On my research activities
A summary of my comparative study
on the U.S. and Japanese medical administrations
from a bioethical point of viewKawahara, Naoto*
1. Introduction
I major in 'Bioethics' which is related to all the human subject as well as medicine and medical care. This discipline identify itself with a civil liberty movement formulating a public policy based on the advocacy of the human dignity.
In this sense I believe it is a new academic field and a movement that originate new values and social agreement that open up a new world in the future.
From this viewpoint, I attempt to have conception of the ideal type of our society based on the principles of Bioethics, namely, justice, beneficence, equality, and autonomy.
In our society any decision is made in a variety of manners in accordance with the fundamental rules that sovereignty rests with ourselves. So, those decisions can come to the public policy as the embodiment of common consent. The decision-making is developed from the validity based on some latent criteria in our society, culture, and history.
Any social resource involving the revenue, manpower, facility, and various other elements is allocated by some criteria. I infer that each the criterion of the social resource allocation should be drawn from a concept of 'Autonomy' as the individual need which respects for the recurrence of 'social beneficence', and 'Autonomy' should be sublimated into 'the social attitude as Equality' and 'the social management as Justice' at the same time.
From this inference, I deduce that social 'Equality' and 'Justice' risen from individual 'Autonomy' influence each other and transform mutual interest into the overall societal 'Beneficence'. Furthermore, I think that as the eventual success the social 'Beneficence' finally bring about the 'Autonomy' again to the individual through a community (Fig. 1.).
Figure 1. "The Bioethical Dynamics in Society" (N. Kawahara, 1998)
At this point, I suggest that just the autonomy of the individual supported justly and equally by a community can lead us to the social beneficence and find a way to the cosmos in our society. This is, so to speak, 'Bioethical Dynamics' in our society.
I suggest that just the chain reaction, that is, Bioethical dynamics realizes the peace as the ultimate end; therefore applying these new ideas of Bioethics to a current social system, I try to reexamine the social consistency with human subjects and formulate an ideal system of social welfare and movement. Because, I think that society should take the responsibility for the human subjects based on each community as a social constituent element, serve the public welfare to support the individual interest by 'the comprehensive welfarism' including the government and the private sector.
I think that just the principles of Bioethics should be applied to the social movement which cope with human subjects. Furthermore, I think that just the current pending problems of a medical administration indicate the characteristic trend of the dynamic state of our society on the whole.
In this logic, I make a comparative study of Japan and U.S. medical administrative organizations with the intention of the practical solution in formulating the public policy as the possibility of Bioethics.
2. The Comparison of Japan and U.S. Medical Administration
In this study, I take notice of the problems of the two countries' social security involving medical insurance, especially the rise of medical expense in the social context of aging.
As an approach to Japan, I focus on the system of the Ministry of Health and Welfare1 and the affiliated organizations.
Besides, I deal with problems of the National Health Insurance involving medical financial difficulties and reconsideration of the consumer choice based on the public information.
In Japan the aging population is now exploding, while the number of children is declining.
This population problem has influenced not only the medical economy but also overall societal health care directly or indirectly.
On the other hand, as an approach to U.S., I investigate the public welfare work of the Department of Health and Human Services and the associated institutions based on the federal system.
In addition, I deal with U. S. social security services involving 'Medicare' and 'Medicaid' which are the U.S. national health insurance systems for the aging and low income bracket. [For Reference (Excerpts from Madison Powers: Justice and the Market for U.S. Health Insurance, Kennedy Institute of Ethics Journal, 1(4), 1995, pp. 307-323.)]
3. The Prospects for the Common Problems
Just then, it is also suggested that expanded consumer choice and overall societal health care cost savings may not be effectively promoted in U.S.
Moreover, many segments of society, including physicians, patients, insurance companies, unions, and large corporations, have expressed dissatisfaction with the increasing costs that effectively limit access to health care for substantial portions of the population2 in U. S.
In other words, there is a great social demand that an equitable access to health care and an adequate level of care without excessive burdens among all the citizens in U. S. as well as Japan.
Table 1. "The ratio of the mdical expenses to the GDP in Japan and U.S.3 "
| / |
The ratio of the medical expenses to the GDP: % |
| U. S. |
11.8 |
| Japan |
4.9 |
In these two countries' social context, we need to reconsider a latitude of our discretion based on 'rationality' as the essential of economy and 'quality' of the service as satisfaction of human subjects regardless of country.
I think that all the medical resource should be allocated efficiently within the limits of the economical restriction. Of course, the allocation should be carried out in order to provide the motivation to achievement of the good quality.
In this sense, I think that the medical delivery system should be developed from multiple choice of health care within the consumer's discretion. Above all, I think that it should be promoted effectively to utilize the vitality of the private sector based on the policy-making of opening of the market.
4. Brief Conclusion
Now, I investigate the Japan and U.S. administrative organizations, considering what are vain systems, how to establish the new systems, which system should be abolished or revised in each practical administration.
In brief conclusion, I infer generally that the spirit of 'National aid (Public Assistance)4 ' has been emphasized in Japanese administration, on the other hand, the one of 'self-help5 ' has been emphasized in U.S.
I think not only these spirits but also the spirit of 'cooperation (mutual help)6 ' should be taken in two countries' administrations more and more.
Figure 2. "Social System as a Balance"
(the original GIF appears in a NIH's webpage, and modified for the study by N. Kawahara, 1998)
'Balance7 ' is the symbol of the methology of Bioethics.
I think that we should find a good balance between not only the country and the people but the social and the individual.
So, I believe that we should draw the validity from a variety of public opinion based on the spirit of 'cooperation', utilize Bioethics for the practical policy-making (Fig. 2.).
Thank you very much for browsing this page!! But, this presentation is a mere assumption of my progressive study...Just now, I investigate the above problems to be in possession of actual proof.
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