Japan was an early adopter of universal healthcare, starting its program in 1961 as the country began its rapid economic growth. Since then life expectancy has risen from 68 to 83 years, the second highest in the world, as the infant mortality rate dropped to the lowest in the world. The World Health Organization (WHO) ranks Japan as the 10th-best healthcare system, a full 27 spots ahead of the United States.
Taiwan’s healthcare system is much newer, starting in 1995 and quickly nearly doubling the percentage of the population covered—from about 54 percent to 99 percent. Public satisfaction with the system remains high at 80 percent, as residents’ out-of-pocket expenses are capped at $1,550 a year and those with “catastrophic illnesses” such as cancer or kidney disease have their medical costs completely covered.
In both Japan and Taiwan, residents can theoretically see any doctor they wish to see as clinics are ubiquitous, and the government requires hospitals to accept every patient regardless of whether they have a referral. The healthcare system extends to expats as well, which greatly helped Jackie Zuiderhof, a South Dakota native, who suffered from severe stomach pains while living in both Japan and Taiwan. In Japan, where she worked as a missionary, she remembers paying $10 monthly premiums for health insurance, and a $10 co-pay at the hospital. She’d spend about 10 to 30 minutes in the waiting room before seeing doctors who spent little time explaining her problems, but gave her antibiotics and tests. Her CT scan cost $100 out of pocket.
After moving to Taiwan to teach English in 2014, the stomach pains returned, and so she made more trips to the hospital, often waiting over an hour to see a doctor. Each visit cost $14, and the most expensive bill she paid was $25 for a CT scan. While the tests have all come up negative and the doctors have yet to diagnose her problem, she noted the relief of being able to afford healthcare, especially since only 1.3 percent of her paycheck went toward the health insurance.
Healthcare in East Asian countries is less expensive than in the United States for several other reasons: Patients file fewer malpractice suits as the countries lack malpractice lawyers and cases are often delayed. Administrative costs are also much lower. In Taiwan, administrative costs make up only 1 percent of healthcare spending as the island has a digitized administrative system: Each resident’s insurance card includes a chip with all the patient’s information, such as previous prescriptions and doctors’ visits, creating a real-time database.
Yet the cost of medical care in Japan is increasing due to new medical technology, a graying population, and the country’s wealth, which encourages people to seek more care, according to consulting firm McKinsey & Company. At the same time, the economies of both Japan and Taiwan are stagnating, with widening gaps between revenues and expenditures. Michael Chung, a National Taiwan University professor who worked on revamping Taiwan’s healthcare in 2012, noted that the current financial model falls apart because “in healthcare, you can never stay where you are. You always need new technology and new facilities.”