Shimohata1

Ruka Shimohata

Emily Litle

ENG 121.001

4 December 2017

The Super Aging Society and the Problem of the Free Ambulance Services

Japan has one of the highest populations of elderly people in the world. In Japan, the

elderly people are referred to as the super-aging population. Japan has the largest super aging

society in the world; 33.8 million people are over 65 years old, which is 26.6% of the Japanese

population. This mean, the number of emergency situation of elderly will increase. It also causes

misuse of emergency services (Yasuhiro). The overall population of the country has decreased

for four consecutive years. They dont want having children because of the bad economy. In

addition, the number of citizens who are of working age, called the production age population,

dropped to 76.95 million people. The working generation supporting the super aging population

is decreasing. Currently, there are only 2.3 people of working generation per each elderly person

(estimated). Japan is fast becoming an elderly nation, and the problem is expected to worsen as

the baby boomer generation ages and there are less workers to support the aging population.

Because of aging population using so many health services, it is costing Japan too much money.

There are four potential problems in charging for an ambulance service. The first is the

risk that the elderly and low income groups will be restricted and not receive the proper care. The

second is the possibility of infringing the citizen's right to receive necessary and sufficient

medical services at any time in a manner appropriate for a person. Third, there is a danger that

the consultation suppression will be strengthened, the doctor will be consulted after the disease

condition gets worse, which in turn will lead to an increase in national medical expenses. Fourth,
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the risk that it leads to an increase in fraudulent users due to paying the fee depending on the

charge setting. However, as the population ages, the state of medical expenses will deteriorate

further. The number of ambulances and emergency rescue squads are not infinite. Considering

such a situation, it is reasonable to charge for ambulances.

One of the main concerns with the super aging population is that it will drastically

increase the costs of medical care throughout the nation. It is expected that the national medical

expenditures will rise to over 70 trillion yen ($625 Billion) per year. This large amount of

money is unsustainable and will cause a social security finance collapse (Population). In

response to the growing crisis, in 2015 the Ministry of Health released a draft outline of the

medical insurance system reform. It clarified the burden for the elderly and the working

generation to cover the growing medical costs due to aging. Among many of the reforms

proposed by the Ministry was a plan to address the misuse of ambulance services by the elderly

population.

The use of ambulance services makes up a significant share of the health care costs in

Japan. Throughout the world, ambulance services operate in different fashions. The ambulance

rate system of cities in the world is public (San Francisco, Geneva, Frankfurt, Rome, and

London), private (Paris and Bangkok), semi-private and semi-public (Ney York, Madrid, and

Beijing) and has various operating modes. Fee is fixed from free to charged, depending on

mileage, it changes according to disease condition, and so on (Tanaka, 1-39). Japan has an

ambulance system that is paid for by the government and therefore free for the patient.

In recent years, the costs associated with ambulance use has skyrocketed. The number of

people transported by ambulance services to the hospital increased by 22% over the past ten

years in Japan. In 2014, ambulances have been dispatched 5,982,849 times and it is estimated
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that the expenditure for transporting ambulances for one year was 269,220,805,000 yen ($20.3

Billion) (Fire and Disaster Management Agency). In addition, it is estimated that 86% of these

transports by ambulance services were made for non-emergent conditions. (Camasso-

Richardson, 1137-1141). The elderly makes up a disproportionate share of the calls for

ambulance services. In addition to the costs, the increased number of ambulance calls has been

shown to slow the response time of the ambulance teams; over the last decade, the response time

by 2.2 minutes, on average. This impedes the transport of seriously ill patients (Umekawa).

Reducing unnecessary ambulance transports could result in significant cost savings and

improved patient outcomes.

Japan has made several efforts to reduce the unnecessary use of ambulance

transportations, which will lead to money savings. In May 2015, the Ministry of Finance made

the opinion that there should be charges as a part of ambulance services. It is a part of

expenditure reform to improve the worst state financial situation in developed countries. The

country is also trying to increase the appropriate use of the ambulance service. As a measure

against this situation, "Call Triage" (Namami, 1-26) was introduced in Yokohama City from

October 2008. It investigated the urgency and severity of the report and chose a hospital. In case

of mild illness, they were transported by private emergency services to appropriate medical

institutions. In this way, it was an important point to control the demand itself for ambulance

transport by trying to ease the tightened medical finance. Also, not only at the time of reporting

but also "field triage" (Namami, 1-26) by emergency teams at the site should be used together.

Such a strategy will help support the basic principle of emergency medical care that is "The

Right Patient, The Right Place, The Right Time" (Hendrikson, 1-23). If elderly people 's

countermeasures are successful, there is a possibility of reducing costs by over 50 billion yen
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($4.5 Billion) (the). This is why Japan made efforts to reduce the unnecessary use of ambulance

transportation.

There are several steps the nation can do to help reduce ambulance usage while

improving the health of its citizens. First, there should be a robust primary care system in place

to help provide preventative care. The guidance of a family doctor can educate and assist in

providing appropriate information to the elderly and their families to make good decisions about

emergencies and when to appropriately use the ambulance. This will to lead to a reduction in

undesired use and inappropriate use of ambulances. Also, it is also important to enhance the

welfare system and increase the number of doctors and nurses. Finally, when charging an

ambulance fee, those situations such as motor vehicle accidents, disasters, crime and other clear

emergencies should be free, while with other mild cases fees should be charged.

Until now, it was ordinary that ambulance is free for Japanese. It should be considered

which way is more efficient to society. Charging ambulance saves more people and money, and

reduce unnecessary transport. For these reasons, ambulance should be charged.

Work Cited

Camasso-Richardson, K. "Medically unnecessary pediatric ambulance transports: a

medical taxi service?." Acad Emerg Med 1997, 4, 1137-1141

"estimated population." Ministry of Internal Affairs and Communications, 24

September 2015, http://www.stat.go.to.jp/data/jinsui/pdf/201509.pdf.

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Hendrikson, H. "The Right Patient, The Right Place, The Right Time." National

Conference of State Legislatures. Colorado & Washington, 2012,1-23

Namami, Ryota. "the role of emergency services." ISFJ policy forum 2013, 1-26

"Population of elderly in the future." The Ministry of Health, Labor and Welfare,

January 2012, http://www.mhlw.go.jp/seisakunitsuite/bunya/hukushi_kaigo/kaigo_k

Oureisha/chiiki-Houkatsu/dl/linkl-l.pdf.

Tanaka, Kouki. "emergency medical service." public policy and its evaluation of economy

Project 2007, 1-39

"the number of calling ambulance." Fire and Disaster Management Agency, 31 March

2016, http://www.fdma.go.jp/neuter/topics/houdou/h27/03/270331_houdou_2.pdf.

Umekawa, Takashi. "Free Ambulance service." Reuters, 11 May 2015, http://jp.reuters.com

/article/idJPL4N0XZ6FI20150511

Yasuhiro, Kadooka et al. "Misuse of Emergent Healthcare in Contemporary Japan." BMC

Emergency Medicine, vol.17, 14 July 2017, pp.1-6. EBSCOhost, doi: 10.1186/s12873-

017-0135-4.