Innovation & Sustainability

The Health at a Glance 2019 OECD Indicators[1] point out the following:

• A continuing problem is that the poorest people in society are less likely to have access to healthcare.
  • It is estimated that one out of five adults who needed medical attention did not receive it, with poorer populations having less access to healthcare. Despite the fact that free cancer screening programs are offered in most OECD countries, the poorer the population, the lower the uptake rate.
  • Despite the fact that most OECD countries have universal or near-universal coverage for core health services, there are problems that impede access to care. Reasons for this include high cost sharing and the exclusion of services from benefit packages. Lack of understanding of health information, flawed communication strategies, and poor quality of medical care are also contributing factors.
• Quality of care is improving in terms of safety and effectiveness, but more attention should be paid to patient-reported outcomes and experiences.
  • To understand more about the quality of healthcare, we need to assess what is important to people. However, few healthcare systems regularly ask patients about their outcomes and experiences with treatment.
• Countries are spending heavily on healthcare, but not always in the most effective ways.
  • The average per capita health expenditure in OECD countries is about USD 4,000 (purchasing power adjusted).
  • Healthcare costs have increased much faster than economic growth so far. Although the increase in healthcare costs has slowed down over the past few years, costs are expected to continue to grow in the future. According to new estimates, health spending across OECD countries is expected to reach 10.2% of GDP in 2030, up from 8.8% in 2018. Concerns about sustainability have arisen because most countries are using mainly public funds.
  • Reforms to improve economic efficiency are crucial. Although increased use of generic drugs has led to cost savings, they account for only about half of the volume of drugs sold in OECD countries.
  • In OECD countries, the number of people working in health and social systems-related jobs is at an all-time high, with about one in ten jobs in health or social welfare. Shifting work from doctors to nurses and other medical professionals can reduce cost pressures and increase efficiency.

[1] Health at a Glance 2019 OECD Indicators (English): https://www.oecd-ilibrary.org/docserver/4dd50c09-en.pdf?expires=1608886951&id=id&accname=guest&checksum=93A0753C6F32C9F1E848BE62915C3E39

• Basic Policy on Economic and Fiscal Management and Reform 2019: A New Era of Reiwa—Challenges toward Society 5.0
  • The government has indicated its intention to compile policies to be addressed in its Basic Policy on Economic and Fiscal Management and Reform 2020: Overcoming the Crisis and Moving Toward a New Future (“Honebuto Policy 2020”), addressing concerns relating to payment and cost burdens.
  • The following initiatives were presented for the reform of the medical and long-term care systems.
    • Increase productivity of medical and welfare sector services by at least 5% by 2040, and by at least 7% for physicians.
    • Comprehensive reform of the medical care delivery system: regional medical care planning, measures to deal with uneven distribution of physicians, and reform of the working styles of physicians.
    • Strengthening of insurer functions: systematic increase in the percentage of evaluations based on outcome indicators, elimination of non-statutory transfers to the national health insurance system, nationwide deployment of advanced and good practices such as unification of insurance premium levels within prefectures, etc.
    • Transformation of the pharmaceutical industry into one with high drug development capabilities and promotion of fundamental reform of the drug pricing system.
    • Medical fees: study for appropriate evaluation of dispensing fees, etc.
  • Basic Policies for Economic and Fiscal Management and Reform 2020: Overcoming the Crisis and Moving Toward a New Future.
    • This plan responds to the spread of infectious diseases and looks at a gradual increase in economic activity. As part of the “With Corona” economic strategy, the government has indicated its intention to strengthen the medical care delivery system (expansion of testing capacity, acceleration and securing of vaccine development, etc.).
    • In order to realize an inclusive society that supports the “New Normal Lifestyle”—a society in which no one is left behind—the government is aiming for a health data reform, including the expansion of the Personal Health Record (PHR) and promotion of the development of a high-quality, efficient, and sustainable medical care delivery system, as part of the establishment of a healthcare delivery system that works in the “New Normal Lifestyle”. The government has indicated that it would promote precautionary health measures, healthy lives, and serious disease prevention in response to the “New Normal Lifestyle”.
  • Meeting on a Social Security System Oriented to All Generations
    • In September 2019, the Planning Meeting on a Social Security System Oriented to All Generations was established. It aims at broadly ensuring peace of mind not only for the elderly, but also for children, the child-rearing generation, and working-age population with sights set on the arrival of the 100-year life society. Sustainable reforms across the entire social security spectrum, including pensions, labor, healthcare, long-term care, and measures to counter the declining birthrate are currently under review.
    • In terms of the proportion of copayments for latter-stage elderly patients, the government is considering the following policy: “For latter-stage elderly patients (75 years old or older, excluding those with incomes equivalent to those of working-age people) with incomes above a certain level, the proportion of copayments at the counter for medical expenses shall be 20%, while for other patients the proportion shall be 10%.”
  • Dealing with High-Cost Drugs
    • Respond by combining systems such as market expansion recalculation, dosage and administration change recalculation, optimal use promotion guidelines, and cost-effectiveness evaluation.