Strategic Direction for Healthcare Reform in Japan

Underlying Social Challenges and Constraints Hindering Japan’s Progress towards Health System Modernization
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Published: 23 Jan 2018

Japan’s healthcare system is an icon of kindness and compassion. The country spends 11.4% of its gross domestic product (GDP) on healthcare, which equates to just over $560 billion or about one-fifth of the healthcare spending by the United States (US). At that level of spending, the Japanese people enjoy universal health coverage, affordable healthcare services, and a phenomenally abundant access to care with even rural areas being well-penetrated by hospitals, primary care providers, long-term care facilities, and specialists. Quality of healthcare outcomes is at par or better as compared to global standards, depending on the therapeutic areas in question. There is high usage of sophisticated medical equipment, with Japan being a leader in the number of units owned and diagnostic exams performed using MRI and CT scanners globally. Healthcare has been declared a birth right in Japan for over half a century. While the government and the country should be lauded for the success it has achieved in creating a good health system, the future of the industry poses serious questions for policy makers. With almost 30% of the population above 65 years of age, Japan represents the “oldest” country in the world. This poses grave challenges to the healthcare system in terms of managing costs and the burden on chronic diseases. Reducing cost and improving the efficiency of care delivery is currently a serious concern for the industry. A number of hospitals are performing at negative profitability or have shut operations due to lack of financial resources. At 16.5 days, Japan’s average length of stay in the hospital is one of the highest in the world although the government has implemented reforms in the last two years to bring it down from 16. About 18-20% of hospital expenditure can be attributed to medical and pharmaceutical products where we see a gross overuse and a high dependence on branded generics. The health system shows a disproportionately high usage of in-patient facilities as opposed to long-term care. One major challenge in this direction is the lack of continuity in healthcare services and information across various points of care. Data privacy regulations prevent free flow patient information among hospitals, primary care, and long-term care. This impacts the quality of care delivered at various outfits. Moreover, cultural as well as regulatory barriers lead to a high dependence on in-person services despite the dire shortage of long-term care workers in the country. Neither are consumers comfortable managing their own health data, nor do they have faith in convenience technologies such as telemedicine, home monitoring, or mobile apps. We believe a novel approach to addressing Japan’s healthcare spending problem would be a fundamental shift in the way healthcare is perceived in the country. The term “value” can mean different things to different people. Most people would subconsciously equate “value-based care” with improvements in health outcomes. However, Japan needs to define value in the context of the current state and challenges of its own healthcare system. For Japan, improving immediate or short-term health outcomes provides only incremental benefits; real value lies in reducing the total cost of healthcare across the population. This then ties in with reducing the burden on hospitals and ensuring care continuity and standardization in a manner that it reduces the patient’s dependence on doctors and specialists. Industry reforms will be greatly accelerated if the payment models are modified to reward payers and providers for financial risk reduction instead of care volume. Simultaneously, efforts also need to be made towards educating and empowering patients and encouraging innovation, especially among young entrepreneurs.



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