Let me talk about how patient information is shared among the relevant parties, such as hospitals and individual medical staff by highlighting the differences between Japan and Singapore.

Spring of 2012 was when I first landed in Singapore. I was surprised to find not a single people there with X-ray images in their bags or hands at the subway (MRT). Wondering why, which was solved after a while: Singapore hospitals gave the image to the patient on site. It's not just X-rays. CT, MRI, CD-ROM (DVD), or even a medical result report (similar to a "medical record" in Japan) were provided to the information holder. 

A normal course for Singaporean medical doctors is like when they graduate from from medical college/university, followed by their many years' experiences in a public hospital, they either become independent or get transferred to a higher-paying private hospital. Engineers, nurses, etc., also hop jobs repeatedly, which cause flexibility of domestic as well as external labor industry. It is almost the same phenomenon observed in Europe, America and Southeast Asia. Paragon, a commercial building facing Orchard Street in Singapore, for example, has tons of private clinics, and they rent operating rooms at those as Mt. Elizabeth and Raffles Hospital. The Japan Green Hospital (JGH) in Paragon, which in 2019 I first visited for colorectal cancer, employ many Japanese doctors, and one of whom then introduced me to an "authority" of gastrointestinal tumors. The "authority" did in the past operations to the Brunei's royal family among others. He also has a clinic in Paragon. The surgical site designated by him was Concord International Hospital, a little off the island.

The flexible labor system with constant in-out of people is of a creation so as not to get those in medical industry be in trouble if there is a delay in exchanging documents containing patient information. Personal information about symptoms should not be clogged in one place. There are many specialist clinics in the city, such as by individual doctors, technician group chains such as X-rays and MRI, nurse dispatch, and hospital managers. Even in major hospitals, offices of individual doctors are packed there, showing dominance of "a group of independent doctors", rather than "salary-person" doctors such as in Japan. Hospital running firms would rather be close to the real estate industry in the Japanese sense. On September 4th, I had a Zoom meeting with a doctor at Raffles Hospital, to which I called in from Narita, and it was also because of the idea of ​​information sharing. I was really impressed with it.

Talking about information sharing, I had a bitter memory in my talks with an insurance company in Singapore. In 2018, right after Koko's breast cancer, I had bought an insurance product from a major US insurance company through a bank in Singapore, in which I have had a personal, as well as corporate, account. It was the financial product, different from the medical insurance covering the costs of surgery and hospitalization. It was the one that in Japan advertises a high yield, saying, "a lot of attractive financial products are waiting for you in Singapore!". Of the insurance that foreigners could get, I picked up that provided by a Singapore company NTUC, local surgery hospitalization insurance company, and the one by US insurance company.

Upon my discharge out of the Concord Hospital and request to the company, the US insurance firm instructed us to fill out a set of notification documents, which I submitted in August 2019. However, at this time, I forgot that I had had an arrhythmia in my heart and visited a large hospital several years ago, probably in around 2015. The doctor I met said, "it's not a big deal. Even if you have a bad stomach, you may have a particular heart condition." I didn't even get furnished with a medical certificate. All of which I remembered later. All those memories come back to me at the time of the call from the US insurance company in 2019. When I applied for a refund of the operation and other costs incurred, I was quite stunned to get notified of the fact of my heart "problem" being pointed out by the US company. It all happened in January 2020. "This liar", my counterpart of the insurance company did not spell out the word, but I heard it in my mind. After back and forth negotiations, both of us settled down a certain amount of reduction. It was already in February 2020. As a result, more than the premium I paid was refunded. After that, NTUC also decided to pay the full amount of costs incurred with no clue of them identifying the fact of my cardiac arrhythmia. I felt quite rage still. 

In Japan, on the other hand, all those are not applicable in every corner of things. For example, a subsidizing system of high medical expenses. Since my previous year's income (fiscal year 2019) is not captured in Japan's domestic, the city office issued a "Certificate of Medical Cost Limit Application" under the category "D" (lowest rank) at my return to Japan. Based on the rank "D", you were requested to pay up to about 57,000 yen per month, but this only applies when you went to see a particular doctor(s) in a particular hospital: there would be no information sharing between hospitals run by different companies/universities. So, the application of the payments for Hospital A and Hospital B is JPY 57,000 yen "per each per month", not a total you would pay. I should raise it as the lack of horizontal information sharing being an issue for our medical system. 

It is often the case that residents in Japan are normally requested by tax authority to process year-end adjustment (tax return) at the end of a particular fiscal year. In my case for the adjustment going forward to March 2021, it might be likely that the total excess beyond JPY 57,000 will be deducted, depending on how I negotiated with the tax officer. I have not heard such a story so far.

For the medical images, it is almost impossible to exchange them but additional cost in Japan. I had not thought this as a strange practice, at least until I started living outside of Japan at the age of 45, when I could solve all of my wonders of Japan in Singapore. An anecdotor is when, two years ago in Tokyo at my business trip to Japan, I dropped by an orthopedic surgeon in front of JR Shinbashi Station, and took X-ray of my finger or shoulder for minor pain. I then requested the clinic for the images, which was/is common in Singapore. However, the nurse, sitting at the clinic counter, suddenly made her suspicious-looking, and awkwardly charged an extra fee for the DVD with my images in it. About 2000 yen. It was a small amount, but I was surprised in the first place that there was no protocol of delivering images, and remember with anger, "people in Japan seem to think they won't go away to another clinic or hospital anyway." At that time, I was thinking that way.

(I remember reading the two-word combination of Japanese characters meaning "patient" are shown as "pain" and "people", and the word "pain" is a symbol of your heart being skewered." So, I would try avoiding as much as possible from using "patient" (患者) in my writings. The photo up above is taken of myself with Optune dated October 8, 2020 at home. To be continued.)