The rise in international migration of labor has created a new problem in Asia, namely how to ensure social security for immigrants.Two approaches to this issue are currently envisaged.The first incorporates foreign migrant workers into an existing social security system; the second offers that service through market forces. Japan is a typical example of the first case, and has designed a solution that covers foreigners via its public medical insurance system. China, on the other hand, is an example of the latter market-force approach. China does not allow foreigners to join its public medical insurance system; these workers have to procure such services through the market. Both systems encountered problems when the numbers of foreigners rapidly increased, since their original plans were based on the assumption that the numbers of foreign workers would be negligible, and could thus be treated as exceptions. However, the problems that each administration faced and the reaction of medical institutions, i.e. the supply side, are distinctly different.
In the case of Japan, the central government did not explicitly announce its policy regarding the treatment of foreign patients who were not covered by the national health insurance. Since foreigners are eligible to join the existing system, the government took it for granted that they would do so. Those who would not were left in the hands of local governments, hospitals, and doctors.
The above attitude caused few problems until recently, as the numbers of foreigners was small.However, a rapid increase in the number of uninsured foreigners has now began to damage management of medical institutions, especially those in districts with a high proportion of foreign residents. The alternative of turning to the market is unrealistic because Japan’s legal system prohibits medical institutions from running on a commercial basis. The high standard of medical treatment in Japan only adds to their difficulties, for it inevitably raises the costs.
On the other hand, China allowed‘ marketization’ and‘ profit-earning’ in the field of medical services, and this enabled hospitals to develop a medical market especially designed for the foreigner.The expensive medical costs caused by such profit-oriented treatment are met by commercial health insurance.
This structure resembles the overall medical security policy that the Chinese government is currently pushing forward. Medical care service designed for the Chinese people is also based upon marketization. It is supported by the government through policies of increasing insurance premiums, limiting the range of application of insurance and promoting private insurance company article purchase.
This process has caused severe disparity among patients.The new, well-equipped hospitals for foreigners and wealthy Chinese, funded by both domestic and foreign capital, are in sharp contrast to the institutions that mainly serve patients covered only by public insurance.
The purpose of this paper is to examine the problems that have occurred in the two adverse measures mentioned above by comparing supply of medical service towards foreign workers in Japan and China.
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