scholarly journals Prognosis of Medical Treatment for Japanese Patients with Carotid Stenosis

2011 ◽  
Vol 50 (4) ◽  
pp. 291-296 ◽  
Author(s):  
Toshiyasu Ogata ◽  
Masahiro Yasaka ◽  
Yoshiyuki Wakugawa ◽  
Kotaro Yasumori ◽  
Takanari Kitazono ◽  
...  
Author(s):  
Tomoyuki Takura ◽  

This study proposes a method for calculating the appropriate medical treatment price level for foreign visitors (FVs) in Japan. Hospital management costs and foreign prices were analyzed from a market principles perspective to determine the medical treatment price. The study involved two stages: a preliminary survey and an extended survey, supplemented by an international survey. Relatively frequent diseases were selected, and the costs incurred by hospitals for the treatment of FVs were analyzed though data from three hospitals, covering 24 outpatients and 4 inpatients. Payments made by three insurance companies for overseas medical institution services for Japanese tourists with pharyngitis were analyzed. This study shows that the appropriate medical treatment prices for FVs, considering profits, were 1.22–4.26 times higher compared with prices under Japan’s public health insurance plans. Furthermore, these prices were 1.31–4.26 times higher for outpatients with pharyngitis and external injury and 1.22–3.66 times higher for inpatients with appendicitis and femoral fractures. The price of pharyngitis treatment in 12 countries was USD 20.32–158.75 per patient for Japanese tourists, whereas FVs paid 60.24 dollars (1.13 times higher than Japan’s public healthcare price) in Japan. This study shows it was appropriate to set the ideal price level for FVs higher than that for Japanese patients.


2016 ◽  
Vol 57 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Kimitoshi Sato ◽  
Kazuhiro Fujiyoshi ◽  
Keika Hoshi ◽  
Chiharu Noda ◽  
Minako Yamaoka-Tojo ◽  
...  

1995 ◽  
Vol 4 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Kazumasa Hoshino

Crucial problems exist in understanding Japanese traditional customs with regard to autonomous decision making by patients in Japan. These problems are difficult to comprehend because they seem, by western standards, to defy logic. Questions that baffle those outside the Japanese tradition, include: Why do many Japanese patients hesitate to make medical treatment and care decisions for themselves without consulting family, close friends, or someone viewed as being in a superior position? Why do many Japanese physicians fail to disclose the truth directly to the patient, instead customarily conveying information to family members, despite the doctors' awareness of their legal obligation to protect the patient's privacy? Why do many Japanese physicians continue to question whether patients should be told the truth at all? What perpetuates Japan's widespread, but often unnoticed, neglect of the individual's right to self-determination in healthcare decision making?


Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1143-1151 ◽  
Author(s):  
Kazumichi Yoshida ◽  
Nobutake Sadamasa ◽  
Osamu Narumi ◽  
Masaki Chin ◽  
Sen Yamagata ◽  
...  

Abstract BACKGROUND: Carotid plaque characteristics influence future risk of stroke considerably. However, the severity of stenosis does not accurately reflect plaque burden in patients with expansive arterial remodeling. OBJECTIVE: To determine the therapeutic outcome of symptomatic carotid low-grade stenosis with vulnerable plaque based on magnetic resonance imaging (MRI) characterization. METHODS: We studied 25 (male, n = 23; age, 74.2 ± 5.6 years) of 29 consecutive patients with symptomatic carotid low-grade stenosis (<50%) and both high-signal plaque and expansive remodeling on T1-weighted MRIs. The remaining 4 were excluded because of impending stroke. A single antithrombotic and statin were administered, and recurrent ischemic stroke was treated with dual antithrombotics. We considered carotid endarterectomy when recurrence was refractory to aggressive medical treatment. RESULTS: During a 31.3 ± 16.4-month follow-up, 11 of the 25 patients developed a total of 30 recurrent ischemic events (46.0% per patient-year). The patients' characteristics did not differ significantly between the groups with and without recurrence (n = 11 and n = 14, respectively). Seven of 11 patients in the recurrence group treated with carotid endarterectomy remained free of ischemic events during a postoperative follow-up of 19.1 ± 14.6 months. CONCLUSION: Symptomatic low-grade carotid stenosis with vulnerable plaque confirmed by MRI was associated with a high rate of stroke recurrence that was refractory to aggressive medical treatment. However, carotid endarterectomy was safe and effective for such patients. Plaque characterization by MRI has the potential for more accurate stroke risk stratification in the management of carotid low-grade stenosis.


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