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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

Laying tracks for better health in Japan

Laying tracks for better health in Japan

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IMG_0627This week I’m reporting from Tokyo and Yokohama.  It is the second time in as many years that I’ve been invited to speak at an industry event here in Japan.  Yesterday afternoon, it was my honor to provide a keynote for the 28th Joint Conference on Medical Informatics being held at the convention center in Yokohama adjacent to the InterContinental Grand Hotel.

On my last journey to Japan and again this time, I’ve been particularly impressed by two things.  First, for a country with such densely populated urban centers Japan is spotlessly clean.  Wandering around downtown Tokyo you rarely see even a gum wrapper.  It’s like Disneyland only cleaner.  Contrast that with most American cities.  Second, the public transportation is fast, efficient and always on time.  You can set your watch by it.  So, it is surprising to note that in a country lauded for lean manufacturing and the “Toyota method” of continuous quality improvement, that healthcare and particularly the implementation of e-Health, lags behind many other developed nations.  Japan has too manyIMG_0628 hospital beds, and their lengths of stay are notoriously long; often twice that of American hospital stays.  Also according to my hosts here, the Japanese are frequent fliers when it comes to utilization.  Dialing 119 (911) to summon an ambulance for the most minor of complaints is almost a sport.  Hospital based physicians are so overworked they are bailing right and left for outpatient practices leaving higher-paying hospital posts with vacancy signs.  Making things even worse, say the locals, is an overall shortage of medical professionals in the face of a growing population of the elderly and more people with chronic diseases including obesity.

Fall Colors Palace Park To help combat these trends, the Japanese government has launched a campaign that stresses more personal responsibility in maintaining good health.  It also asks employers to take a stance.  For instance, employers must now measure the waistline of each employee and report results to the central health authority.  They must also provide obesity management programs for overweight employees and will be fined if offenders don’t “measure down” appropriately.  Somehow I don’t think this program would fly in America.

The Japanese are also very interested in the idea of promoting personal health records.  Every government official and healthcare executive I meet wants to talk about HealthVault and Google Health.  “When will we have something like HealthVault in Japan?”, they ask.  They seem to agree that aggregating health data around consumers is a good idea and they are making plans to provide every citizen with a PHR.Tracks2

I was also surprised to learn that home health isn’t popular in Japan, even  though it would make perfect sense to move in that direction.  My hosts were really keen to learn what other countries are doing and how home tele-health monitoring is being deployed to manage patients with chronic disease and assist the elderly.

Clearly the Japanese are placing some big bets and laying down tracks for a new approach to healthcare.  If they do it as well as they keep their cities clean and their trains running on time, it should be something worth watching.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation 

  • Dr. Crounse from the Microsoft Health Blog shares some information about healthcare in Japan.  I

  • Japan's health care system is rather odd.

    Kaiser Foundation stats: All hospitals and physicians' offices are not-for-profit; 80% of hospitals and 94% of physicians' offices are privately operated. Japan has 15.8 inpatient beds per 1000 people, but only 1.6 physicians and 7.8 nurses per 1000 people. Long hospital stays are encouraged by per-diem reimbursements.  

    WRT "frequent fliers", doctors are as much to blame as the patients. Apparently the government-set rates are so low, doctors make their living by prescribing a lot of (anonymous, unlabeled) medications, which they sell direct to the patient in limited quantities, thus the patient has to go back fairly often for refills.(McKinsey states drug dispensing is 2.3 times higher than the US per disease burden).  

    You can't pop down to a 24-hour CVS with a Minute Clinic, and you don't get printouts with your Rx explaining how to use it, what it is for, side effects, or warnings in Japan.You get an envelope marked with the quantity of one dose (tablet, capsule, or powder), how many times/day to take it, and little else. There are lots of strange OTC products you can buy at "drug stores", but floor space for various departments seems to indicate the money is made on HBA.  

    Home health care is different. The traditional multigenerational (grandparents, husband and wife, kids) family living under one roof is disappearing. Japanese demographics are shifting steadily toward an elderly population w/one of the world's highest life expectancies, due to delayed marriage, delayed childbearing, and sheer expense of raising children. There is a chronic shortage of nurses, and getting work visas for foreign nurses is difficult, even though home health care might be considered a '3K' job - kitanai (dirty), kitsui (difficult), kiken (dangerous).  

    Ambulances are another story. You might be able to get one, but you might not be lucky enough to find a hospital to take you. When I was in Japan last year, a pregnant woman in Nara prefecture was denied treatment at a hospital 3 minutes away. Seven other hospitals turned her down, and the ambulance she was in collided with a minivan on the way to the 9th hospital, 45 miles away in Osaka prefecture. Sadly, Japan has a shortage of emergency doctors, and this is not an isolated incident.  

  • Ku,

    Thank you for your insightful, first-person account of healthcare issues in Japan.  You confirm many of my own observations.  There are  big challenges, but also huge opportunities for Japan to harness technology and apply it to the provision of better, more efficient care for all citizens.

    Bill Crounse, MD

  • Japanese companies have been known world wide as offering to the market high quality well designed high tech products. However, the adoption of similar products domestically, particularly in healthcare, has lagged other industrialized countries historically.

    The changing demograhics in Japanese society are such that the Japanese Ministry of Health and the private healthcare sector has recognized home health care as a growing need. Products like Healthvault which will put patients in touch with their healthcare providers remotely would fill a need in that market.

  • Dear Sir/Madam:

    I am currently working in United Kingdom as Staff Nurse for seven years in General Surgery & Medical Ward with ample experience in Oncology & Neuro-surgery ward.

    I am vey much interested to work in Yokohama University Hospital & would greatly appreciate if you can help me to get thru.

    I am currently holding a British Passport & been resident

    in UK for 7 years, many thanks.....

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