government contributes 24% to medical care expenditures and local governments contribute 7%.

About 80% of hospitals and 94% of private clinics are privately owned and operated. While some public not-for-profit hospitals exist, investor-owned for-profit hospitals are prohibited in Japan. Patients are free to choose their ambulatory care physicians, who are reimbursed on the basis of a negotiated, uniform fee-for-service schedule. Physicians have no formal gatekeeper function. Due to the combination of medical and pharmaceutical practices a large part of a physician's income is derived from prescriptions. Hospital physicians have fixed salaries.

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