cultural differences that surface when tackling a healthcare structure. For this study, I chose to investigate the dynamics of a Japanese community and their healthcare structure while highlighting four important concepts: 1) communication, 2) social organization, 3) spatial dynamics and 4) locus of control. I will also explain the dynamics of a case study where the attitude of a Japanese family towards the treatment of sickle cell anemia will be highlighted. I will also focus on the cultural stressors or Japanese families and their coping strategies along with the responsibilities or attitudes of nurses that impacts the overall healthcare system.

The entire healthcare structure and organization of Japan is under the control of the government that also covers and manages all the health insurance fees and policies. Since the national government cannot cover all of the aspects of healthcare structures, the local government bodies play their part by implementing all healthcare policies and adjusting them as the situation or demographics require. The local government bodies also control the healthcare structure for those people who don’t have health insurance; in this case, the organizational structure designates responsibilities on the shoulders of the employers who can work in coordination with the local governments through national health programs. The main formats of health insurances that are offered to Japanese residents are Kenk?-Hoken (translated as social health insurance) and Kokumin-Kenk?-Hoken (translated as national health insurance). The former is mainly structured for the corporate sector while the latter is applicable to the students and the self-employed entrepreneurs. It is important to note here that the social organizational structure of Japan’s healthcare structure makes it necessary for every Japanese citizen to be using one of the aforementioned insurance programs (Matsumoto et. al, 2004).

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The overall social organization of healthcare systems in Japan over the years has been more inconsistent with high level of income or revenue being allocated for the industrialized or metropolitan cities while a much lower percentage was allocated for the rural areas. This pattern also carries through in other sectors of healthcare like the hiring or employees and medical equipments (Matsumoto et. al, 2004). The government has been trying to adjust this inconsistency since the early 1990s through categorizing the structure in three different degrees namely: primary secondary and tertiary pertinent to the topography. These categories would serve as the foundation for all decisions made with regards to hospitals, clinics, etc. being opened in the different regions as well as the finance allocated, number of employees, medical equipment support, etc. This strategy has, over the years, not only been able to attain its primary objective but also has been able to help the government control or at least manage the expenses and finance that the entire health sector required form the national budget (Matsumoto et. al, 2004).

One other thing that the Japanese government needs to take of urgently is the deficiency of ample space available in medical outlets or clinics. Stats from a government survey for the year 2007 demonstrate the need for the solution of this problem as more then 40,000 patients could not get timely medical care because there wasn’t enough place for them in hospitals/clinics. One of the most publicized cases that highlighted this problem and became the cause for strict international criticism was when an elderly woman with a breathing illness could not be admitted in a hospital in Tokyo even after 49 attempts (Yamaguchi, 2009).

Despite of the many changes in the structure, the centre of control for most of the finance and insurance still lies with the government. Most of the governmental healthcare policies designate more then 70% of the each medication expense, from the purchase of a bottle of medication to the complete operation, to the government and the citizens pay the remaining percentage. Furthermore, the overall monthly insurance rent that the government allocates to the citizens below 50,000 Yen for the entire family. Furthermore, the overall supporting expenses are given on a daily fixed rate to hospitals/clinics. This of course puts a lot of financial pressure on the government but does allow them the control and power to monitor the overall heath structure of the country (Yamaguchi, 2009).

The choice of choosing the healthcare facilities is not influenced by the government, however, the cultural traditions of the country makes the head of the family (usually the father) make the decisions as far as which hospital, which treatment and how much money will be spent in the pursuit of medical care for a disease. There are many studies hat have been conducted over the years that have confirmed that the medical influence of the father on the family is almost silencing i.e. The other members of the family tend to not speak up or have an opinion once the father has established a course of action. This usually seems to restrict the overall medical freedom or communicational access that the doctors or nurses have with the patient (Black, 2003).

It is important to note here that most of the cultural healthcare preferences for the Japanese strings from Confucianism. One such phenomenon of cultural healthcare belief that is influenced by Confucianism is the filial piety belief structure. This concept was originally structured in China and found its way into the Japanese culture. This concept places tremendous importance on the obedience and loyalty of children towards their parents in their personal and professional lives. Furthermore, the overall social structure of Japan under the filial piety structure obligates children to take care of their parents as they reach the elderly stage. The filial piety concept also made the parents live their lives for the betterment of their children and if they did so appropriately then it was a responsibility of the children t return the favor, in a manner of speaking, by taking care of them at old age. Even though, the analysis of the output of such an influence does not really result in great elderly care as the children do have their own families and professional responsibilities, but the percentage of children taking care of their parents is still very high as the admittance of elderly in an old-home or institution is thoroughly frowned upon (Kino*****a & Palevsky, 1992).

Another huge impact of culture on the overall approach towards life and tackling the various stressful of life has been the journey form being a Shinto to a Buddhist. The generally accepted concept in Japan in that every child is born a Shinto and then with the passage of life and important influences the child finds a path of clarity, physical and spiritual, and lives a healthy life. Everything that is related to illness is considered an impurity, in Japanese culture, and hence is taken as a sign of death or an end. This is one of the main reasons why having an open and informed mind towards medical processes is difficult for a majority of the Japanese to grasp still. Hence, the job for the doctors and nurses to conduct effective and becomes far more difficult. Many of the medical treatments is Japan are still based on herbal treatments such as Moxibustion. This is where the transformation to a Buddhist lifestyle comes in for most Japanese citizens. Buddhism preaches that death, like birth, a natural process of life and death in one life denotes a new birth or a rebirth in another life. This makes them more comfortable in implementing medical procedures with the passage of time as for them death is not something to be frowned upon or an impurity, in fact for them it is a chance for correction and improvement (Kino*****a & Palevsky, 1992).

One of the other frowned upon medical traditions in Japan is the organ donation phenomenon. Despite the fact that most of Japan’s medical processes and approaches are strongly influenced from the West, this particular phenomenon, which is popular and acceptable in the West, still has lose footing in Japan as most still find the entire concept a little difficult to grasp and unreal (Kino*****a & Palevsky, 1992).

Upon careful analysis of the lifestyle and diet choices of the Japanese, one can clearly see that the main idea of health and illness is based on the concept of maintenance and balance. The Japanese acupuncture techniques are one of the most popular ways of relieving stress ad maintaining physical fitness. Furthermore, most Japanese societies rely on herbal intake to cure diseases and eat a heavy amount of vegetables on a daily basis which, they believe, helps them maintain a healthy outlook physically and mentally (Yamaguchi, 2009).

Anemia is one of the most widespread diseases amongst females in Japan and has been facing quite a few medical concerns from a majority of the citizens. In my case study, I will discuss the scenario of a troubled mother opening up about here daughter’s illness of sickle cell anemia and her concerns about the impact of the disease on her daughter’s life. Sickle cell anemia is a condition whereby the individual has a deficiency of red bloods cells and the small of red blood cells that are present in the body become stiff, sticky and crescent-shaped. These, then, eventually die leaving the transfer of oxygen in your blood being absolutely limited and far below the point at which the flow of oxygen needs to be in a human body. The flow of blood and transfer of oxygen eventually slows down tremendously and can cause terrible pain as well as make the immune system to be vulnerable to a variety of different diseases. There are many medical procedures that can allow the individual to find a relief (Lozoff et al., 2003).

In our case study, we will mainly highlight how the mother’s approach was tentative and skeptical and how the four points that have been mentioned initially (communication, social organization, spatial dynamics and locus of control) are impacted through her approach. The first important thing to note about the attitude of the mother is that she does seem very forthcoming to find out as much as she possibly can about the sickle cell anemia disease that she fears her daughter has. This is directly linked to eth social order and locus of control in the social order that has been aforementioned. In the Japanese culture the primary decision maker is the father (the head of the family) or the oldest son, hence the mother’s tentative and un-curious approach. It is important, in such circumstances, that the nurse or doctor takes the situation in their hands and make all the inquiries that they need to be answered in order to make a verifiable analysis. One of the most successful ways that this can be done is by respecting the restrictive environment while maintaining an inquisitive and genuine interest in the story of the patient. This allows the visitor, in this case the mother, to feel more comfortable to open up because she feels that there is a certain level of understanding coming from the other end. Also it is very important that the doctor or nurse handling the case does show any form of preferences or biases to the patient or visitor. In this case specially, the nurse needs to be very friendly, kind and forthcoming with all the necessary information that the mother will need regarding the disease as well as the possible treatments because of the lack of inquisitiveness form the mother (Black, 2003; Izumi, 2008).

The impact of such a restricted approach on the overall communication process is very negative as the entire has to be initiated from one side without any guarantee of a feedback from the receiver (mother). It will be the nurse’s job to probe and pry and make the mother give her details about the conditions and symptoms that her daughter is facing. Furthermore, to instigate a response the nurse can resort to adopting a popular and successful strategy of revealing a personal experience and/or lesson and then ask the mother what she thinks about the situation (Black, 2003).

Anemia and iron deficiency have grown to be two of the most pressing diseases amongst the children and elderly women in Japan. The overall spatial dynamics and problems that the government of Japan has to take care of include the efficiency of nurses and doctors on giving timely and acceptable remedies because without it the government has to face the financial burdens of treating relative problems like psychomotor progress, damaged cognitive operation, and growth retardation amongst others (Lozoff et al., 2003). Furthermore, acceptable remedies have to be the ones that will not go against or offend the overall social structure or beliefs of the patient. This is one of the most important factors in providing healthcare in any and every culture. The nurse and doctor have to make sure that they are respectful of the individuals, their principles, their traditions and their biases while simultaneously controlling their own biases (WHO, 2001). This can be done through really listening to the story of the patient when he/she is willing to tell it as through that story the nurse can get a very clear pattern of the dos and don’ts of the medical preferences. If the patient is not very forthcoming with a story, as is the situation in this case, it is the nurse’s task to be tolerant and intelligently structure a conversation whereby he/she can clearly illustrate and explain to the mother what needs to be done and give her time to fully grasp the situation. Furthermore, it is very important that the nurse takes an ‘apprentice’ approach here and aims to learn facts from the mother through genuine and curiously designed questions. Its is also very important for the nurse in this situation to be absolutely transparent and clear about what she wants the mother to know, what are her responsibilities as a family member and let the mother know her contribution as a nurse (Izumi, 2008).

In such a scenario, a possible implication for the Japanese government could be to use the Synergy model of nursing which is basically an American procedure of nursing whereby the burse is able to balance the needs and demands of the family and the patient. This is very important within the dynamics of the Japanese culture because the overall stringent approach of the father making all the medical decisions (whether to get the disease treated or what treatment to use, etc.) could lead to situations where the right decisions are not always made for the patient. Furthermore, this model allows the nurse to have complete control over her own biases and will be trained to amalgamate the traditions and beliefs of the patients into the medical procedures that he/she is offering to the patient with substitute analyses and treatments (Izumi, 2008).


Throughout this paper, I have focused on the healthcare differences and problems that the country and citizens of Japan face everyday and how four particular aspects 1) communication, 2) social organization, 3) spatial dynamics and 4) locus of control have an impact over their comprehension and approach towards different life processes, like birth and death, their approach towards handling stress, their overall approach towards maintaining health, their approach towards various medical procedures and situations, the nurse’s input and the impact of the cultural differences that will occur in the treatment process.


Black R. (2003) Micronutrient deficiency — an underlying cause of morbidity and mortality. Bulletin of World Health Organization, 81:79.

Dr Izumi, S., (2008) Japanese Patients’ Descriptions of ‘The Good Nurse’, accessed on February 28, 2009.

Kino*****a, J., & Palevsky, N. (1992) Gateway to Japan (Rev. ed.). Tokyo: Kodansha International.

Lozoff B, De Andraca I, Castillo M, Smith JB, Walter T, Pino P. (2003) Behavioral and developmental effects of in . Pediatrics.112:846-854.

Matsumoto, M., Okayama, M., Inoue, K., Kajii, E. (2004) and hospitals in Japan: a comparison to the Japanese average.

WHO. (2001) Iron Deficiency Anemia: Assessment, Prevention, and Control. World Health Organization.

Yamaguchi, M. (2009) Injured man dies after rejection by 14 hospitals, Associated Press, February 4, 2009.

Cultural Case Study: Japan