Is the grass really greener on the other side? Comparing Japan and Germany #1 Finding a pitfall at a supposedly heavenly hospital in Japan

 I have been living in Germany for quite some time. Last fall, for the first time in decades, I had a hospital experience in Japan as I accompanied my mother for surgery.

What surprised me was the number of nurses working on the floor. There’re just so many! According to OECD’s statistics, the number of nurses per 1,000 people is 12 for both Germany and Japan, but it looked as if the Japanese hospital had 50% more nurses. I asked myself why and came up with some possible answers. In Germany, about half of the nurses work part time. They also take almost all paid leave days and often miss work. From what I heard, Japanese workers are far less likely to work part time and miss work. I’m not sure how OEDC collects the data, but I would say the difference may reflect the actual working hours rather than headcount.

Another difference was the role played by administrative staff. In Germany, you would almost never see them at a nurse station. But in Japan, they were playing key roles that nurses would be expected to perform in Germany, like guiding a patient to the hospital bed, giving admission orientation, explaining financial and administrative matters, etc. Consequently, nurses in Japan could focus on medical care. They would come right away when I pressed a nurse call button, and would attentively listen to my mother although she often made little sense. Since nurse call buttons in Germany rarely functioned despite a slight improvement recently, the Japanese hospital looked like heaven.

But later, I found that the heaven also had a pitfall.

The surgery my mother had was quite minor, requiring only a few days of hospital stay even for older people (and no overnight stay for young people) in Germany. She was mostly back to normal in two days after the surgery but remained in the hospital for five days, which I think was too long and deteriorated her functioning. When she came back home from the hospital, she couldn’t walk up the step at the entrance, no matter how many times she tried. Her legs had been getting weaker even before the surgery, but the five long days of hospitalization made it worse. She could no longer stand up on her own and became unable to live at home.

In Germany, a little over 20 years ago, the healthcare system was changed in order to shorten hospital stay, which had been longer than other countries. Under the new system, the shorter the hospital stay is, the more money hospitals can make. The new system has been tough for patients as they are more likely to be kicked out even before full recovery. Some media criticized the system by callint it “bloody discharge.“ Meanwhile, some argued that shorter hospital stay was not just to cut healthcare costs but also to help patients recover. I had totally forgot about that argument, but my mother’s case showed what that meant. This experience has also made me realize that the German system, which tends to be tough on patients, also has a positive side.

Keiko Yoshida

Japanese/German interpreter and research coordinator