English version - Fit for Work Europe

MSDs and health care professionals
42
5.2
Access to
health care
in Japan
Japan operates a free-access medical system, which means that patients are not registered
with a specific doctor and are free to select and visit a physician of their choice, without referral
from a GP. While there are a small number of family doctors in Japan who practice in a way
similar to GPs, the majority of Japanese choose to attend a specialist clinic based on their
symptoms. Even though this system provides access to a wide range of treatments and affords
the patient a high level of choice in the treatment process, the doctor-patient relationship
remains paternalistic. Patient empowerment in Japan is a developing concept, and while
progress has been made in issues such as informed consent, many patients remain reluctant to
question the expertise of their physician.
All residents are enrolled in a universal statutory health insurance system either through their
employer (kumiai hoken) or through the national citizens’ insurance programme run by the
government (kokumin hoken), which covers around 40 per cent of the population (Tatara and
Okamoto, 2009). Both systems cover a minimum of 70 per cent of the cost of the majority of
treatment and prescription costs, with an income-dependent cap in place (currently between
JPY 80,000 and JPY 287,000 per month) in the case of long-term treatment. Extra benefits are
available for the elderly and those with disabilities or on low income.
In the case of MSDs there are a range of treatment options for patients. Hattori (2006) found
that of those seeking treatment for chronic pain (the majority of which was caused by MSDs),
45 per cent attended an orthopaedic surgeon, 21.3 per cent – a general clinician, 15.1 per cent
– a massage therapist or chiropractor, 12.4 per cent – an osteopath and only 0.8 per cent – a
specialised pain clinic. A 2010 survey of patients suffering from chronic musculoskeletal pain
showed that less than half (42 per cent) of those with symptoms sought medical treatment.
Of those, only 19 per cent visited a hospital or clinic, while 20 per cent sought complementary
therapy such as massage, or folk remedies (Nakamura et al., 2011).
This apparent reluctance to seek treatment suggests a lack of awareness of treatment options
for MSDs in the early stages, or a failure to recognise the serious impact of MSDs for everyday
life and workplace productivity.
It is important to recognise that for majority of those in employment occupational physicians
are the first point of contact in case of illness. Occupational physicians should work together
with other health care professionals to gain a better understanding of the physical, social and
psychological risk factors for a range of work-related conditions. It is noted, however, that some
delays in access to treatment occur due to the lack of communication between the occupational
physicians and other health care professionals.
Fit For Work? Musculoskeletal Disorders and the Japanese Labour Market