The Health Science Council’s Community Health and Nutrition Team released an interim report on September 15, 2005, entitled “Future Promotion of Lifestyle Disease Countermeasures.” That report cited challenges such as the following regarding the promotion of lifestyle disease countermeasures: insufficient sampling reliability of populations at risk for lifestyle diseases and insufficiently thorough health guidance; the need for thorough, evidence-based health examinations and guidance; the need for further improvements in the quality of health examinations and guidance; insufficient presentation of concrete strategies and programs by the National Government; and insufficient general understanding of the current situation / insufficient data for policy evaluations. The creation and strengthening of lifestyle disease countermeasures was deemed necessary in order to address these issues.[2] To that end, “Specific Health Examinations” and “Specific Health Guidance” were formulated in April 2008. Furthermore, in order to successfully “extend the nation’s healthy life expectancy,” (an important measure within the Japan Revitalization Strategy), it was decided that health insurance associations would be required to draw up and implement Data Health Plans and that corporations would be required to promote corporate wellness efforts.[3]
5.2 Disease Prevention and Health Promotion by Insurers
Specific Health Examinations / Specific Health Guidance
The Japanese government has formulated treatment plans for medical practitioners—Specific Health Examinations and Specific Health Guidance—in an effort to tackle lifestyle diseases, which are causal factors in approximately 60% of deaths each year in Japan. Specific Health Examinations and Specific Health Guidance focus on treating metabolic syndrome in adults ages 40 to 74. This is done through a two-step process. Patients first receive Specific Health Examinations. For patients identified as being at high risk for developing lifestyle diseases and who can expect preventative effects from lifestyle changes, public health nurses then provide Specific Health Guidance, supporting the re-examination of lifestyle choices. The MHLW created this program with the goal of reducing the number of people suffering from lifestyle diseases such as diabetes by 25% between FY2008 and FY2017. Based on that goal, individual insurers are expected to create plans to promote Specific Health Examinations and Specific Health Guidance for enrollees. These plans are created based on basic measures laid out by the national government such as Specific Health Examinations.
At present, the actual implementation rate for Specific Examinations among all insurers is 50.1%. When broken down by insurer type, implementation rates vary considerably, with municipal sections of the NHI at 36.3%, the National Health Insurance Association at 46.7%, the Japan Health Insurance Association at 45.6%, National Seamen’s Insurance at 46.8%, Health Insurance Societies at 73.9%, and Mutual Aid Associations at 75.8%. Although rates for Health Insurance Societies and Mutual Aid Associations exceed 70%, rates remain low for other insurers, such as municipal sections of the NHI. Implementation rates for Specific Health Guidance, when compared to rates for Specific Health Examinations, are significantly low for every single insurer, with municipal sections of the NHI at 23.6%, the National Health Insurance Association at 8.9%, the Japan Health Insurance Association at 12.6%, National Seamen’s Insurance at 6.9%, Health Insurance Societies at 18.2%, and Mutual Aid Associations at 19.6%.[4] One reason for low Specific Health Guidance implementation rates is that same-day blood test results are unavailable, so it can take several months from screening to guidance.[5]
Data Health Plans
In response to the development of advanced population aging and following Japan’s monetary and fiscal policies as the “Third Arrow” of Abenomics, the Japan Revitalization Strategy was announced, setting “extension of the nation’s healthy life expectancy” as an important goal. During the first phase of this initiative, between FY2015 and FY2017, in order to realize that goal and as a new approach for disease prevention and health promotion, all health insurers were required to prepare and publish Data Health Plans. These plans laid out strategies that each insurer would take to maintain and improve the health of its enrollees based on analyses of health and claims data. As of April 2018, the second phase of Data Health Plans was implemented and is now headed for full-scale implementation. Similar initiatives are also required for the municipal sections of NHI. By preparing and utilizing Data Health Plans, it is hoped that health insurers will move toward the operation of more effective healthcare programs.
One goal for the creation of Data Health Plans is to promote the effective and efficient implementation healthcare programs via plan-do-check-act (PDCA) cycles based on analyses of health and claims data. Another goal is the realization of healthy workplaces through collaborative health programs in which businesses cooperate with insurers on initiatives to create healthy working environments and improve the health awareness and lifestyle habits of employees.[6] This goal is clarified within the Basic Policies on Economic and Fiscal Management and Reform 2016 (“Big-Boned Policies”) approved by a Cabinet order in 2016 which states that “Further collaboration between corporate wellness and data health measures will be promoted by corporations.” There are high hopes for preventative medicine and health promotion measures implemented by insurers.
Corporate Wellness
The strengthening of incentives for individuals and insurers is yet another way to encourage preventative medicine and health promotion.
As an incentive for encouraging preventative medicine practices and health promotion in individuals, some insurers in Japan are implementing “healthcare points” systems or offering support such as for insurance payments. For example, enrollees who make the effort to receive Specific Health Examinations or who improve their examination results might receive health-related goods or discount coupons for future examinations.[9]
In terms of strengthening incentives for insurers in order to make it easier, among other things, for them to fully apply their functions according to their unique characteristics, the following measures were included within policy revisions such as that of the National Health Insurance Act of 2015: (1) the establishment of insurer effort support systems for residence-based NHI, and the evaluation of objective indices and creation of subsidies for initiatives such as those aimed at preventing the worsening of diabetes; and (2) comprehensive reviews (implemented from FY2018) of the systems used for calculating financial support for people aged 75 and over who are enrolled in health insurance or mutual aid associations that evaluate insurers based on not only their reported results from Specific Health Examinations or Specific Health Guidance, but also on multiple other indices such as cancer treatment initiatives or collaborations with businesses. Reforms of the system for calculating contributions from health insurance associations and mutual aid associations for those aged 75 and over were implemented from FY2018, emphasizing incentives for insurers’ efforts such as those aimed at disease prevention and health promotion. The reforms are expected to have far-reaching but minor implications in terms of penalties for many insurers, while introducing step-wise reductions in insurers’ financial contributions according to their level of achievement on certain indices.
The Promotion of Incentives for Individuals and Insurers
In response to the development of advanced population aging and following Japan’s monetary and fiscal policies as the “Third Arrow” of Abenomics, the Japan Revitalization Strategy was announced, setting “extension of the nation’s healthy life expectancy” as an important goal. During the first phase of this initiative, between FY2015 and FY2017, in order to realize that goal and as a new approach for disease prevention and health promotion, all health insurers were required to prepare and publish Data Health Plans. These plans laid out strategies that each insurer would take to maintain and improve the health of its enrollees based on analyses of health and claims data. As of April 2018, the second phase of Data Health Plans was implemented and is now headed for full-scale implementation. Similar initiatives are also required for the municipal sections of NHI. By preparing and utilizing Data Health Plans, it is hoped that health insurers will move toward the operation of more effective healthcare programs.
One goal for the creation of Data Health Plans is to promote the effective and efficient implementation healthcare programs via plan-do-check-act (PDCA) cycles based on analyses of health and claims data. Another goal is the realization of healthy workplaces through collaborative health programs in which businesses cooperate with insurers on initiatives to create healthy working environments and improve the health awareness and lifestyle habits of employees.[6] This goal is clarified within the Basic Policies on Economic and Fiscal Management and Reform 2016 (“Big-Boned Policies”) approved by a Cabinet order in 2016 which states that “Further collaboration between corporate wellness and data health measures will be promoted by corporations.” There are high hopes for preventative medicine and health promotion measures implemented by insurers.
References
[1] Ministry of Health, Labour and Welfare “Revision of Basic Policies for Medical Cost Optimization / Plans for Medical Cost Optimization” http://www.mhlw.go.jp/file/05-Shingikai-12401000-Hokenkyoku-Soumuka/0000148008.pdf (Accessed 2017, Nov.27)
[2] Ministry of Health, Labour and Welfare “Future Promotion of Lifestyle Disease Countermeasures (Interim Summary)” http://www.mhlw.go.jp/shingi/2005/09/s0915-8.html (Accessed 2017, Nov.21)
[3] Ministry of Health, Labour and Welfare “Section 1: Background and Aims of the Data Health Plan” http://www.mhlw.go.jp/file/06-Seisakujouhou-12400000-Hokenkyoku/0000069365.pdf (Accessed 2018, Feb.7)
[4] Ministry of Health, Labour and Welfare “2015 Fiscal Year Implementation Status of Specific Health Examinations and Specific Health Guidance” http://www.mhlw.go.jp/file/06-Seisakujouhou-12400000-Hokenkyoku/0000173319.pdf (Accessed 2018, Feb.2)
[5] Ministry of Health, Labour and Welfare “Future Measures for Increasing the Implementation Rates of Specific Health Examinations and Specific Health Guidance” http://www.mhlw.go.jp/stf/shingi/2r9852000002e0cn-att/2r9852000002e0hh.pdf (Accessed 2018, Feb.2)
[6] Ministry of Health, Labour and Welfare “Primer on the Creation of Data Health Plans” http://www.mhlw.go.jp/file/06-Seisakujouhou-12400000-Hokenkyoku/0000178352.pdf (Accessed 2018, Feb.2)
[7] Ministry of Health, Labour and Welfare “The Corporate ‘Workplace Wellness’ Guidebook ~ Recommendations for Promoting Health Through Collaboration and Cooperation ~ (Rev.1st ed.)” http://www.meti.go.jp/policy/mono_info_service/healthcare/kenkokeiei-guidebook2804.pdf (Accessed 2018, Feb.9)
[8] Ministry of Health, Labour and Welfare “Data Health and Collaborative Health Guidelines for Promotion of Corporate Wellness” http://www.mhlw.go.jp/stf/houdou/0000170819.html (Accessed 2018, Feb.9)
[9] Ministry of Health, Labour and Welfare「Insurer Incentives」http://www.mhlw.go.jp/file/05-Shingikai-12601000-Seisakutoukatsukan-Sanjikanshitsu_Shakaihoshoutantou/0000163331.pdf (Accessed 2018, Nov.28)
