title: The German and Japanese health care systems: an international comparison using an input-output model.
abstract: OBJECTIVE
  The German and Japanese health care systems have common roots, but have evolved differently. Whereas the German system is often considered as expensive and poorly efficient, people in Japan are viewed as healthy and health care as comparatively cheap. In this study, we compared the quality, the effectiveness and efficiency of the German and Japanese health care systems.
  
  
  METHODS
  This study includes comparative health care data analysis.
  
  
  METHODS
  The quality and effectiveness of the German and Japanese health care systems were analyzed using an input-output model including 12 countries based on health indicators published by the OECD. Besides the invested resources, a risk-related input dimension was used for risk adjustment. The efficiency of the systems was assessed by relating the average output to the health expenses per capita.
  
  
  RESULTS
  Health risks seem qualitatively different in Germany and Japan, but at the aggregate level, lifestyle does not seem to be an outstanding explanatory factor for health outcome differences between both countries. For investments in health resources, Germany is in a top position, whereas in the international comparison, the outcome is rather poor. The resources invested in Japan are also high, but slightly less than in Germany, whereas on average, the outcome is better. However, in the international comparison, resources as well as results in Japan show a very high variability. Relating the average output to the health expenses per capita indicates that on the average, the health care system in Japan is more efficient than in Germany.
  
  
  CONCLUSIONS
  Germany and Japan have a quality problem with their health care systems. In Germany there is a transmission failure from structural to outcome quality that might be related to coordination problems between the outpatient and inpatient sector. Japan shows an unbalanced system that may be suspected to have a quality problem as a whole. As the development of the remuneration system including quality requirements is under the direct responsibility and guidance of the Ministry of Health in Japan, the issue might however be more easily solved in Japan than in Germany. Although on average, health care seems more efficient in Japan than in Germany, taking into account health as well as long-term care expenses and uncertainties related to exchange rate adjustments, the higher efficiency of the Japanese system becomes questionable.
authors.affiliation: Institut für Radiobiologie der Bundeswehr, Germany. Electronic address: AlexisRump@t-online.de.
authors.forename: A
authors.initials: A
authors.lastname: Rump
authors.affiliation: Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Schöffski
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D017598:Efficiency, Organizational; D005858:Germany; D006801:Humans; D038622:Internationality; D007564:Japan; D008962:Models, Theoretical; D011787:Quality of Health Care / Q000706:statistics & numerical data*
keywords: Efficiency; Germany; Health system; Input–output model; Japan; Quality