The medical care delivery system
The provision of personal health care services for the general public in Japan consists of a mix of public and private efforts. As we saw in Chapter 4, responsibility for the planning and implementation of public health programmes, including community health and environmental services, rests with the government at national and provincial levels. At the national level responsibility for these programmes is vested in several bureaux of the Ministry of Health and Welfare. The provision of medical care services to individuals is largely and primarily in the hands of the private sector and the ministry, though the Health Service Bureau has an advisory role and some super-visory responsibility. This system, or more correctly, pattern of care is hospital-and clinic-based and emphasis is on the provision of curative rather than preventive measures of health care. Health care in Japan is highly fragmented and any attempt to classify it according to the standard models of health care delivery systems is difficult. At best it is possible to delineate two separate systems running in parallel to each other. Within the sector which can be described as personal medical care services there are again two channels of service delivery. There are the hospitals, public and private, which provide in-patient and out-patient services; and the clinics and offices of medical practitioners, which provide ambulatory care and also offer some limited in-patient services. Links between the two channels are not formally established and co-ordination of services is therefore almost non-existent. In this chapter we provide a detailed description and analysis of these channels of service provision; we look at the nature of the health services they provide, the benefits and advantages afforded by this pattern of service delivery, and we note the problem areas. We also examine whether this pattern of provision is adequate in Japan today and whether it is appropriate to the health care needs of the Japanese population.