My husband and I had planned to take our family to Japan on a sabbatical to study housing and long-term-care issues, but the high cost of living there prevented our going. (Elementary school for our three children in Tokyo would have cost more than $35,000.)
Instead, we spent three months in Australia and New Zealand, and a shorter time in Italy. In all three countries, I was struck by the many Japanese tourists who are traveling in record numbers. Songs, menus and travel guides were written in Japanese. In many shops, Japanese salespeople were employed, and signs welcoming Japanese tourists were plentiful.One of the compelling pressures facing Japan is the need to examine its systems of health and social care in light of a rapidly aging population. Japan's population is aging faster than any other industrialized society: The percentage of Japan's elderly is projected to skyrocket to almost 25 percent of the population by the year 2020.
This large number of older people will place great demands on the system for medical and social services. Partly because of a strong family-care system, Japan lacks nursing homes and other geriatric programs and facilities.
Traditionally, families have provided most of the care for their frail older members, the majority of whom live in the same dwelling with their sons. Many families now lack the space to house and care for their elderly members. And women, the traditional care-givers, are increasingly entering the labor force. Attempts to expand the long-term-care system are under way; however, as in the United States, programs must compete with other priorities.
Japan's public expenditures for social services and medical benefits are lower than those of all the major Western countries. While the United States spends 11 percent of its gross national product on health care, Japan spends 7 percent.
Another difference between our system and Japan's is the length of hospital stays: While the average in Japan is 39 days for patients of all ages, in the United States it is seven days for older people under diagnosis-related groups.
Researchers attribute the long stays in Japan to cultural and economic factors including a tendency to pamper the sick; an expanded definition of "illness"; the emphasis on "ansei" (peace and quiet, or bed rest) as the major treatment for any ailment; the absence of limits in all health-insurance plans; and the assistance of families in caring for people even in hospitals. Hospital stays may be long, but they are less expensive. Expenditures per day in Japan are about $60, while in the United States they are $360.
Because of the strong yen and weak dollar, my closest encounters with Japanese citizens have been at the Vatican and the Great Barrier Reef. Nevertheless, I remain interested in their culture, traditions and how they will meet the needs of their growing elderly population.