Survey of people going to Japan for treatment: the middle class can afford it, and Chinese patients are the largest

Tencent News Prism

2024-06-12 15:46Published on the official account of the "Prism" column of Tencent News in Beijing

Shonan Kamakura General Hospital is a private hospital that is part of the Tokushukai Group, Japan's largest medical group. Photographed by the author

Author | Wang Weikai

Produced by | Prism Tencent Xiaoman Studio

Half a year ago, Wu Tong (pseudonym) reached a low point in her life, and she was not sure how long her life would be.

Wu Tong, who is in his 30s, is a Beijing office worker from a small county in Shanxi. In September 2023, the bad news befell her, she was diagnosed with intrahepatic cholangiocarcinoma, the tumor in the body has different degrees of invasion or enveloping of the three veins of the liver, this situation is difficult to treat surgically, and only a more conservative chemotherapy method can be used.   

However, chemotherapy is not as effective. In desperation, she decided to go to Japan for medical treatment.

In December 2023, Wu Tong chose Juntendo University Hospital for treatment. After an imaging diagnosis, the attending doctor brought her good news - surgery can be performed. On January 29, 2024, she underwent a left liver resection and reconstructed her right hepatic vein, which has now largely recovered to its pre-operative level.

"The feeling given to me by the doctors in China is that they always have some concerns, but the Japanese doctors seem to be very confident that they can cure me." Wu Tong recalled to the author.

She left Japan on March 22 and is now undergoing rehabilitation at a hospital in her country.

In the wake of the pandemic, more and more Chinese patients are starting to seek medical treatment overseas, and Japan is becoming an important destination.

Zhao Jianyong, deputy general manager of Shengnuo, an overseas medical treatment agency, told the author of Prism that at present, the most Chinese patients go to the United States, but Japan, due to its proximity, low price, cultural proximity and high medical level, accepts Chinese patients second only to the United States.

For Japanese hospitals, Chinese patients are also their most important international patients.

According to statistics from the Medical Excellence JAPAN (MEJ), a Japan organization for the promotion of international medical services, from April 2022 to March 2023, 749 international patients from 40 MEJ-accredited Japan International Hospitals (JIHs) visited Japan, of which 414 were from China.

In 2019, the author of "Prism" traveled to the United States and the United Kingdom to interview Chinese patients who seek medical treatment there. Recently, the author of "Prism" went to Japan and interviewed dozens of hospital directors and department heads, and conducted an in-depth analysis of the topic of "going to Japan for medical treatment" from the perspectives of technology, cost, policy, and intermediaries.

Can Japan really become the preferred destination for overseas medical treatment for the average middle class?

The cost is about twice that of Japanese nationals

In the center of Tokyo, adjacent to the Imperial Palace, the National Diet Building, and the Prime Minister's Office, there is a prestigious hospital called Toranomon Hospital.

Originally a health and welfare facility for civil servants and their families, the hospital is now a large general hospital where Japan's richest man, Masayoshi Son, and many Japanese dignitaries were treated.

On the 19th floor of the inpatient department is the VIP ward, which has a total of 36 beds, each of which is a single room with a sofa, TV, kitchen and bathroom, and special meals. There are 24 nurses in the wards on this floor, one of whom is fluent in Chinese.

The price varies depending on the area. Toranomon Hospital's VIP rooms are divided into three categories and are priced at 770,000 yen/day, 165,000 yen/day, and 22,000 yen/day.

VIP ward at Toranomon Hospital, photographed by the author

International patients from all over the world are treated here. According to the medical staff, since international patients need interpreters, in order not to affect other patients, the hospital has arranged them here. A number of hospitals in Japan visited by the author had similar requirements.

"The average length of stay for patients here is nine days, and the occupancy rate is now 40 to 60 percent, and in addition to international patients, some local patients also live here." Medical staff introduced to the author of "Prism".

However, for international patients, the ward is only a small part of the cost, and treatment, medication, etc. are the main part of the cost.

"The hospital clearly told us that the cost of treatment was three times that of Japanese nationals. However, cost is not a factor for us, and our main concern is the success rate and recurrence rate of the surgery. Wu Tong's father told the author.   

According to the authors' visits, different hospitals charge different fees for international patients, for example, Juntendo University Hospital, Cancer Institute Ariake Hospital, and Toranomon Hospital charge three times the national fee, Tokyo Medical and Dental University Hospital charges 1.8 times the Japanese national fee, and Shonan Kamakura General Hospital charges twice the Japanese national fee.

Taking colon cancer and rectal cancer as examples, Yoya Kuroyanagi, vice president of Toranomon Hospital in Japan, told the author that the average cost of Chinese patients is 5.5 million yen and 6.8 million yen respectively, and the average cost of Japanese patients for these two cancers is about 2.5 million yen.

Wu Tong did not calculate in detail how much money she spent in Japan, and she spent about 1 million yuan in total based on the cost of treatment in China and Japan. Fortunately, Wu Tong had previously purchased critical illness insurance, and if it went well, he could be reimbursed 60%.

Zhao Jianyong told the author that many people who go to the United States for treatment are very wealthy, and many people will even choose to charter a flight to go, which costs millions of yuan, and the cost of treatment in Japan is much lower, and some ordinary urban middle class can afford it. If you have purchased the relevant business insurance, the cost will be lower.

"Japan implements universal medical insurance, and the national medical treatment can be reimbursed 7 percent. For international patients, the hospital can set its own fees according to the situation. The vice president of Shonan Kamakura General Hospital told the author, "In Japan, the cost of treatment is uniform in both public and private hospitals. ”

Shonan Kamakura Hospital is a private hospital that is part of the Tokushukai Group, Japan's largest medical group.   

According to the introduction of many Japanese medical professionals, detailed treatment guidelines are one of the major features of Japanese medical care. Under the guidance of these guidelines, the treatment plan for the same condition is generally the same, regardless of whether the doctor is experienced or not, and the cost of treatment does not vary too much, and the treatment received by international patients is not much different from that of Japanese nationals.

The main factors that contribute to the increase in the cost of treatment for international patients are the cost of services, such as communication, single rooms, remote diagnosis, translation of old medical records, etc.

The only way to seek medical treatment in Japan is through an intermediary

Unlike in the United States, Japanese hospitals do not accept applications from individual international patients.

"If an international patient comes to us, we put them in touch with an agency." Kanryu Ito, senior director of the Department of Hepatobiliary and Pancreatic Surgery at Cancer Institute Ariake Hospital and director of the International Relations Office, told the authors, "These intermediaries can sort out a relatively comprehensive medical data, which is conducive to our judgment of the condition." ”

Located in Tokyo, Cancer Institute Ariake Hospital is an affiliated institution of the Japan Association for Cancer Research, and has a history of more than 70 years, and its cancer treatment has been ranked No. 1 in Japan for many years.

Takuya Okada, head of the International Medical Department at Tokyo Medical and Dental University Hospital, also told the authors that they ask patients to communicate with them through intermediaries.

"Why go through an intermediary? Because hospitals need to know in detail and accurately about the treatment methods and drugs taken by patients in their home countries, if it is an individual patient, there may be errors in communication due to language differences. Takuya Okada said.

Of course, not all intermediaries are able to cooperate with hospitals, and Japanese hospitals are very cautious when choosing which intermediaries to work with.

Ken Ishii, director of the International Department of Toranomon Hospital, told the author that at present, there are about 250 intermediaries in Japan, but only a few have been certified by AMTAC, and the three intermediaries they cooperate with are all certified, such as Shengnuo, JTB Co., Ltd., and Japan Emergency Relief Co., Ltd.

The full name of AMTAC is Accredited Medical Traval Assistance Company, and the MEJ is responsible for the certification of the system. In 2015, MEJ initiated the certification of AMTAC, with 3 intermediaries fully accredited and 3 intermediaries pre-certified.

MEJ has strict requirements for AMTAC certification, such as accepting more than 150 patients to Japan every year; Must be eligible to sponsor in Japan; Recommended by at least 3 JIH-certified hospitals; Acquired Japanese privacy protection certifications, etc.

"Many people have a misconception about intermediaries, thinking that we are just helping patients register and translate medical records, but in fact, we have a lot of services, which can greatly shorten the time for patients to seek medical treatment, and can also find the best treatment plan for patients on a global scale." Zhao Jianyong, deputy general manager of Shengnuo, told the author.

In addition, major hospitals in Japan have set up international departments dedicated to serving international patients, and the international departments are small, mostly about 5 people, but will include 1-2 Chinese or Japanese employees who can communicate fluently in Chinese.   

However, it is worth noting that, according to MEJ staff, before the pandemic, 80% of the international patients admitted to their accredited JIH hospitals were from China, but after the epidemic, the number of Vietnamese patients increased rapidly, and in 2022, 30% of patients were from Vietnam, while the proportion of Chinese patients dropped to 50%.

"We are a national university hospital, we do not pursue commercial interests, we hope that our medical technology can benefit more people. When choosing an intermediary to work with, we will also choose the same as our philosophy. Takuya Okada told Prism, "We tend to work with organizations that have a very high level of translation and interpretation. ”

Takashi Kadowaki, the director of Toranomon Hospital, told the author that they did not consider the benefits of the hospital in accepting international patients, but contributed to all patients treated in Toranomon, not only Japanese patients, based on the hospital's spiritual purpose.

"We have a very close relationship with China, and we hope that Chinese patients can receive good treatment at Toranomon Hospital." Takashi Kadowaki said.

In fact, at present, there are not many international patients who come to Japan for medical treatment, and even if hospitals charge several times as much for international patients as their own patients, these benefits are not large for those large hospitals. For example, the authors of Prism learned that in 2023, less than 0.1% of all international patients will be hospitalized at Cancer Institute Ariake Hospital.

Most of them have advanced cancer

The detailed and patient communication of the Japanese doctor left a deep impression on Wu Tong.

"When treating in China, doctors are more accustomed to communicating with family members, such as calling family members to the office to talk. But Japanese doctors tend to communicate with patients, and as a patient, I also want to know what I will face. Wu Tong introduced to the author.

Dr. Akio Saiura of Juntendo Hospital was treated by Dr. Akio Saiura, a renowned doctor in the Department of Hepatobiliary and Pancreatic Surgery in Japan, with more than 6,000 surgeries to be performed. During the first diagnosis with Wu Tong, Dr. Akio Saiura spent an hour inquiring about Wu Tong's condition in detail and explaining to her the treatment plan, which was an important reason why Wu Tong made up his mind to be treated in Japan.

"Preoperative communication and mutual trust are very important." Hiromito Ito, director of the International Relations Office at Cancer Institute Ariake Hospital, told the authors, "We will tell patients what to expect from surgery and our plan B. ”

According to Ito, many hospitals in Japan require doctors to provide a diagnosis of more than 30 minutes for first-time patients and less than 15 minutes for follow-up patients, and the specific diagnosis time will be determined according to the condition. "It's not that when a doctor is more famous, he will have less time for patients."

Masashi Ueno, Specially Appointed Director of the Department of Digestive Surgery (Lower Gastroenterology) at Toranomon Hospital, is one of the Japanese doctors who receive the most Chinese patients, and has received more than 100 Chinese patients so far.

He told the author that what Chinese patients are most looking forward to is that Japanese doctors can give them a treatment plan and instructions that they approve of. In order to meet the needs of patients, they do a lot of preparation, consult with other departments, and after formulating a plan, they also explain it to the patient in an easy-to-understand manner.

"Sometimes, we need to draw some pictures to explain our plan." Masashi Ueno said.   

Masashi Ueno was impressed by the fact that the vast majority of Chinese patients who came to Japan for treatment were in the advanced stage of cancer and could not be treated at other hospitals.

During the visit of the author of "Prism", many medical staff expressed the above views to the author. Yuki Yamagami, director of the Pancreatic Cancer Center at Shonan Kamakura General Hospital, has treated five Chinese patients, one with colorectal cancer and four with pancreatic cancer. All five patients have terminal cancer and have received high-quality treatment in China before coming to Japan.

Ito told the author that although most international patients have advanced and advanced cancer, there are many differences in the types of diseases and conditions. For example, patients with colorectal cancer with liver metastasis, even if it is stage 4, can create a chance of surgery through active treatment and strive for the possibility of cure. In their hospital, the 10-year survival rate of patients with stage IV colorectal cancer has reached 40%. In the case of pancreatic cancer, liver cancer, and bile duct cancer, some patients can also win surgery and then have a chance of long-term survival.

Many medical staff also emphasized the importance of physical examinations, believing that physical examinations can help patients detect symptoms early, and if it is cancer, early intervention will make it much less difficult to treat and the cure rate will be higher.

Taking gastric cancer as an example, the 5-year survival rate for gastric cancer in Japan is close to 80%, which is the leading one in the world. The main reason for the author's analysis to the author is that the prevalence of medical examinations in Japan is very high, and 60%-70% of gastric cancer patients can be detected at an early stage.

"Physical examination is the treatment of 'disease', and what we call 'health' includes both physical health and mental health. The purpose of the medical examination is to allow everyone to live physically and mentally healthy. Yasunari Miyazaki, director of the Medical Examination Center at Tokyo Medical and Dental University Hospital, told the author.   

According to him, the largest number of people in Japan who undergo regular medical checkups are manual workers, who undergo medical checkups once a year.

It is worth noting that Japan's medical examination is known for its meticulousness, and the medical examination centers of many large hospitals can only receive a maximum of a dozen medical examiners per day, and the physical examination time of the physical examination of the medical examiners often takes a whole day.

"If you only serve Japanese people, it will be a waste of resources"

The International Department is an important department for Japanese hospitals to connect with international patients, and the authors of Prism found that many Japanese hospitals established international departments around 2016.

Dr. Suzuki, head of the Department of International Healthcare at Keio University Hospital, explained to the author that this is because the MEJ began the JICH certification in 2016. The full name of JIH is Japan International Hospitals, and many hospitals have set up international departments based on this opportunity.

MEJ was established in 2011 to promote the Japanese government's strategy of globalizing healthcare services.

It is worth noting that the Ministry of Health, Labor and Welfare, which is responsible for medical care and hygiene, is not supporting the establishment of the MEJ, but the Ministry of Economy, Trade and Industry, which is responsible for the economy.

"We didn't start accepting international patients until we had an international department. At the beginning, many doctors were reluctant to accept it because it was very troublesome, and the treatment methods at home and abroad were different, and a lot of information needed to be consulted. The vice president of Shonan Kamakura General Hospital came down to the mountain and told the author.

Since 2016, the internationalization of medical care in Japan has begun to develop rapidly. In 2016, for example, Toranomon Hospital received 562 first-time international patients (including residents in Japan), and since then it has increased year by year to 1,042 in 2019.

The pandemic has affected the pace of international patients at Toranomon Hospital, and in 2020, the number of international patients plummeted to 622. But since then, it has increased year by year, and in 2023 it has reached a record 1,116 people.

Although the number of international patients admitted to major hospitals in Japan is increasing, the level of internationalization of medical care in Japan is not high.

Kenji Shibuya, chairman of the MEJ, told the authors of Prism that according to their estimates, Japan can accept 20,000 to 30,000 international patients a year, which is far lower than those in Asia where medical internationalization is well developed, for example, Singapore and South Korea can receive 500,000 international patients a year, and Malaysia can receive 1.2 million international patients.

It is worth noting that Malaysia has been selected as the "Global Preferred Destination for Medical Tourism" by the American magazine "International Life" for many years in a row.

In Shibuya's view, there are three main reasons why Japan's medical internationalization is relatively backward: Japanese hospitals feel a high burden when accepting international patients; Most of the international patients are at an advanced stage of cancer, and it is hoped that more patients will be treated at an early stage. Medical institutions are still the main ones that accept international patients, but there are also more health care facilities such as hot springs and healthy diets.   

Kenji Shibuya believes that the biggest feature of Japanese medical care is safety, medical technology is in a leading position, and the cost is relatively low, and he believes that the internationalization level of Japanese medical care can go further.

Shuzo Kobayashi is a highly respected doctor in the Japanese medical field and currently serves as the director of Shonan Kamakura General Hospital. He told the author that the Japanese government has been cautious in promoting the internationalization of medical care, and few people have thought about the combination of medical care and economic benefits before, and if they are more active, the gap between Japan's medical internationalization and other countries will be narrowed.

Currently, Shonan Kamakura General Hospital has four ABCD buildings, and they will build a new E building to serve international patients.

"We can now accept 60-70 international patients per month, and hopefully it can increase by more than 10 times in the future." Shuzo Kobayashi told the author of "Prism", "We have a lot of excellent equipment and doctors in our hospital, and it would be a waste of resources to serve only Japanese people, and we hope to serve more Asians." ”

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