by Elyse M. Rogers
UNDERSTANDING THE JAPANESE HOSPITAL SYSTEM
Newcomers to Japan, and even those who have lived here for a long lime, often do not understand the hospital system and how it differs from the system in other countries.
Since an important part of being prepared for an emergency is knowing and understanding the hospital system in Japan, let’s examine the system and discuss what each of us must know and do to work within that system.
“Open” and “Closed” Systems
Unlike the United States and many other western countries, Japanese hospitals hire their own physicians and do not use outside, private physicians. In other words, the doctors who treat patients in that particular hospital are on staff or are employees of that hospital. This is called a “closed” system.
In the “open” hospital system private physicians admit patients to one of perhaps several hospitals (where he/ she has “privileges”) and if a patient needs hospital care or surgery, that patient goes to the hospital and is under that doctor’s care. During the patient’s stay he/she may be treated by resident physicians who are employed by the hospital, but the ongoing responsibility and authority is that of the patient’s private physician.
The important thing to remember is that Japan operates mainly under the “closed” hospital system, and private physicians (who account for less than two percent of total physicians in Japan, by the way) do not “follow” their patients into the hospital and care for them as they do in America. You may see a private physician in his office and be told to go to the hospital, but once you are in the hospital you are under the care of that hospital’s staff physicians. Your doctor has no ability to care for you, order medications, supervise treatments, etc.
I should mention that there are a few exceptions to this rule. Sometimes a private physician will also be a part-time staff physician, so if his patients are hospitalized in that particular hospital where he is on staff, he can. of course, care for that patient, or at least help direct the care.
In addition, some of the physicians in Tokyo who care for foreigners have some privileges at Seibo (Catholic International Hospital). A few have other connections. Be sure to ask the important question of hospital-connection, if you want your physician to serve you both in the medical office and at the hospital.
Emergency Rooms and Care
Most hospitals in Japan do not have specific, well-staffed Emergency Rooms as we know them in the States. Many hospitals do treat emergency cases, however, but the patient is usually dispatched to them via the ambulance and the Fire Department’s Dispatching Service. (The Fire Department runs the ambulance system).
In addition, some hospitals handle no emergencies at all! So, just because a hospital is a large general hospital, do not assume that it can take care of middle-of-the-night emergencies.
Hospitals that are “authorized” emergency hospitals are ones that adhere to certain stipulations defined by the government. Normally, in an emergency you would not contact the hospital directly, but rather go through the am-ambulance-dispatch service at the Fire Department if you are in need of emergency medical care.
Fortunately, a few hospitals do have 24-hour emergency care available and more and more seem to be adding that service in recent years. Two good “authorized” ones that accept foreign walk-in patients (although they prefer to be called in advance) are Keio University Hospital (Shinanomachi), and Hiroo General Hospital (Hiroo). Also, St. Luke’s and Seibo are examples of hospitals that will take care of some emergencies.
In Japan, hospitals and the ambulance are related. The system works this way: In an emergency you would dial the country-wide number of 119 to call an ambulance. (You should do this in Japanese or have your doctor or Japanese friend do it for you.) When the ambulance arrives to pick up a patient after a call, the ambulance personnel will immediately go to the nearest hospital that has suitable facilities and staff.
The appropriate hospital is decided upon by the central dispatcher, and not by the patient and this can be a real problem for the foreigner who expects to tell the ambulance driver, “Take me to St. Luke’s” or “I want to go to Seibo.”
Fortunately, in many cases, particularly if you get your doctor involved and he calls the hospital to be sure there is room for you, the ambulance drivers will take foreigners to a particular hospital as specified by doctor or patient.
Payment of Bills
If you have a national health insurance (kenko hoken) card, you will be cared for at any hospital. When you do not have one, even if you have private insurance, you may be asked to pay at least sonic money “up front” for services. I suggest that you keep ¥20,000 in an envelope in a handy drawer for such emergencies.
Sometimes large companies have arrangements with hospitals to cover costs, and often your personal meishi (business card) will work if it’s from a well-known company. In typical Japanese fashion they figure that if you are the employee of a large, prestigious company, you are the kind of person who will pay your bills.
Choosing a Hospital
If your doctor has called ahead, and if the ambulance drivers and dispatchers are helpful, they will take a foreigner to the hospital of his/ her choice, I hate to be so “iffy” about the situation, but that’s the way it is. If you kind of “know your way around” and are adamant, most of the time you can get to the hospital of your choice.
You may wonder why getting to one particular hospital is important, 50 let me explain. Oftentimes “suitable” hospitals, chosen by the ambulance dispatcher are not suitable by foreigner’s standards. Since many hospitals in Japan are small, “clinic” type hospitals, they often have minimal equipment and a staff with limited capabilities. This is fine if you are in for routine care, but may not be so fine if you have a medical emergency of some undiagnosed nature. In addition, few of these small hospitals have anyone who speaks English.
There’s another good reason for choosing a hospital: most medical problems are not that immediate. If your son cuts his arm, or your spouse feels “sick” there is ample time and available transportation (taxi or car) to get to the hospital of your choice.
Find out which hospitals have the facilities you want and make sure you know the exact location. Ascertain what parking space is available if you plan to drive. If you will go by taxi, learn the name of the hospital in Japanese, or get a Japanese map from the hospital to give to the taxi driver. A “dry run” or two to make sure you know where the hospital is and how to get there is very wise since nothing is easy to find in this sprawling city.
Language & Cultural Problem
No discussion on hospitals would be complete without mentioning the problem of language and different customs. Naturally the language is going to be a problem here. If you don’t speak Japanese and/or do not have a close family member who does, you might want to make arrangements with a Japanese friend or teacher who would be willing to help you in an emergency.
Many physicians speak some English, but you have to get through the system before you reach a physician and in most hospitals the receptionists and nurses speak only Japanese. You’ll have more luck in international hospitals but even in those institutions evenings and nights may be touchy. Remember that patience and a friendly smile help a lot in any type of difficult language situations. So, try to “keep your cool” even in a medical emergency.
Quick reference books, such as How to Consult the Doctor in Five Languages, published by The Japan Times and available at most hotel or international bookstores, are handy helpers that you might want to buy for reference.
Knowing the hospital system and learning how to work within that system makes good emergency-medical sense.