Japan’s health system is specifically characterized by universal health insurance, which provides excellent health outcomes at a relatively low cost with equity (Ikegami N et al., 2011; Murray CJL, 2011).
By law, all residents of Japan (including foreign nationals with a residence card) must be enrolled in a health insurance programme. There are two major types of insurance schemes in Japan; Employees’ Health Insurance and NHI. Employees’ health insurance covers those who are public servants or work in companies, while NHI covers the self-employed and unemployed. Employees’ Health Insurance is further divided into four major categories: Japan Health Insurance Association (JHIA), Society Managed Health Insurance (SMHI), Mutual Aid Association, and Seamen’s Insurance (JHR, 2017). There is no such health policy in Bangladesh centrally which may play vital roll to reduce amount of money from patients. The government of Bangladesh has adopted a healthcare financing strategy that aspires to move toward universal health coverage for its population by 2032. The strategy has three objectives to mobilize resources for health: improve equity of healthcare services, improve access to healthcare services, and enhance the efficiency of the health system.
Bangladeshi health system is a pluralistic system with four key actors that define the structure and function of the system: government, private sector, nongovernmental organizations (NGOs) and donor agencies. The Government or public sector is the first key actor which by constitution is responsible not only for policy and regulation but for provision of comprehensive health services, including financing and employment of health staff. The Ministry of Health and Family Welfare, through the two Directorates General of Health Services (DGHS) and Family Planning (DGFP), manages a dual system of general health and family planning services through district hospitals, Upazila Health Complexes (with 10 to 50 beds) at sub district level, Union Health and Family Welfare Centres at union level, and community clinics at ward level. In addition, the Ministry of Local Government, Rural Development and Cooperatives manage the provision of urban primary care services. Quality of services at these facilities, however, is quite low due to insufficient allocation of resources, institutional limitations and absenteeism or negligence of providers.
Medical costs regulation policy:Japan government regulates drug prices and medical equipment centrally so that nobody frauds. Therefore, once in every two years, the MHLW reviews the scope of coverage by the national insurance scheme and the reimbursement billing conditions for procedures, drugs, medical devices. All hospitals and clinics are required to comply with the nationally uniform fee schedule set by the MHLW and cannot set their own prices for treatments under the NHI scheme. Such system in Bangladesh to fix prices every after certain years is invisible but during each budget, government declares sector wise price increases or decreases. Emergency health service:Emergency care is delivered at different levels, from the sub district UHCs to the tertiary public sector facilities.
Large hospitals in the nonprofit and for-profit sectors also provide emergency care. Emergency transport services (ambulance) are available in public sector facilities. There is no centralized system geared for accessing ambulance services. Individual facilities need to be approached to access the service.
There are also some for-profit private enterprises that provide emergency transport services. However, the public sector ambulance services can be ill-equipped, out of order, and sometimes used for other purposes. Big hospitals in the nonprofit and for-profit private sector provide emergency ambulance services. Ad-din has a fleet of small ambulances mainly for the transport of pregnant women within Dhaka City. Some hospitals such as Square and Appllo also offer air ambulance services. Nonprofit organizations such as Anjuman Mofidul Islam and Markajul Islam provide free emergency transport for patients and also for dead bodies. (bd health review, 114). To provide emergency ambulance health, health ministry revealed a number (16263) to dial from any mobile to get ambulance (Samakal, 2016) .
Japan: The Ministry of Internal Affairs and Communications (MIC) is in charge of pre-hospital care, while the MHLW is in charge of providing emergency care at health care facilities. The major challenges facing emergency care in Japan are as follows: the increasing demand for emergency care because of ageing and overutilization of ambulance services, the quality of pre-hospital emergency care and the still-low survival rate of out-of hospital cardiac arrests, as described below, pre-hospital care by physicians, emergency life-saving technician, emergency medical care at health care facilities. Emergency care for children as a pre-hospital care service, a public pediatric emergency telephone consultation service called “child emergency phone services #8000” was established in 2010. The number of telephone consultations is increasing yearly; in 2011, it reached about 53 million consultations, of which one quarter was deemed to require emergency room visits (Ministry of Health, Labour and Welfare, 2018). 119 for fire and ambulance in Japan but there may be not English speaker. Health care service for elderly:Aging population in japan is increasing continuously that is why the demand for health care services is forever increasing. Ensuring a high quality of services becomes a main task for health service provider/local and regional governments. In 2000, Long-term care insurance (LTCI) was launched in Japan and as of January 2015, provides benefits to over five million persons 65 years and older, about 17% of this age population.
Japan’s LTCI is a mandatory program that provides benefits for the long-term care for older persons, although which was opposed by the younger persons. All services are subject to a 10% copayment. On the other hand, there is no long-term care service in Bangladesh as yet. The government allocated BDT 8.
91 billion in 2011-2012 to provide old age allowance for senior citizens, and people why various disabilities like handicaps, physical infirmities and partial handicaps have. Elderly people in Bangladesh are generally taken care by their immediate family, such as sons or daughters, and then get long-term care by family in case of debilitating old age. Family members are provided care for the elderly, disabled and chronically ill persons. In October 2013, the parliament passed the 2013 Parents’ Care Act, an unprecedented law mandating children help their elderly parents financially if their parents live separately. Under the law in effect, children must give parents who live apart from them a monthly income as a subsistence allowance or violators face a three-month sentence or a fine (US$ 1,280).Health service for disable people:The Japanese government introduced dog as assistant for physically challenged persons to walk, listen, and walk. The term “Assistance Dogs” for persons with physical disabilities refers to “guide dogs”, “hearing dogs”, and “service dogs” that assist persons with disabilities of the eyes, ears, or limbs.
These dogs are certified in accordance with “The Act on Assistance Dogs for Physically Disabled Persons” and also have received special training. They are partners of persons with disabilities and therefore not pets. As they are properly trained and taken care of, they are able to follow social manners and are kept clean. Therefore these dogs are accepted in many areas where people tend to go. Guide dogs help people who are not able to see or have difficulty seeing safely navigate through town (MHLW, 2018). No system prevails in Bangladesh. Currently, 815,000 people with disabilities get a monthly allowance from the government. All the disabled people, as per the list made in 2013, will get government allowances from next year.
After the enactment of the Disability Welfare Act, and the Neurodevelopmental Disability Protection Trust Act in 2013, the government has done a mapping and found that 1.51 million people with disabilities live in the country. We are now trying to ensure the allowance for all from next year (Dhaka tribune, 2018).