Physicians' conflicts of interest in Japan and the United States: Lessons for the United States

Japanese health policy shows that even with physician ownership and the abs ence of for-profit, investor-owned health care, physicians' conflicts of in terest thrive. Physician dispensing of drugs and ownership of hospitals and clinics were justified in Japan as ways to avoid commercialization of medi cine. Instead, they create physicians' conflicts and fuel patient overuse o f services. Japan's Ministry of Health and Welfare (MHW) has responded by i ntroducing per-diem payment, thereby creating incentives to decrease servic es in ways similar to those of American managed care organizations, but wit h none of their benefits, such as coordination of care, oversight of physic ians practices, and quality assurance. Although the United States and Japanese health care systems are organized a nd financed differently there is convergence in the source of their physici ans' conflicts and the way they are addressed. The United States is startin g to integrate institutional and physician payment and align their incentiv es, in a traditional Japanese way. In so doing, the United States creates n ew physicians' conflicts and reduces the role of countervailing incentives and power, an advantage of previous policy. Japan, in turn, has combined in centives to increase and decrease services, thus moving closer to the U.S. policy.