••••••••••••7Diff erences Between the U.S. and Japanese Healthcare Systems and Comparison of Medical Insurance and Medical ExpensesHealthcare Cost Gap in the U.S. and Japan IntroductionHello everyone. My name is Kyoka Tonoshi, and I just fi nished my second year at Whitman College in the United States. During my two years in the U.S., there were times when I had to see a medical provider even though I thought the medical costs were high. Based on my experience of facing a system that differed significantly from the one in Japan, I became interested in the differences between the insurance and medical systems in the U.S. and Japan. In this article, I would like to explore those differences in more depth.The U.S. Health Insurance SystemAnnual deductibles, fixed contributions, and contribution ratios vary depending on the insurance held.• Mandatory participation: none (after 2019, mandatoryThe characteristics of the insurance system, as described above, show that in Japan, the public system enables everyone to receive a certain level of medical care at a low cost. In the U.S., the quality of medical care is high, but the cost is exceptionally high, making it difficult for uninsured people to access medical care. Medical costs are high because hospitals determine the cost of medical care through free medical care. Health care costs vary from state to state and region to region in the United States. Every five years, the Centers for Medicare & Medicaid Services' (CMS) Office of the Actuary compiles Health Expenditures by State of Residence and Health State Health Expenditure Accounts is a subcomponent of the National Health Expenditure Accounts (NHEA) and the government's official estimate of health care expenditures in the United States. State Health Expenditure Accounts are a subcomponent of the National Health Expenditure Accounts (NHEA) and represent offi cial government estimates of healthcare expenditures in the United States. The Health Spending Per Capita presented here includes expenditures for all private and publicly funded personal health care services and products (hospital care, physician services, nursing home care, prescription drugs, etc.) for each state of residence (total expenditures divided by population). (total expenditures divided by population). Hospital spending is also included, refl ecting net revenues (gross minus contractual adjustments, bad debt, and charity care). Costs for insurance program administration, research, and construction are not included in this total. For example, the high per capita healthcare cost in New York in 2020 was $ 14,007. In contrast, Utah, the lowest state, had a median income of $ 7,522. New York's healthcare costs were approximately 1.86 times higher than Utah's. This data also shows that the per capita cost of medical care varies greatly among the states.Figure 1 below illustrates the diff erences in per capita healthcare costs by state.Figure1.Whitman College, U.S.Kyoka TonoshiPrivate insurance mainly (public insurance only partiallycovered)Operating entity: private insurers + some public (Medicare,Medicaid, etc.)participation will be abolished at the federal level)Premium payment method: individual or employer payspremiums (not income-linked)Copayment ratio: High (complicated by co-pays, deductibles,coinsurance, etc.)Free choice of health care providers: limited by insurance plan(out-of-network is expensive)The insurance system in JapanUniversal health insurance (some form of public insurancecovers all citizens)Operating entity: public (government, local government,health insurance association, etc.)Obligation to joinPremium payment method: based on income (companyemployees receive a salary deduction)Copayment ratio: 30% in principle (10-20% for the elderlyand children)Free choice of health care providers: Yes.(Large hospitals areacceptable without a letter of referral. You are responsiblefor the diff erence in bed charges, etc.)
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