カテゴリー: Masahito Abe

Preventive Health Care (Part 1)

　In the previous essay (No.42), I reviewed the necessity and basic direction of the reform of health care system in Japan. The following six are the main issues that are interrelated to each other: (1) medical fee, (2) drug pricing system, (3) burden of social insurance premiums and taxes, (4) patient’s co-payment and high-cost medical care expenses, (5) health care delivery system (including telemedicine), and (6) preventive health care.
　Among these, (1) to (5) have generally been discussed and reformed as major issues, while (6) has become more critical in recent years, as discussed in my previous essay. There are two main reasons: first, the average age of workers is rising, and the number of older workers with some health risks and lifestyle-related diseases is increasing. Second, as the population ages and the birthrate declines, the number of beneficiaries in social security is increasing, while the number of workers as the main bearers is decreasing (Note 1). In this essay, I would like to give an overview of (6) as a new issue, before discussing (1) to (5).
　Among preventive health care, that for workers has been primarily advocated by the Ministry of Economy, Trade and Industry, the Ministry of Health, Labor and Welfare, and by companies and public health care insurers. In general, various plans have been introduced depending on the type of industry and occupation, and in their practice, the voluntary participation of each worker is required.
　The basic purpose of these efforts is to promote the health of workers over the long term, it is pointed out that there are three outcomes expected from this. First example is the maintenance and improvement of labor productivity. The second is the extension of the number of potential working years, and the third is the reduction of the increasing in medical expenses. The first and second are considered effective in the context of a declining working-age population, and the second could be also a fundamental factor in the choice of deferred entitlement for public pensions (in this case, the way of employment of the elderly would be questioned).
　Preventive health care is not always emphasized in Japan compared to other developed countries, such as European countries and the United States, and it is thought that the effect of prevention on reducing medical expenses is not clear (Note 2). Despite this negative evaluation, preventive health care will produce significant consequence that is not able to be defined merely by the amount of medical expenses. Especially in the present age when it is possible to improve the outcome of prevention by the advancement of inspection equipment and technology (including data management), promotion of such health care will be beneficial in economic activities and financial stabilization of public pensions.
　In considering the future direction, it is necessary to review the trends and issues to date. I will discuss this in the next essay, “Preventive Health Care (Part 2)”.

(Note 1) As an example, see Nihon Keizai Shimbun (September 3, 2019), “Preventive health care, supporting companies – Social security reform starts after seven years”.
(Note 2) Cohen, J., P, Neumann. and M, Weinstein (2008) “Does Preventive Care Save Money? Health Economics and the Presidential Candidates”. The New England Journal of Medicine, Vol. 358, No. 14, pp. 661-663. Tsugawa, Y. (2014) “About 20% of preventive care is effective in reducing healthcare costs”. https://healthpolicy healthecon.com/2014/ 07/17/cost-saving-preventive-medicine/ (visited: 6 September 2019).

This essay is the English version of No. 70, September 27, 2019 on the Japanese website.

(Author: Masahito Abe)

Considering the Direction of Health Care Reform

　In Japan, since the universal health insurance system was introduced in 1961, equal opportunity to see a doctor has been basically guaranteed for each person. Consequently, the country has achieved a society with long, healthy life expectancy, and low infant mortality rates. On the other hand, the financial balance of health care insurance is deteriorating mainly due to the increase in medical expenses with the aging of the population and the advancement of medical technology. The reform of the health care system (especially its financial system) has become one of the important issues in modern times.
　With the basic purpose of maintaining and stabilizing this system, medical fee, drug pricing and health care delivery systems have been reviewed respectively. Furthermore, social insurance premiums, taxes and patient’s co-payment have also been revised. The main contents of these revisions are as follows: (1) Gradual shift from fee-for-service system to flat-rate medical fee system (e.g., per diem, capitation), (2) Reduction of drug price standard as official price of medicine, (3) Regulation for the number of hospital beds and promotion of home care. For financial resources, social insurance premiums and patient’s co-payment have been gradually raised, and a portion of the revenues by increasing consumption tax (raising the tax rate) is supposed to be allocated to social security benefits according to the “Comprehensive Reform of Social Security and Tax.”
　While these have been the basic directions for reforming the health care system, in recent years, promotion of preventive health care, introduction of telemedicine (online medical care) and strengthening of family doctor function are being advocated mainly by the Ministry of Health, Labor and Welfare as well as public health care insurers (e.g., National Federation of Health Insurance Societies and Japan Health Insurance Association). Although these proposals may lead to a change in the conventional method of consultation and treatment (which is based on free-access and face-to-face treatment), they are considered useful in reducing the incidence of disease, serious illness and long-term hospitalization respectively.
　With respect to this, in Japan, as in other developed countries, some diseases related to lifestyle and mental health are increasing, and primary prevention and secondary prevention are becoming a crucial measure. In general, primary prevention refers to encouraging periodic health checkups and improving lifestyle, and secondary prevention refers to early detection and early treatment. Furthermore, for improvement in outcome, it is thought that an appropriate combination of face-to-face treatment and telemedicine is important, and that long-term and continuous efforts between patients and their doctors are also important for prevention.
　These are issues related to the review and reform of the basic structure rather than the maintenance and stabilization of the existing health care system, and require basically the voluntary participation and action of each person/patient. Although there are still some issues to be solved, such as how to coordinate prevention and treatment and how to deal with the system of medical fee, the reforms in this direction are considered necessary for the future health care system.

This essay is the English version of No. 42, July 30, 2019 on the Japanese website.

(Author: Masahito Abe)