Patterns of epilepsy care in Japan.

Abstract

Japan is an island country covered mostly by mountains and hills(figure 1). The great majority of the population lives on narrow plains along the coasts of the four main islands. About three-fourths of the 125 million residents of Japan live in modern, urban areas that make up only 20% of Japan's 145,870 square miles.1 This makes Japan one of the most densely populated countries of the world. Tokyo alone has a population of 11.7 million (1996) and there are 10 other Japanese cities with populations of one million or more. Unlike some of the other densely populated countries, Japan has a modern network of highways and trains, so that access to health care is readily available. The cost of health care in Japan is about half what it is in the United States, largely due to considerably lower fees for physician consultations, medications, and inpatient and outpatient hospital care.2 Figure 1. The majority of the Japanese population lives on narrow plains along the coasts of the four main islands. Epilepsy care. Physicians. Japanese statistics for 1992 show that there are 170 physicians per 100,000 people. According to a 1992 survey conducted by the Japanese Ministry of Health and Welfare,3 the vast majority of practicing physicians in Japan are specialists (99.4%), the greatest number of whom specialize in internal medicine (41.9%), followed by surgery (16.1%) and pediatrics(16.0%). There are almost no general practitioners in Japan; internists fill that role. Unlike care in the United States, Japanese patients with epilepsy receive their care primarily from neuropsychiatrists (45.5%), pediatricians (24.8%), or neurologists (5.6%) (figure 2).4 Japanese neuropsychiatrists, the physician group with the greatest responsibility for epilepsy care, see patients who have either neurologic or psychiatric disorders. The majority of Japanese neuropsychiatrists practice in a hospital settings (96.5%). …