Universal Healthcare Can Save Money, But Innovation Is Key: My Experiences in Japan and the U.S.
I was born and grew up in Japan and have first-hand experience as both a doctor and a patient in my native country—a nation that offers universal health care coverage to its citizens. I have also been a patient, an academic researcher and a biotech entrepreneur here in the United States, my home for the past 10 years. These experiences have helped me to compare and contrast and to see the advantages and disadvantages of both countries’ healthcare systems. My work as an entrepreneur has also led me to examine these systems’ effects on innovation in the biotechnology and pharmaceutical sectors.
In thinking more closely about health care, I have come to several conclusions. First, access to quality health care coverage for all people is key. Second, any health care reform implemented here in the United States should not negatively impact the high quality of care that the U.S. is known to provide and that U.S. citizens enjoy. Third, it is also very important that any health care reform not come at the expense of cutting-edge research and medical advances that could spur the next generation of safe and effective treatments.
Japan has embraced universal health care coverage and it has been relatively cost-effective for that country. We know that Japan is spending only about the half of the amount on health care compared to the United States in terms of percentage of GDP; however, it is important to note that individual out-of-pocket costs are not that different.
Also, the patient experience is vastly different. In the United States, private health insurance providers dictate which hospital you can go to and what kind of treatment you can access. In Japan, regardless of what type of insurance you have, everyone is covered. Individuals can select to see almost any doctor they would like, and their co-pay is often 30 percent but there is a cap of approximately $700 per month. However, my experience is that Japanese patients have a trade-off – they only see their doctor for three minutes (usually after three hours of waiting). I have also seen first-hand that doctors are overworked and underpaid relative to other industries. For example, currently in Japan, there is a dramatic decrease in the number of doctors who are willing to become pediatricians or OB-GYNs due to the challenging work environment. While the clear benefit is that everyone is insured in Japan, there is the downside: the average quality of medicine does not rival that of the United States.
There is another important contrast in Japan: the institutional approach to healthcare can make innovation and the discovery of breakthrough treatments even more difficult. In the U.S., companies are known for and our industry’s success is driven by an indomitable entrepreneurial spirit. Pharma and biotech leaders strike out on their own and start up new companies to spur growth, explore new technologies and build innovative pipelines focused on cutting-edge (and largely untested) research. This is often not the case in Japan where the corporate culture tends to retain top talent within its hierarchical structure, as opposed to ‘spinning out’ these minds to create the next generation of companies. There are companies in Japan that are innovating, though—for example, Otsuka, one of Japan’s largest pharmaceutical companies has partnered with Acucela, the Bothell, WA-based company I founded in 2002, and together we are working to develop novel, first-in-class treatments for blinding eye disease.
With health care reform pending in Washington, D.C., I think it will be critical that we strike the right balance of providing an institutional structure that provides baseline coverage for everyone in the country while not sacrificing our high quality care. It is also essential to address how any shift in the focus of our current health care system could affect the research, drive and innovation that leads to medical breakthroughs. These innovations are the cornerstone of our industry’s entrepreneurial culture and have the potential to greatly improve the nation’s health and quality of life.
We must keep innovation at the forefront of our minds and our strategies through any health care reform process. To be sure, access to quality health care is critical and a top priority for our country, but we must also remember that our unique American spirit of exploration and entrepreneurship feeds the global need for medical breakthroughs and creates a wealth of effective treatments for all the citizens of the world. We must examine closely solutions that could dampen that spirit or institutionalize innovation – they are assets.