Nov 24, 2019 (Japan Times) - One of the criticisms of the “Medicare for All†government-run health care scheme proposed by U.S. Democratic presidential candidates Bernie Sanders and Elizabeth Warren is that eliminating all limits to treatment would lead to “overuse†of the medical care system, meaning people would be seeing doctors for every little perceived ailment, which is wasteful.
Given the vast number of Americans who presently forego medical attention because they cannot afford private insurance, overuse of medical resources should be considered at worst a necessary evil.
In Japan, which has national health insurance, the government is trying to address this overuse problem, which is exacerbated by the country’s rapidly aging population. Because the elderly pay less out of pocket than others, when many visit the doctor they tend to go more often, even when their issues aren’t serious. But medical professionals have a hand in the problem, too, encouraging such visits and suggesting treatments and procedures that may not be necessary. After all, they can charge the government for their services with complete confidence that they will be paid. More to the point, they can prescribe as much medication as they like, which also pleases drug manufacturers and pharmacies. Anyone who has lived in Japan for any length of time will likely have had the experience of leaving a pharmacy with a duffel bag full of pills and powders for a common cold.
A lot of these drugs, in fact, go unused. If the patient’s complaint is not related to a chronic condition — and sometimes even when it is — they may stop taking the drug once the symptoms go away. Consequently, many people have “leftover drugs†(zan’yaku) in their homes and, according to a Nov. 4 article in the Tokyo Shimbun, a research group tied to Kyushu University’s graduate school estimates that “reusing†these drugs could reduce medical costs by ¥330 billion a year.
The newspaper reports that three local pharmaceutical associations — one in Tokyo and two in Fukuoka — are testing a drug return system wherein people bring unused medications back to pharmacies. The drugs are registered and the pertinent doctors informed that medication they previously prescribed were returned. Redistributing drugs that have already been paid for has its own built-in problems, including possible fraud, but the real purpose of the scheme is not recycling but rather getting doctors to prescribe less once they understand about the leftovers.
This theory presumes a lot about doctors’ — and even pharmacies’ — motivation for distributing drugs, but, in fact, there is a concerted movement in the medical community to cut back on prescriptions for reasons other than money. Another Tokyo Shimbun article that appeared Nov. 9 described “polypharmacy,†the practice of taking multiple types of medication at the same time. The interaction of certain drugs can lead to unforeseen side effects, which means doctors must know exactly what other medications a patient is taking before prescribing new ones.
