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Japanese hospitals explore opportunities

Japan wants to be a medical tourism destination

Dec 25, 2009

While many Japanese companies have gone global over the years, making companies like Toyota, Sony and Canon household names in every corner of the world, the Japanese health care industry is focused largely on the domestic market and has long been shielded from pressure for change.

Most hospitals in Japan are not very foreigner-friendly. They have few doctors or staff who speak foreign languages. And some of their practices, including the notorious "three-minute consultation after a three-hour wait" leave foreign patients flummoxed. Medical procedures often seem based less on science than the doctor's whim.

But change is afoot. As the majority of hospitals in Japan struggle to survive, interest in "medical tourists" from abroad is mounting. And that could help some hospitals become more international and accommodative toward foreign patients' needs, experts say.

"If you go to hospitals in Thailand and Singapore, you would be amazed at how modernized and internationalized the hospitals there are," said Dr. Shigekoto Kaihara, vice president of International University of Health and Welfare in Tokyo. "They have multilingual reception desks, and even sections where they would sort out the visitors' visa issues."

Medical tourism is rapidly growing worldwide, and in Asia, Singapore, Thailand and India have emerged as major destinations for patients from the U.S. and Britain, where their skyrocketing health care costs have driven more people to seek treatment options offshore.

According to Washington-based Deloitte Center for Health Solutions, an estimated 750,000 Americans traveled abroad for medical care in 2007. That number is estimated to increase to 6 million by 2010. Several U.S. insurers, seeking to cut health care costs, have entered into tieups with hospitals in India, Thailand and Mexico, the center said in a report.

Although medical tourism is still in its infancy in Japan and there are no official statistics on how many foreigners come here for treatment, there are signs the government is getting serious about attracting more in hopes of making hospitals more internationally competitive and making it easier for foreigners to visit and stay in Japan.

The Ministry of Economy, Trade and Industry released guidelines for hospitals in July on how to attract such travelers, noting Japan boasts "cost-effective" health care and advanced medical technology.

"By introducing Japan's health culture and the underlying health care system abroad, Japan can make contributions to the world in areas other than manufacturing, and can also shore up related industries domestically," the guidelines say.

METI will soon launch a pilot program under which two consortiums, made up of hospitals, tour operators, translators and other businesses, start accepting patients from abroad.

Under the program, 20 overseas travelers will be brought to Japan by early March for health checkups or medical treatment at hospitals, said Tadahiro Nakashio, manager of marketing and sales promotion at JTB Global Marketing & Travel, which has been selected as a consortium member. He said the company will bring in patients from Russia, China, Hong Kong, Taiwan and Singapore.

Nakashio said some of visitors will combine sightseeing with their hospital visits, staying at hot springs resorts or playing golf, during their weeklong stay.

The Japan Tourism Agency convened a panel of experts in July to study medical tourism. The agency, which aims to boost the number of overseas tourists to 20 million by 2020, will soon start interviewing hospital officials in Japan and their foreign patients, as well as researching the practices in other parts of Asia, said Satoshi Hirooka, an official at the agency.

"We think of medical tourism as one of the ways to achieve our 20 million target," Hirooka said. "We decided to research this further, as Thailand and South Korea are very active on this front, with medical tourism making up 10 percent of their total inbound tourism volume."

Although the numbers are small, Japan has a track record of accepting medical travelers.

Tokyo-based trading company PJL Inc., which exports car parts to Russia, started bringing Russians, especially those living on Sakhalin island, to Japanese hospitals four years ago.

According to Noriko Yamada, a director at PJL, 60 people have visited Japanese hospitals through PJL introductions since November 2005. They have come for treatments ranging from heart bypass surgery to removal of brain tumors to gynecological screenings. PJL receives fees from patients for translating documents and interpreting on site for them.

One morning in October, a 53-year-old Sakhalin business owner visited Saiseikai Yokohama-shi Tobu Hospital in Yokohama to seek treatment for shoulder pains and other health problems.

The man, who declined to give his name, said there may be MRI scanners on Sakhalin but none work properly.

"The doctors and staff are good here, better than the ones in Russia," he said in Russian as Yamada translated. "But not everyone can come. You have to have a certain level (of income) to receive care in Japan."

The hospital's deputy director, Masami Kumagai, said the key to success in building up the medical tourism industry is finding enough skilled interpreters and translators who can communicate patients' needs to hospitals before they arrive.

"In health care, the textbook approach to translation won't work," she said. "Translators must have a deep understanding of the patients' social and cultural backgrounds. And even with advance preparation, patients sometimes cancel tests at the last minute because they have spent their money elsewhere, like sightseeing in Harajuku."

Medical tourists are not covered by Japan's universal health care system, which means hospitals are free to set whatever fees they like for such patients. As Japan's health care is known for being relatively cheap, patients from abroad are generally satisfied with the care they get here, even when they pay up to 2.5 times more than Japanese patients under the national health insurance scheme, experts said.

At Saiseikai Yokohama hospital, Russian patients are charged about the same as those covered by national health insurance, Kumagai said.

Through dealing with foreign patients, hospital staff have grown more sensitive to patients' needs, Kumagai said.

"We try to offer quality service to Russian patients who come all the way here, just the way we have tried to offer quality service to domestic patients," she said.

"For example, we have found a local bakery that sells Russian bread, and serve it whenever a Russian patient stays overnight."

John Wocher, executive vice president at Kameda Medical Center, a 965-bed hospital group in Kamogawa, Chiba Prefecture, said hospitals in Japan could market themselves more by obtaining international accreditation. Kameda in August became the first hospital in Japan to get approval from the Joint Commission International, a U.S.-based hospital accreditation body aimed at assuring the quality and safety of care.

Worldwide, more than 300 health care organizations in 39 countries have been accredited by JCI.

To be approved, hospitals must pass inspection on 1,030 criteria, including infection control and protection of patient and family rights.

Wocher, who has spearheaded the hospital group's efforts to obtain accreditation, said it didn't seek the JCI status just to attract more foreign patients, but it certainly helps.

Kameda now gets three to six patients per month from China, mainly for "ningen dokku" (preventive and comprehensive health checkups) and postsurgery chemotherapy that uses drugs patients cannot get in China.

Wocher expects to accept more patients from abroad next year, having recently signed an agreement with a major Chinese insurer that covers 3,000 affluent Chinese and expatriates.

Wocher said that accepting medical tourists from abroad would benefit long-term foreign residents in Japan as well, by expanding hospitals' multilingual capabilities and amenities, although these might come at an additional cost.

"I think that the infrastructure required to accommodate medical travelers will benefit all foreign residents as hospitals become more foreigner-friendly," he said. "Much of the infrastructure will involve patient choices, perhaps choices that were not available before."

But for medical tourism to grow in Japan, the government needs to do more, Wocher said, noting the government has so far invested almost nothing in this area.

In South Korea, the government is spending the equivalent of $4 million this year to promote medical tourism. It issues a medical visa promptly when foreign patients get a letter from a South Korean doctor saying they will be treated there, he said.

But Toshiki Mano, a professor at Tama University's medical risk management center, sounds a cautious note. Japanese hospitals face a shortage of doctors, particularly in high-risk fields such as obstetrics and gynecology. They might face public criticism if physicians spend more time on foreign patients who are not part of the national health insurance system.

"There would be a battle for resources," Mano said.

But he added that accepting more patients from abroad could substantially help hospital finances. "It would give hospitals one way to make up for their sagging revenue," Mano said.

Japan wants to be a medical tourism destination

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