Being still sick today, I decided to kill two birds with one stone and go see a doctor about a hand injury that’s been getting worse over the last few months. It’s a common kick-boxing related problem, no big deal, just a strain in the area at the base of my thumb, but it has been slowly getting worse (usually this goes away with some stretching) and so it’s worth checking if there isn’t some kind of minor fracture or strain that requires medicinal assistance or complete rest from punching. So off to the doctor I went.

The doctor I chose was the Abe Orthopedic Clinic near Kichijoji station, and when I turned up at 3pm (the start of afternoon opening hours) it was already full to over-flowing with old people, all of whom were waiting their turn patiently for a “rehabiliation massage.” Each would go into a room and sit on a chair where, for about 15 minutes, they would receive a massage from a physiotherapist. Then they emerged, got charged ridiculously small amounts (“100 yen!” “150 yen!”) and go home. After an hour I was called in, told it was just a minor strain and given a prescription for some kind of anti-inflammatory stick-on treatment, and out I went again. Total charge: 1050 yen for the consultation, about $10 US. Before my health insurance is taken into account that would be about $30 US, about the same as an equivalent consultation in Australia. My drugs cost a further $7 US.

Now let us compare with the same process in the UK. First I have to visit my general practitioner (GP), which I can only do with an appointment in most cases. The appointment will require a wait of 1-4 days, so I couldn’t have done it on a random day when I was already home sick. The GP won’t offer me any medical opinion, but will prepare a referral to a local hospital outpatient clinic, which I then book. This referral will take between 2 weeks and 3 months, usually somewhere more toward 6 weeks – unless one of the new-fangled “Referral Management Centres” decides my referral was inappropriate, in which case I’ll be redirected either to a specialist or back to the GP (with further waiting in both cases). So after 2-12 weeks (roll 2d6!) I will get to the outpatients’ clinic in the hospital, and assuming I am seen on time (unlikely) and don’t need an X-ray, will be given my prescription and sent home. Total cost: nothing.

Which system would you rather be getting treated in? Bearing in mind that when I say “health insurance” about Japan I don’t mean it in the American sense of “capricious company with a god complex that will decide whether you get reimbursed,” but “government-run single payer that covers everything.”

Which system would you be more likely to not bother attending for non-urgent healthcare in, especially if you’re a healthy young male who thinks he’s invincible? So, your health problem niggles away but you wait until it becomes acute because, well, this whole thing is too much trouble. Sure it’s still your fault when your diabetes gets out of control, you lazy shit; but wouldn’t it have been better if the unnecessary barriers to care weren’t there in the first place? And ultimately, from a health system perspective it doesn’t matter whose fault it is: you’ll still be turning up at the emergency department with acute unmanaged diabetes.

This isn’t necessarily just a problem with financing (everything in the NHS is free so queues can be used as a form of rationing). It’s a fundamental problem of the gatekeeper system that the NHS uses: if the gatekeeper doesn’t provide a good range of medical services onsite and/or the time from gatekeeper to gate is very long, it acts as a huge disincentive to voluntary healthcare-seeking behavior. And in modern health systems, voluntary healthcare-seeking behavior is very important: in testing as a component of controlling infectious diseases like HIV and TB; in managing chronic illness like diabetes; and in identifying preventable health conditions like osteoporosis.

Anyway, nothing’s wrong with my hand, and no nasty comments about the real cause of inflammation in my right wrist, if you please!

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