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・Research on the management of healthcare institutions by utilizing business reports and other information of medical corporations
・Fact-finding research on the management of healthcare institutions utilizing postal questionnaire surveys

Summary 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.
HIAS team members Ko Arai, Ryo Watanabe, Hiromasa Sakaguchi, Kentaro Koi, Madoka Ishida

Social determinants of health in middle-aged and older adults: A panel analysis based on large-scale social surveys / Grants-in-Aid for Scientific Research (KAKENHI), Scientific Research (C) 23K01419

Summary The purpose of this research is to obtain policy implications for improving the health and social welfare of middle-aged and elderly people. In the analysis, we not only take into account various individual-level socio-economic factors such as income, educational background, and employment status, but also regional-level socio-economic factors such as disparity and poverty in the area of residence, level of social participation activities, and employment status. We will focus on the social determinants of health among middle-aged and elderly people and analyze them under a dynamic framework, as well as calculate the impact of pension and employment system reforms on health disparities as a policy simulation. Furthermore, we will attempt to compare Japan and Japan by using individual data from various large-scale social surveys conducted in China.
HIAS team members Takashi Oshio

Research on workers’ health and working conditions

Summary The health status of workers not only affects their own happiness, but also has a major impact on companies and society as a whole through medical costs and labor productivity. In this study, we will use individual data on health checkups, stress checks, and labor affairs provided by a company to analyze health factors related to physical and mental health that affect work conditions. This research not only improves the health status of workers, but also has great social significance, as it will lead to reduced medical costs and improved productivity.
HIAS team members Kazumitsu Nawata
  • • Nawata, K. (2023) “An Analysis of Health Factors Affecting Employees’ Absenteeism: Influences of HDL Cholesterol and Blood Sugar Levels,” Health, 15, 397-412.

Verifying the effectiveness of policies for children and young people to resolve social issues that have become more serious due to the COVID-19 pandemic

Summary In response to the declining birthrate and deterioration of the environment surrounding children that has progressed due to the COVID-19 pandemic, this project aims to (1) preform a full-fledged evaluation of measures that have the potential to stop the declining birthrate, and (2) analyze what kind of children are affected by the prolonged COVID-19 pandemic. Therefore, regarding (1), this project will examine the effects of subsidies for infertility treatment and the effects of lump-sum childbirth grants and for (2), an analysis of various individual data will be conducted.
HIAS team members Reo Takaku


Discrete choice experiment (DCE) study for the project ‘Genital InFlammation Test (GIFT) for HIV prevention and reproductive health: point of care cytokine biomarker lateral flow test for asymptomatic inflammatory sexually transmitted infections (STIs) and bacterial vaginosis (BV)’

Summary Early detection and treatment of STI and BV can lower the risk of HIV in women and reduce pregnancy complications, both of which continue to be major public health issues, particularly in low- and middle-income countries (LMIC). However, routine testing for these common conditions is not offered in LMIC, often due to the high cost of testing. A low-cost, lateral flow device, the Genital InFlammation Test (GIFT), has been developed to test for STI and BV. The GIFT device can be used at the point of care (POC). The GIFT-Africa research consortium will undertake a diagnostic trial to assess the performance of the GIFT device and undertake an integration study to look at how best to incorporate the GIFT device into routine care in a feasible, acceptable, and cost-effective way.
HIAS team members Ayako Honda

A systematic review and network meta-analysis of technology-based interventions for improving childhood immunization in low- and middle-income countries

Summary Technology-based interventions (TBIs) are widely used for improving routine vaccination coverage and timeliness among children worldwide. A pairwise meta-analysis and network meta-analysis will be performed to estimate the direct and indirect effects of interventions for each outcome and their cost-effectiveness.
HIAS team members Rashedul Islam

Improving the efficiency of medical resource allocation in Asia

Summary 公Efficient resource allocation in public healthcare is an important policy issue worldwide. Cost-effectiveness evaluation is an effective means of achieving this, and each country has introduced a budget allocation system that utilizes cost-effectiveness evaluation for drugs, medical equipment, the allocation of medical personnel, etc. The value of cost-effectiveness evaluation depends on whether standards (thresholds) for judging evaluation results are appropriately set. The thresholds currently in use in almost all countries have little scientific basis. In this study, we quantitatively derive the cost-effectiveness threshold in Japan, Bhutan, Singapore, and Thailand from administrative data, and estimate the effect on medical resource allocation when changing the threshold. In order to maximize the policy impact of research results, research will be carried out in collaboration with relevant national government agencies.
HIAS team members Ryota Nakamura

Informing the design of policies aimed at increasing health financial protection to accelerate universal health coverage in West Africa

Summary Achieving universal health coverage (UHC), i.e. equitable access to health services for all, is one of the main Sustainable Development Goals adopted by the United Nations General Assembly in 2015. In sub-Saharan Africa (SSA), however, many households are still confronted with a high risk of incurring financial hardship when seeking care. To address this issue, many governments have recently committed to increasing health financial protection in their population with support from international partners, including Japan. The objective of the proposed research is to inform the design of policies aimed at increasing financial protection in eight West African countries where data is currently outdated or lacking (Benin, Burkina Faso, Côte d’Ivoire, Guinea Bissau, Mali, Niger, Senegal, and Togo). In addition to providing up-to-date estimates of the incidence of catastrophic health expenditure and health insurance rates at a regional, national, and subnational level, the project will provide insights into the potential impacts of reforming the current public health insurance systems on the economic welfare of target populations. Such evidence is critical at a time where many governments in SSA have committed to reducing inequities in access to care to achieve UHC.
HIAS team members Thomas Rouyard, Ryota Nakamura

Evaluating the sustainability of financial incentives to encourage preventive health behavior: Ghana Financial Incentives Trials – Wave I and II

Summary Evidence suggests that financial incentives can promote specific health behaviors, particularly “one-off” preventive actions such as vaccination or disease screening. While there is limited evidence from low- and middle-income countries, recent studies have shown promising results. In 2022, in collaboration with our colleagues from the University of Oxford and from the University of Ghana, we conducted a field experiment in rural Ghana to assess the impact of cash incentives on COVID-19 vaccine uptake. The results demonstrated the effectiveness of modest cash incentives and, importantly, the absence of negative spillover effects on neighboring individuals who did not receive incentives. However, an unanswered question pertains to whether financial incentives can yield negative within-subject spillover effects. It remains unclear whether individuals who receive incentives for a specific health behavior, such as taking the COVID-19 vaccine, are influenced in subsequent decisions to engage in similar preventive health behaviors without the need for extra incentives. To address this gap in the existing literature, we will conduct a new experiment to evaluate compliance with tuberculosis testing among participants who did and did not receive cash incentives in the COVID-19 trial.
HIAS team members Thomas Rouyard, Ryota Nakamura
  • • Duch R, Asiedu E, Nakamura R, Rouyard T, Yevenes C, Roope L, Violato M, Clarke P. A randomized controlled trial to test financial incentives for COVID-19 vaccination in Ghana. Nature Medicine 2022; 28(8): 1516-1517.
  • • Duch R, Asiedu E, Nakamura R, Rouyard T, Mayol A, Barnett A, Roope L, Violato M, Kotlarz P, Sowah D, Clarke P. Cash for COVID-19 Vaccines in Africa: A Financial Incentives Trial in Rural Ghana. Working Paper 2023.
  • • Duch R, Clarke P, Asiedu E, Robinson TS, Nakamura R, Rouyard T, Yevenes C, Roope L, Violato M. Pre-Registration of Ghana Financial Incentives Trial Wave II – Spillover and Tuberculosis Screening. 2023. Web.
  • • Duch R, Clarke P, Asiedu E, Nakamura R, Rouyard T, Yevenes C, Roope L, Violato M. CANDOUR Ghana Protocol: Ghana COVID-19 Vaccinations and Financial Incentives. 2022. Web.

Fukushima study for Engaging people with type 2 Diabetes in Behaviour Associated Change (FEEDBACK): a cluster randomised controlled trial

Summary The growing burden of type 2 diabetes mellitus (T2DM) and the rising cost of healthcare worldwide make it imperative to identify interventions that can promote sustained self-management behaviour in T2DM populations while minimising costs for healthcare systems. The present research aims to evaluate the effects of a novel behaviour change intervention (FEEDBACK) designed to be easily implemented and scaled across a wide range of primary care settings. A cluster randomised controlled trial (RCT) will be conducted to evaluate the effects of a personalised, multi-component intervention intended to be delivered by general practitioners during a routine diabetes consultation. This intervention consists of five steps aimed at enhancing doctor-patient partnership to motivate sustained self-management: (1) communication of cardiovascular risks using a ‘heart age’ tool, (2) goal setting, (3) action planning, (4) behavioural contracting, and (5) feedback on behaviour. We aim to recruit 264 adults with T2DM and suboptimal glycaemic control from 20 primary care practices in Japan that will be randomly assigned to either the intervention or control group. The primary outcome measure will be the change in HbA1c levels at 6-month follow-up.
HIAS team members Thomas Rouyard, Masako Ii, Ryota Nakamura, Michiko Moriyama
  • • Rouyard T, Endo M, Nakamura R, Moriyama M, Stanyon M, Kanke S, Nakamura K, Chen C, Hara Y, Ii M, Kassai R. Fukushima study for Engaging people with type 2 Diabetes in Behavior Associated Change (FEEDBACK): study protocol for a cluster randomised controlled trial. Trials 2023; 24(1): 1-15.

The Long-Run Health and Economic Benefits of Universal Health Insurance in Japan

Summary The goal of this research is to estimate the long-run impacts of early life exposure to universal insurance on health and economic outcomes in prime age. Due to the phase-in of universal insurance in Japan in 1956-1961, insurance coverage increased more in prefectures with initially low coverage prior to the reform, and the policy led to exogenous variations in exposure across cohorts born during the reform period. Exploiting the variation, I estimate the long-run impacts of exposure on mortality, morbidity, as well as education and employment outcomes using current population surveys. These results could inform policy debates in countries recently reforming or expanding insurance coverage.
HIAS team members Hongming Wang

Mixing Age and Risk Groups for Accessing COVID-19 Vaccines: A Modelling Study

Summary In Japan and elsewhere, a standard approach to distributing COVID-19 vaccines is through a multi-stage rollout targeting different mixes of age and risk groups in each stage. To optimize the design of such policies, we first calibrate a SEIR model to capture the virus transmission patterns before the vaccine rollout in Japan. We then search over all possible targeting strategies to identify the optimal ones for three policy objectives: minimizing deaths, minimizing cases, and minimizing severe cases. We show that mixing age and risk groups outperforms targeting individual groups separately, and low-risk young adults are increasingly targeted together with the oldest age groups to further reduce deaths under high virus transmissibility. In simpler rollouts targeting either old age or high risk, using high-efficacy vaccines can mitigate the health losses due to suboptimal targeting in the rollout.
HIAS team members Hongming Wang, Yoko Ibuka, Ryota Nakamura

The Convergence of Health and Wellbeing Around the World: The Impacts from Trade

Summary In recent decades, health measures such as life expectancy and healthy life years lived without disability are increasingly valued as indicators of national wellbeing. This paper first documents the convergence of life expectancy and healthy life years across the world since the second half of the 20th century. Exploiting the ascension of transportation technology that greatly reduced the shipping costs across disparate parts of the world, the paper then explores whether and to what extent trade expansion in a globalizing world reduced mortality in less developed countries, the specific causes of death and disease burdens behind the mortality effect, and how the health profiles of nations can complement economic accounts for a more complete understanding of the wellbeing increases during a period of rapid globalization.
HIAS team members Hongming Wang