Rural Health Care in Japan and the United States: Shared Challenges and Solutions

Brief Summary of Proceedings

In these two conferences, the Mansfield Foundation brought together health care experts, policy makers and practitioners to address problems and solutions regarding access to health care in rural areas.

The conferences provided a forum to:

SAPPORO (June 2, 2001)

Dr. Naoki Ikegami, who served as moderator, introduced the sessions with a comment about the difficulty of defining remote or rural areas. After an overview of the differences and similarities of the Japanese and U.S. health-care systems, panelists provided rural health perspectives for each country and discussed medical training programs aimed at encouraging practice by physicians in rural areas.

 

Among the Japanese panelists' suggestions for resolving primary, acute care and long-term care problems in rural areas were: the training of more generalists and an emphasis on more group practice and community-based consultations. U.S. solutions included changes in policy to provide more flexibility for maintaining some hospital services in low-population areas and integrating primary and long-term care services for cost-savings. Technological solutions include the use of telecommunications equipment to bridge distances between remote areas and major medical centers.

 

BOZEMAN (July 7, 2001)

Presentations and suggested solutions for access to rural health care ran parallel to the conference in Sapporo but discussants were able to build on the past conference to raise questions about underlying attitudes that complicate transferability of solutions across borders. Among these are: whether national policy endorses equity through urban/rural subsidies and whether culture itself encourages or discourages improvements to the health care systems.

 

Examples include:

Japan explicitly strives for equity in medical coverage and expenditures, while America's Medicare system ends up providing rural subsidies for urban Medicare users.

 

The voices for change in Japan and the United States are different: Japan tends to have a strong, single lobbying voice offered by the Japan Medical Association while the United States has a cacophony of separate interest groups. Both systems have their advantages.

 

Possible cross-border solutions do exist, however. Primarily they relate to medical education, group practice incentives for rural areas, and quality monitoring techniques.

 

These conferences were generously supported by:
The Maureen and Mike Mansfield Foundation
The Japan Foundation's Center for Global Partnership
The Japan-U.S. Friendship Commission
The American Consulate General in Sapporo
The American Center in Sapporo

Additional support in Japan provided by:
The Hokkaido Medical Association
The Institute for Health Economics and Policy
The Japan Medical Association
The Ministry of Health, Labor and Welfare

Additional support in the United States provided by:
The Lee/Adler Foundations
MHA—An Association of Montana Health Care Providers
The Maureen and Mike Mansfield Center
at The University of Montana
The Montana Academy of Family Physicians
The Montana Department of Health and Human Services
The Montana Office of Rural Health
The Mountain Pacific Quality Health Foundation
The University of Washington WWAMI Program