Abstract
In medical ethics, an appropriate national healthcare system that meets the requirements of justice in healthcare resource allocation is a major concern. Japan is no exception to this trend, and the pros and cons of introducing a two-tier healthcare system (mixed billing system), which permits insured medical care services to be provided along with services not covered by social health insurance, have been the subject of debate for many years. The Supreme Court ruled in 2011 that it was valid for the government to ban mixing medical treatments and both the Ministry of Health, Labour and Welfare and Japanese Medical Association oppose the introduction of such a system. In this paper, we examine the main arguments against the introduction of a two-tier healthcare system and ideas that form their basis, which can be broadly divided into opinions based on the importance of equality and those derived from the logical conclusion that the outcomes would be detrimental. We point out issues and shortcomings of each standpoint and argue that the introduction of the system would not necessarily threaten equality and social solidarity in Japanese society, and that abuses of a self-pay tier would be controllable to a certain extent. Then, the authors—who do not actively promote the introduction of a two-tier healthcare system—conclude that the allegation that is completely devoted to one side (i.e., the importance of equality) and the theory that social healthcare is collapsing, which makes the public excessively nervous, cannot be accepted.
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References
Adachi, Hideki. 2014. Patient-proposed heal services and mixed billing system. Journal of Japan Physicians Association 29: 610–611.
Asahi Newspaper. 2011. The Supreme Court ruled first that it was valid for the government to ban mixing medical treatments. Oct. 25.
Beauchamp, Tom L., and James F. Childress. 2013. Principles of Biomedical Ethics. 7th edition. New York: Oxford University Press.
Brett, Allan S. 2007. Two-tiered health care: a problematic double standard. Archives of Internal Medicine 167: 430–432.
Daniels, Norman. 2009. Is there a right to health care and, if so, what does it encompass? In A companion to bioethics, ed. Helga Kuhse and Peter Singer, 362–372. Oxford: Blackwell Publishing.
Frankfurt, Harry G. 2015. On inequality. New Jersey: Princeton University Press.
Hashimoto, Hideki. 2015. The future of healthcare. Tokyo: Kirajennu.
Ikegami, Naoki, Byung-Kwang Yoo, Hideki Hashimoto, Masatoshi Matsumoto, Hiroya Ogata, Akira Babazono, Ryo Watanabe, et al. 2011. Japanese Universal Health Coverage: Evolution, Achievements, and Challenges. The Lancet 378(9796): 1106–15. https://doi.org/10.1016/S0140-6736(11)60828-3.
Japan Medical Association. 2017. What is mixed billing system? https://www.med.or.jp/nichikara/kongouqa/appeal.html.
Kirino, Takaaki. 2014. Choices of healthcare. Tokyo: Iwanashi Shobo.
Kodama, Satoshi. 2016. How will the ideal healthcare change in Japan with heath inequality? In Happiness and justice in a super-aged society with falling birthrate, ed. Atsushi Asai and Taketoshi Okita, 124–135. Tokyo: Japanese Nursing Association Publishing Company.
Krohmal, Benjamin J., and Ezekiel J. Emanuel. 2007. Access and ability to pay. Archives of Internal Medicine 167: 433–437.
Mano, Toshiki. 2012. An introduction to health policies. Tokyo: Chuko Shinsho.
Mano, Toshiki. 2017. Healthcare in Japan: the best in the world by ten victories, five defeats, and three ties. Tokyo: Kodansha plus α.
Ministry of Health, Labor and Welfare. n.d. Regarding permitting insured medical care services to be provided along with services not covered by social health insurance. Available at http://www.mhlw.go.jp/topics/bukyoku/isei/sensiniryo/heiyou.html
Sabin, James E. 2012. Medicine and society: individualism, solidarity, and U.S. health care. AMA Journal of Ethics 14: 415–418.
Saito, Hiromi. 2009. What affects people’s attitude toward mixed medical care services? An empirical analysis using a questionnaire survey. Iryokeizai Kenkyuu 1: 55–72.
Shimazaki, Kenji. 2015. Considering healthcare policies again. Tokyo: Chikuma Shinsho.
ter Meulen, Ruud H. J. 2014. Solidarity. In Bioethics 4th edition. ed. Bruce Jennings, 2983–2990. Farmington Hills: Macmillan Reference USA.
Tsutsumi, Mika. 2015. America, a sinking giant: Get way! Japanese healthcare. Tokyo: Shueisha Shinsho.
Ue, Masahiro. 2016. Health insurance system: we should discuss the implications of mixed billing system now! Health Insurance Healthcare (January): 26–28.
Uemura, Satoshi. 2015. Why do they keep discussing about “mixed billing system problems”? Shikai Tembo 126: 1068–1069.
World Medical Association. 2005. WMA Declaration of Lisbon on the Rights of the Patient. Available at: https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/.
Yomiuri Newspaper. 2009. Give more thought to mixed treatment issue. Oct. 1.
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Asai, A., Okita, T., Tanaka, M. et al. A Critical Discussion of Arguments Against the Introduction of a Two-Tier Healthcare System in Japan. ABR 9, 171–181 (2017). https://doi.org/10.1007/s41649-017-0023-y
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DOI: https://doi.org/10.1007/s41649-017-0023-y