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Respiratory Care Week 2014: East Meets West - Points of Convergence between the U.S. and Japan’s Healthcare Delivery System

By Vernon Pertelle posted 10-24-2014 19:46

  

As Respiratory Care Week (October 19-25, 2014) draws to a close, it is an excellent time to reflect on the many activities to celebrate the role of respiratory therapists (RTs) in caring for patients with diseases and injuries of the lungs.  RTs are essential team members in acute care settings, but they also contribute significantly in post-acute care.  They serve as experts to help educate patients and health care workers (HCWs) on respiratory equipment and supplies used by patients with Chronic Obstructive Pulmonary Disease (COPD).  They assist medical device manufacturers and represent product segments focused on obstructive sleep apnea (OSA); invasive and non-invasive ventilation, humidification, drug delivery devices (nebulizers), and long-term oxygen therapy (LTOT).  This year’s respiratory care week was especially fun for me, because of the opportunity to partner with a medical device manufacturer, which hosted an event to share perspectives with a large group of home care respiratory professionals from Japan. 


The Great Divide – “Not So Great”

In the United States, the Medicare program bears a significant burden of healthcare costs.  Healthcare in Japan is mandatory for all of its citizens, and while the government funds a lower portion of healthcare (individual out of pocket costs represent 30% while government costs are 70%), working adults contribute through payroll taxes and employers contribute a portion.  Individuals that are self-employed pay for insurance, and their premiums are based on income.  Health Care in Japan emphasizes utilization of ambulatory care instead of in-patient care.  Typically, when a patient does require admission to the hospital, their length of stays (LOS) are significantly longer because bed rest and convalescence is emphasized versus early discharge.  In contrast to our system, they have a lower rate of overall hospital readmissions, although mean LOS is longer.  While we are focused on reducing readmissions; they use readmission rates to understand trends in healthcare quality to reduce their LOS.1

These are measurable differences in utilization, driven in part by cultural, political and institutional factors.  Japan operates under a centralized healthcare system with a highly homogeneous population, and a tradition of government intervention with their health insurance plans.  In the U.S., under the Medicare program, health policy is heavily influenced by the federal government based on the premise that government authority will solve problems.  This view is inherently flawed due to the heterogeneity, autonomy and dynamics of the various states; differences in health plans and local demographics. The Affordable Care Act (ACA) will possibly help to simplify benefits, disparity and coverage, yet time will tell how effective the ACA will be in reshaping healthcare delivery in the U.S.

Home Respiratory Care

In the U.S., there is a significant push towards reducing reimbursement for home respiratory equipment.  There is a stark contrast in the provision of LTOT in Japan, particularly with liquid oxygen (LOX) therapy.  The payer system in Japan supports sufficient reimbursement for LOX while the coverage afforded by Medicare barely allows home medical equipment (HME) companies to break even.  The views of professionals and the payer system in Japan is that LOX provides better therapy, and is a much better solution in light potential natural disasters that cause power outages.  Space is a major concern for Japan, so patients that use LTOT require smaller, lighter, quieter and more efficient stationary and portable oxygen systems.  In the U.S., portable LOX systems and portable oxygen concentrators (POCs) are not routinely provided to patients, even though they would help prevent readmissions by supporting greater activity outside of the home.  In Japan, it is common for patients to use lightweight LOX systems and POCs, and the expectation is that they are routinely provided. 

Respiratory care professionals from Japan look to the U.S., for guidance and insight to develop practical solutions that meet the needs of patients.  These views only touch the surface of the differences between the U.S. and Japan, but can certainly help inform how we deliver respiratory care, to improve health outcomes and reduce costs.  Overall, this was a great experience that will rank high on my list of respiratory care week celebrations. 

References

  1. Otsubo TImanaka Y. Readmission rate for health care delivery system assessment. Nihon Eiseigaku Zasshi.2012 Jan; 67 (1):62-6.

 

 

 

 

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