Why Japan hospital prices are lower
Japan posts one national fee. Every hospital gets paid that — $432 a night, not $3,180. The US night is expensive because the hospital can threaten to leave the network. The insurer does not want that rate. It cannot walk, so it pays, then spreads it across premiums.
National fee schedule (DPC/PDPS + NHI)
How it works
Acute hospitals bill DPC/PDPS — Japan’s DRG-like bundle — plus a national NHI fee schedule for everything else. Kenko Hoken and kokuho pay the same tariff. The hospital cannot write a secret commercial multiple for a job plan, because the job plan is not setting the rate. Stays run long. The night is cheap.
Why it holds
Wammes is the sourced proof, not a model: Japan’s expensive 5% spent 97.7 inpatient nights vs 6.6 in the US, at $432 a night vs $3,180 (PPP, ~2013). More hospital, 14¢ on the US night. iFHP does not publish a Japan private-plan CABG, so we do not fake one. The hospital lever on this tab is that night ratio — older PPP, not 2022 commercial. OECD 2024 still has Japan at $5,790 per person, near the average, because the nights are cheap. Walking off ‘the network’ is not a strategy; the fee schedule is the country.
The invoices
See iFHP, RAND hospitals, Papanicolas, Wammes.