With the advent of an aging society, healthcare (including nursing care and welfare) is increasingly important but the cost of providing healthcare is increasing. As a result, there is a demand for high-quality and efficient healthcare. In that regard, it is the healthcare institutions that actually deliver the healthcare to the patients and users. Therefore, management of healthcare institutions is extremely important in realizing cost-effective healthcare. By our research in healthcare institution management, focusing on the medical corporations at the center of Japan’s healthcare institutions, we will search for solutions to the problems of today.
As national healthcare expenditures exceed 40 trillion yen, containing the increasing healthcare expenses is an urgent problem. Healthcare is the greatest risk for Japan’s fiscal situation. It is necessary to enhance efficiency of healthcare resources (budget) allocation without hurting the quality of healthcare. Toward that end we are working on visualization of regional differences and elimination of inefficient regional differences. Also it is necessary to review the social insurance premiums which are overall regressive and causes a disincentive to regular employment. We address these policy issues based on EBPM (Evidence Based Policy Making).
In this study, we conduct the 4th study of LOSEF: Longitudinal Survey on Employment and Fertility, a large-scale panel study already conducted for three times under the Specially Promoted Research and Scientific Research (A). Moreover, we conduct a panel analysis of childbirth/child care, intergenerational succession of socio-economic status, determinants of subjective well-being, dynamic mechanisms of work behavior, risk factors for being poor, and the impact of retirement and nursing care on health and lifestyles, etc., using the longitudinal information obtained from LOSEF and other related panel surveys. Based on those results, our goal is to make effective policy recommendations that improve social welfare.
The current social security system of Japan and its financing have major problems in sustainability. The number of elderly people continues to increase and it is estimated that in 30 years the number of elderly people will reach nearly 40% of the population. Japan’s 2004 pension reform introduced an institutionally sustainable system, but this kind of system design has not been implemented for healthcare. Together with the increasing elderly population, there is continuing transition to a democratic system where the voices of the elderly are more likely to be reflected (the so-called “silver democracy”), and it is expected that the public’s voice will further increase in regard to improving healthcare and long-term care.
Under these conditions, to ensure sustainability, efforts to develop networks to mitigate health risk are becoming important. Considering that low fertility rate is the root cause which threatens the sustainability of Japanese society, it is especially valuable to pay attention to regional networks to alleviate the low fertility problem by reducing young couples’ anxiety about pregnancy, children’s health risks and child raising, in addition to the health risks of the elderly. By collecting and analyzing cases in which networks try to reduce health risks of the general public, we are researching ways to design institutions to ensure the sustainability of the social security system in aging democratic societies.
A community-based initiative for preventive care and long-term care is one of the key measures to restrain increasing medical expenses as emphasized in “the Community-based Integrated Care System” advocated by the Ministry of Health Labor and Welfare. Through the analysis of receipt data (data of medical practitoneres’ receipt for health claims) as well as the analysis and evaluation of local governments’ initiatives, we conduct researches on the problems of the primary care system and the long-term care insurance system in Japan, especially the characteristics and issues around community-based healthcare, and studies to make a proposal to enhance overall quality management and provision of health care and long-term care.
For long-term care insurance and disability-welfare services, fiscal year 2018 saw the introduction of single integrated facilities that provide inclusive social care services to various users such as the elderly and people with disabilities. This research aims to explore, from the angle of inclusive social care services, how to provide appropriate long-term care and welfare services in a society with the assumed lifestyle structure of people are continue to live in the same community. In order to achieve the research objectives, we consider the challenges of future inclusive social care services from four viewpoints: (1) analyzing the lifestyle structure of local residents, (2) study of existing inclusive social care services and models, (3) research on introducing inclusive social care services to elderly people with disabilities, and (4) research on introducing inclusive social care services in regions with insufficient local resources.
Universal health coverage, or providing every citizen with basic health care, has been a global policy goal as part of the Sustainable Development Goals. As one nation that has swiftly realized universal health coverage, Japan can contribute to advance UHC worldwide with international support and exchanging knowledge. Today, there is enormous demand not only for funds but also for other items, including ICT and human resources to manage health financing systems. HIAS Health is working on an evaluation of the effects of financial and technology support for universal health coverage in the Republic of Senegal in cooperation with the Japan International Cooperation Agency (JICA) and the Government of Senegal. Based on the results of this evaluation, we aim to expand our initiatives to monitor and evaluate universal health coverage in other countries including Asian countries.
We will evaluate the impact of the universal health coverage (UHC) project in Senegal (Africa). UHC aims to provide medical insurance to all citizens (especially the less fortunate) in developing countries to avoid catastrophic expenditure risk of households due to medical costs as well as to improve access to medical services. The Japanese government set mainstreaming of UHC as a strategic goal in Japan’s Strategy on Global Health Diplomacy (May 2013) and pledged a yen loan to make this possible. The Senegal UHC project has received a yen loan and technical cooperation from the Japan International Cooperation Agency (JICA) for the period of support from 2017 to 2021. Since technical assistance covers three out of 10 departments in three regions in Senegal, comparative analysis is possible in the intervention group (3 departments) and the control group (7 departments). The purpose of this research is to verify the economic effectiveness of the support, such as the participation rate of social insurance and alleviating burden on households, etc. We will also verify the complementarity of the technical assistance and the yen loan. Specifically, before the support starts (2017), surveys of households and mutual aid associations (insurers) have been locally conducted in three regions in Senegal, and data on the current insurance participation rate and union governance are gathered and analyzed. The sample size of the household survey is 4,000 in three regions of Senegal. The data collection protocol has been created. After the support ends in 2021, the same survey will be conducted again and the improvement effect will be quantitatively verified.
In 2015, noncommunicable diseases (NCDs) killed 39.5 million people, accounting for 70% of total global deaths. NCDs have recently become one of the most serious health problems not only in high income countries, but also in low and middle income countries. In HIAS Health, we investigate social determinants of health behaviour and outcomes, aiming to inform policies for changing population health behaviour and for reducing socioeconomic health inequality. In particular, we conduct research to analyze a large scale consumer panel survey data, to understand the patterns of purchasing of risk-factor products (tobacco, alcohol, and soft drink), and also to quantitatively evaluate the impacts of public health policies to encourage healthier life styles.
Health technology assessment (HTA) has been increasingly used internationally to support policy decisions about resource allocations in healthcare. In the HTA program, we conduct research to empirically estimate a `health opportunity cost’ for Japan and other countries, to inform a cost-effectiveness threshold for judging the cost-effectiveness of health interventions in the health systems.
HIAS Health is a member of the Board of Directors of HTAsiaLink (2018-19), one of the key international networks of HTA institutions mainly for the Asia Pacific region. Through HTAsiaLink, we help member countries’ decision making and also to contribute to train junior researchers.
A lot of effort is being made all over the world to develop the operation of public healthcare systems using evidence of “cost effectiveness” of health technologies. This research project aims to quantify “the health opportunity cost” of the healthcare budget. The health opportunity cost is a quantity that provides grounds for coverage and pricing of health technologies (medicine, medical devices, etc.) based on “cost effectiveness” for the purpose of improving the efficiency of healthcare resource allocation. The health opportunity cost of funding a given health technology can be defined as the level of population health that could have been gained if the budget had been allocated to another technology within the healthcare system. This research quantitatively identifies the health opportunity cost using data on individual medical expenses in Japan, a high-income country, as well as in the Republic of Indonesia, a middle-income country. The extracted quantitative values will be used as a criteria to inform the cost effectiveness of health technologies in each country, or in another words, “the cost effectiveness threshold.”
Big data such as receipts (medical fee statements) are available in the area of healthcare and nursing care and analysis of these data is expected to contribute to more efficient healthcare and nursing care. By developing analysis methods to analyze behavior change (incentives) of patients and healthcare institutions through analysis of domestic medical information, and utilizing a network of collaboration with overseas universities (SIGMA) which is promoted by Hitotsubashi University, HIAS Health works with big data used in international comparisons and other sources.