Japan: Health-, Elderly- and Child- Care in comparison to the German system: based on a case study

Research Paper (undergraduate), 2009
17 Pages, Grade: 1,6



1 Introduction

2 Case 1
2.1 Home facilities/ Area where the family is living
2.2 Cultural values/ Religion
2.3 Relationships/ Roles in the family
2.3.1 Domestic situation
2.3.2 Male-Female Relations
2.3.3 Values of the family

3 Case 2
3.1 Health Care System of Japan
3.1.1 History
3.1.2 Insurances
3.1.3 Financing System
3.1.4 Hospitals and doctors
3.1.5 Costs for services
3.1.6 Problems and aims

4 Case 3
4.1 Elderly Care
4.1.1 Demographic Change
4.1.2 The “Gold plans”
4.1.3 The long- term care insurance system
4.2 Child Care

5 Conclusion

6 List of literature

1 Introduction

The development of the Japanese society is characterized by a lot of similarities to Germany. This is why I have chosen the country to compare especially the Health Care System with the German one. Not only the economic achievements are comparable, but first of all the Demographic Change. In 2020 in Japan there will be 28% of the population over 65 years old. In Germany it is prognosticated to be around 21% (Tab.1). Moreover the Japanese Health Care System is known as own of the cheapest of the industrial countries. This leads to the question of adoption of some parts or ideas from the Japanese system to the German one. In my elaboration I want to describe a case of a family in Japan regarding the family and work situation, the Health Care System in general and additionally the system of taking care of the elderly and the children. My example family has got following parts: The mother is 42 years old, she works as a nurse in an outpatient department of a local government. In addition she has to take care of her parents almost every day. The father is 45 years old, works as an engineer and likes his hobby, which is driving motorbikes. The daughter of them is 7 and their son is 13, both go to school. The grandmother has got dementia, she is 76 years old and lives together with her husband, who is 76 and has got diabetes. They live in the neighborhood of their children and grandchildren.

Case 1: Values, Culture, roles of the family members.

Case 2: Health Care System of Japan in comparison to the German one. What happens after a traffic accident of the father?

Case 3: Elderly and Child Care in general and in the case of the accident and depression of the mother in the family.

2 Case 1

2.1 Home facilities/ Area where the family is living

In Japan the greater part of the population lives in the city (66%). A great part of the country is landscape, where it is not possible to occupy a house because it is really mountainous. This consequences the high density of population (340/km²) in comparison to Germany (236/km²).

One can imagine that this leads to the fact that a lot of people live in houses which are small and close to each other. Furthermore a lot of companies have their own houses for their workers (S.-C. Kim, 2005). Additionally there is great diversity between the social ranks. It is similar to the German situation. Because rich people get more and more money, whereas the middle class gets contemporary few money and is going to be minimized. The poverty of Japan is over the OECD average. Many people and first of all many children are poor and dependant on the welfare system. Nevertheless a lot of people in Japan are satisfied although belonging to a lower rank (S. Aßmann, 2004). The example family could belong to a middle rank. The father is a fully qualified and not an unlearned worker. And additional the mother works, what is nowadays more and more normal in Japan, but is not usual for a woman who has to take care of children and grandparents.

In the last decades there has been a great change in the lifestyle of the Japanese people. Consumption has become an important part of the society. This is caused by a long period of time where Japan was marked-out of the western world. The fact that people weren´t allowed to use all the achievements of the industrial nations and had a strict government leads to the extremity of usage of technical offers. It is used to show to which generation or group of thinking one belongs to. The isolation of oneself from the traditional way of thinking is very important for a lot of young people. (S. Aßmann, 2004). In the example family we would find traditional things, like Buddha, icons and pictures of their emperor next to the flat- screen, notebook and cell-phones.

2.2 Cultural values/ Religion

Many people have got a special picture of Japan in their head, which consists of: well- organized groups, Japanese copying other nations, too hard work, play little, travel around the world (J. Hendry, 2003). These are not false, but need to be defined. I want to give a short view of the culture of Japan which developed over a long time and with much influence: The culture of Japan is influenced by Russia, China and Europe. Most of the time there was a system with social stratification and a strict regime. A major influence is given by the Chinese system and hereby first of all the Confucianism (J. Hendry, 2003).

At the beginning of the nineteenth century Japan was without influence of other nations or missioners. The nation developed extremely fast to a country with major power in the world. The economy grew and new technologies were find out by Japanese, whereas the self-consciousness grew (J. Hendry, 2003). Although there has been a change from a traditional to a more or less modern country the Japanese life is still influenced by rites and traditions. A main part of society is etiquette and the right behavior in all situations. Additionally religion plays a big role in the life of most of the people (J. Hendry, 2003). In year 2000 Shinto (108 million followers) and Buddhism (95.4 million followers) were the main religions as it was many hundred years ago. The whole population of Japan is only 127 million- what leads to the fact, that many people belong to more than only one religion. The example family would belong to both religions, too. They use the Shinto for their daily life. They pray to one of many gods for good grades, luck and visit their shrines. The Buddhism is used only for big happenings. Like the marriage of their children in some years or a funeral. Other minor religions are the Taoism, Confucianism and Christianity (J. Hendry, 2003).

2.3 Relationships/ Roles in the family

The system of family in Japan has been strengthened through the whole history. In cause of the extreme religions, like Confucianism, the roles in families have been the same for centuries. Just since the World War 2 the system changed slowly. Women became more rights and roles needed to be defined again. The Japanese call their family the “Ie”, what means “house” or “family”. This means not just the relatives, but all persons who have a great influence in life of one person. Even the dead and the unborn are included in this system and the Japanese think of them when they talk about the “Ie”. A long time it was even written in the legal system, that people in one “Ie” were responsible for each other and had to take care of each other. (J. Hendry, 2003). This differs from our understanding to call only our direct relatives as our family.

2.3.1 Domestic situation

In the past it was also obligation to live in a house with all generations under one roof. So that the whole “Ie” was together. In the 80´s it was still typical to live with three generations in one house. Today the rate of people who live like this decreases as it does in other countries. Many people live nowadays in a single-household or with a partner and children. The grandparents often live nearby, whereas the relatives still care for each other more than in other nations. The mother of our family has got responsibilities which are quite usual for Japanese circumstances. But even in Japan the number of people taking care of the elderly decreases (J. Hendry, 2003).

2.3.2 Male-Female Relations

Since 1946 the autonomy of the male is not guaranteed by law anymore. This means that women should have the same rights like the men. In reality a lot of things have already been changed, like the permission to work or the right of choice. But the roles still differ from each other. The men are often still the head of the family and earn the money. The Women are responsible for the budget, the children and elderly. Additionally many women have to work in a part- time job, because of the ailing economy and following decreasing salaries (50% of the married women work). In most parts of the society it is an ideal to have equal rights and for Japan it is even harder to reach this aim because of the traditions with their enormous influence (F. Coulmas, 2003).

2.3.3 Values of the family

The most important value for many Japanese is it to take care of their family in every situation, as it was mentioned before. Usually education of the children is another main part. All children enter school at the age of 6 officially, but a lot of them can read and write before. It is possible to give a child to the pre- school at the age of one and many people use this offer. At school children learn loyalty, there is a strict hierarchy between pupil and teacher and school endures mostly all-day and even on Saturdays. In 2002 there has been a reform , which indicates “to make education less regimented and more nurturing of children´s ability and willingness to solve problems by themselves” (J. Hendry, 2003, P.98). The third value is the company. To work for a company means to be deeply connected with it. For many people even company and their leaders are part of their family. Many work all their live in one and the same, they get the house from it, often the kindergartens and schools belong to it as well. Many firms have got an oath, a slogan and all have to wear the same cloth (F. Coulmas, 2003). Consumption is another value for many people. You need to have technical achievements and knowing about actual music, films etc. As I mentioned before the long period of time where Japan was isolated from the western world lead to a eagerness of new techniques and a feeling to be known as an industrial modern country as well (F. Coulmas, 2003). Other important values are the etiquette and the religion, which I have both described before.

3 Case 2

3.1 Health Care System of Japan

3.1.1 History

The Japanese government began in 1927 to provide a health insurance. This was focused on employees and not for elderly or people who were self-employed. In 1947 Japan was described as a welfare state by law. In the constitution a lower limit of healthy and cultured life was guaranteed. This also means that there were insurances against unemployment, for welfare, pension and of cause health care. In the case of the family mentioned at the beginning, one can say that after an accident of the father the family will get support by the welfare system comparable to Germany. Whereby the value of support won´t be that high as it is here in Germany, but basic support is guaranteed. In 1961 the health insurance for everyone was implemented. Nowadays the insurance is obligatory. When Japan implemented the first insurance, they orientated it quite close by the German Bismarck- model. In the following years the system worked well, but the rate of people over 65 grew and following in 1983 every insured had to pay a higher premium to ensure the supply of the elderly. Additionally since then people had to pay a part of the medical service privately.

In 1994 a reform implemented some new things in the system: more nurses in each hospital, higher additional payment by private, more ambulant services, private payment for the catering in the hospital (M. Schneider et al., 1994). In Germany we don´t have a fund for the elderly in the health care insurance like it is in Japan and we don´t have so many and high additional amounts. Another big difference in the system are the private insurances. The Japanese don´t have it because they want the system to be as equal as possible.

3.1.2 Insurances

In total there are more than 5000 independent insurance plans in Japan, which can be divided in three parts: The first plan is an insurance for large- firm employees and their dependants, which is called the “Society – Managed Health Insurance”. For the public- sector employees it is called “Mutual Aid Associations”. They have to pay 6%- 9.5% of monthly wages. Employer and employee pay each the half of it. The second plan is the insurance for small- firm employees (Government- Managed Health Insurance), which is operated by the Ministry of Health and Welfare. Here the premium is about 8.6 % and the employee pays the half of it.

Dependants are family- insured in the first and second plan, even if there is only a cohabitation. The third plan is for self- employed and pensioners (Citizens´ Health Insurance), which is operated by all the 3000 cities, towns and villages in Japan. The premium is based on the income, number of people living in household and assets (N. Ikegami, J. C. Campbell, 1999).

3.1.3 Financing System

The system is financed by the premiums, subsidies of the government and additional private payment by the insured, which differ from 10-30% depending on age and revenue. In 1998 the premiums made 52.9%, the additional payment 14.9% and the government paid with taxes 32.2%. Although the system is subsidized by the government, 70% of the insurances made a deficit in 1999, whereas most of them are insurances for people with a low income (H. Jeong, 2001). The main difference to Germany is the high rate of subsidies. If these were not, the Health Care System of Japan wouldn´t seem to be so cheap. Moreover the system differs at the rate of private payment. In Germany we have to pay for service mainly 10€ every three months and of course for special services (IGE- Leistungen). In Japan you have to pay for every service and additionally the whole catering in hospital. In general you can say the services for which the insurance pays are quite similar to the German system, including Rehabilitation and sick- payment. But in all cases, even in the case of emergency you have to pay from private up to a special rate each month (around 400 €). Mainly in the psychotherapeutically sector many long- term- therapies are not included in the insurance, what goes together with the fact that psychological illnesses are still a taboo in Japanese society and these illnesses are expensive and hard to bear for those people (Sonnenmoser, M., 2008).


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Japan: Health-, Elderly- and Child- Care in comparison to the German system: based on a case study
University of Applied Sciences Bremen
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ISBN (Book)
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Japan, Germany, Health Care, Healt Care Systems, Comparison, Vergleich Gesundheitssysteme, Elderly-Care, Child-Care, Pfelegversicherung, Values, Culture, Roles, Werte, Kultur, Rollen
Quote paper
Anja Hellmann (Author), 2009, Japan: Health-, Elderly- and Child- Care in comparison to the German system: based on a case study, Munich, GRIN Verlag, https://www.grin.com/document/149799


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