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dc.contributor.authorRamseyer, J. Mark
dc.date.accessioned2013-07-24T15:49:07Z
dc.date.issued2009
dc.identifier.citationJ. Mark Ramseyer, Universal Health Insurance and the Effect of Cost Containment on Mortality Rates: Strokes and Heart Attacks in Japan, 6 J. Empirical Legal Stud. 309 (2009).en_US
dc.identifier.issn1740-1453en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10880603
dc.description.abstractFor more than four decades, Japan has offered universal health insurance. Despite the demand subsidy entailed, it has kept costs low by regulatorily capping the amounts it pays doctors, particularly for the most modern and sophisticated procedures. Facing subsidized demand but stringently capped prices on complex procedures, Japanese physicians have had little incentive to invest in specialized expertise. Instead, they have invested in small private clinics and hospitals. The resulting proliferation of primitive clinics and hospitals has cut both the number of complex modern medical procedures performed, and the number of hospitals with any substantial experience in those procedures. With a quarter of the heart disease in the United States, Japan performs less than 3 percent as many coronary bypass operations and less than 6 percent as many angioplasties. Of the 855 cities and regions in Japan, 77 percent lack any hospital with substantial experience in the sophisticated modern treatment (defined below) of cerebrovascular disease, and 89 percent lack much experience in angioplasties. In this article, I estimate one of the costs of this regulatorily-driven lack of expertise. Toward that end, I combine mortality data from 855 cities with information on local hospital expertise and local demographic composition. In the typical city, I find that the addition of one hospital with substantial experience in modern stroke treatment would cut annual stroke mortality by 7 to 16 deaths. The addition of one hospital with substantial experience in angioplasties would cut the annual deaths from heart attacks in the city by over 19.en_US
dc.language.isoen_USen_US
dc.publisherBlackwell Publishingen_US
dc.relation.isversionof10.1111/j.1740-1461.2009.01145.xen_US
dc.relation.hasversionhttp://onlinelibrary.wiley.com/doi/10.1111/j.1740-1461.2009.01145.x/pdfen_US
dash.licenseOAP
dc.titleUniversal Health Insurance and the Effect of Cost Containment on Mortality Rates: Strokes and Heart Attacks in Japanen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalJournal of Empirical Legal Studiesen_US
dash.depositing.authorRamseyer, J. Mark
dc.identifier.doi10.1111/j.1740-1461.2009.01145.x*
workflow.legacycommentsYellow journal. Published by Wiley-Blackwell in collaboration with the Cornell Law School. Only able to find copies for pay.en_US
dash.contributor.affiliatedRamseyer, John


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