Monday, February 28, 2011

The Japanese Congress and the Global Health Forum

This week,  I traveled to Japan as part of a 'US-Japan health care policy dialogue' a partnership between the Center for Strategic and International Studies (CSIS), a Washington-based foreign policy institute, and the Health and Global Policy Institute (HGPI), based in Tokyo.  This collaboration between American and Japanese experts focused on critical areas of innovation and reform in the health sectors of both Japan and the United States - initially payment systems and healthcare IT.  Over the next 6 months, we'll complete an analysis with actionable policy recommendations.

As part of the effort, I provided testimony to the Japanese Congress (Diet) and joined an all day Global Health Forum organized by the Health and Global Policy Institute (HGPI), a leading Japanese think tank.

The Congressional experience was interesting.  Japan has the longest lifespan of any country in the world, has comprehensive healthcare coverage for all citizens, and has very low healthcare costs - less than half the US expenditure per person per year.   It's challenging to highlight lessons learned from the US which has highly variable quality, high cost, and 40 million uninsured.

Luckily, the Japanese agreed that Healthcare IT is to be embraced for quality/safety/efficiency, cost reduction, and job creation.

I described the US Healthcare IT program as guided by 5 goals

*Improving quality, safety, efficiency, and reducing health disparities
*Engage patients and families in their health care
*Improve care coordination
*Improve population and public health
*Ensure adequate privacy and security protections for personal health information

achieved with 5 tactics

* Policy (Health Information Technology Policy Committee)
Certification and Standards (Health Information Technology Standards Committee)
Privacy and Security Tiger Team
Regional Extension Centers and Health Information Exchanges ($2 billion)
Incentives to adopt and achieve “Meaningful Use of Electronic Health Records” ($21 billion)

The Japanese legislators asked great questions about the role of genomics, the role of telemedicine, and the potential for job creation.   I remain optimistic that the Japanese will consider their own healthcare IT stimulus program.

The all day Global Health Forum included several important key points:

In Japan over the past 50 years, the economy has shifted from agricultural to industrial, from rural to urban, and from communities bonded together to often impersonal cities without support systems of the family and friends.   Many Japanese die alone and do not have the eldercare they need.

25% of Japanese are over 65 and over the next 50 years, the problem will get worse, such that 2 working age individuals will be paying for the care of 1 retirement age individual.   The Japanese birth rate is 1.3, so the Japanese population will fall rapidly over the next 50 years, reducing the workforce and tax base.   Immigration is very limited in Japan, so diminishing Japanese and limited foreign workers with result in a crisis of public funding for healthcare .    The Japanese will try to balance cost, quality, and healthcare access with available funds, but even now there is gap between the funds received from workers and the funds paid out to pay for the care of the elderly.

IT can provide some mitigation of the problem.   Japan has one of the best wired and wireless networks in the world.   These can be leveraged to create virtual communities/social networks of carers as well as support homecare including telemedicine and remote monitoring.   IT can provide data for population health and care coordination.

At present Japan has many policies which discourage the use of the public internet for healthcare, data exchange, and homecare. Changing policy/regulation and providing incentives to move care to the home is an important next step.  Focusing on wellness and day to day life rather than just treatment of disease is also an important tactic.    Japan describes this as a transition from "medical policymaking"  to a "health policymaking".

The session on healthcare IT included my presentation, a presentation from Dr. Akiyama of Tokyo University, and a presentation from Intel.

Many of themes in Japanese society apply to the US.   Our aging baby boomers will require more care than the Medicare system can afford.    Secretary Sebelius has said that 1/3 of US healthcare is redundant and unnecessary.      I look forward to continued exchange of ideas between the US and Japanese.  We are meeting again this July at CSIS in Washington.


Donald Green MD said...

The real challenge of learning from the Japanese system of health care is that everyone is in and nobody is out. The only way to significantly reduce expenses is an much expanded risk pool with non profit insurance.

Other reductions will depend on improving work flows and cooperation. Once these are in place our electronic knowhow can make further gains. However without the initial groundwork we may en-codify our inefficiencies.

Suki Tsui said...

In January 2009 China also announced a $124 billion investment to overhaul healthcare system. Like the United States, China is unprepared to deal with its aging population and other issues such as social and economic disparities, lack of healthcare coverage, unaffordable medication cost, inefficiency and antiquated healthcare delivery system, and lack of incentive for providers to deliver quality patient care (instead of prescribing "unnecessary" medication treatment to drive profit/revenue), etc...

A major part of the reform is to modernize healthcare through information technology. Lessons learned from the US will definitely be valuable.

Unknown said...

Not only did the Japanese have the longest lifespan of any country in the world, they also have the world’s lowest infant mortality rate. A friend of mine who live there told me that they can always see a doctor anytime they like, yet often wait hours for a few minutes consultation. Anyway, the important thing is they get the good basic care, and will never be bankrupt due to medical bills.

Dong Henze