The major issues in the health care system reform in 2006 include the health insurance system, reform of the medical care system, measures against lifestyle-related diseases, revision of the long-term care insurance system, and rationalization of medical expenditure for each of these. Among these issues, measures against lifestyle-related diseases seem to have focused on diabetes, various studies and programs of which have been conducted; Diabetes Prevention Study (DPS) in Finland, the National Health Insurance Health Promotion Model Project in Japan, etc. The Standard Medical Examination and Health Guidance Program (tentative version), proposed by the Health Service Bureau of the Ministry of Health, Labour and Welfare in July 2006, presents the goals of medical examinations and health guidance, while pointing out the skills required of health guidance providers. In this article the author describes the background and goals of new strategies to combat lifestyle-related diseases in the health care system reform in 2006.
The health reform program in 2006 was the biggest one for the last 30 years in Japan. According to the plan a nation-wide health promotion program for healthier population will be introduced. As a main program of health promotion, the specified health checkup and follow-up health guidance and intervention program will be introduced from 2008. This program is a Japanese disease management program. In 2006 the preliminary programs have been launched in the three prefectures (Chiba, Toyama, and Fukuoka) and several operational problems have been clarified. In this article the author presents the general feature of program and some critics for it.
In May, 2006, the Ministry of Health, Labor and Welfare published a part of the results of the Comprehensive Survey of Living Conditions of the People on Health and Welfare 2005. The report has clarified that one of two men and two of five women from 40 to 74 years old are regarded as the Metabolic syndrome or suspicious cases. In order to counteract these situations, much concern is given for the Disease management programs that have been developed in the USA. In Japan, traditionally a various health promotion activities have been organized in the occupational setting under the Occupational safety and Health Law. These activities can be regarded as disease management (DM) programs. In this perspective, the authors have conducted a literature review about health promotion programs conducted in the occupational setting. The authors have reviewed 30 articles by the formative evaluation using DM concept. In fact there were many DM like programs conducted in the Japanese workplaces. However, it is very difficult to develop the effective DM program directly from these experiences under the actual situation. The most important problem to be solved is the fact that there is no standardized methodology for intervention and evaluation. The authors concluded that it might be pragmatic to develop the Japanese DM programs based on the experiences in occupational settings with combination of the American sophisticated DM framework.
The estimation of medical expenses based on disease structure is necessary to improve the efficiency of the health care delivery system and to maintain the social health insurance system in Japan in the face of the rapid aging of the population which is anticipated in the near future. Our aim is to estimate regional needs for health care services by using a national patient database in conjunction with the diagnosis procedure combination (DPC) patient classification system. A data warehouse was constructed with dimensions including year, regions, DPC disease classification, and provider attributes, and then subjected to OLAP analyses. Needs for health care services in the designated medical service areas were estimated from disease structure in the districts and the average health service utilization for relevant DPC groups, as determined from DPC claim data. Actual needs for acute care hospital beds were estimated from disease structure in the districts, and revealed a large excess of acute care beds in most of areas. Admissions of patients to hospitals in medical service areas different from those for patients' residences were quantitatively determined for each of the DPC groups. It was found that patients requiring cardiac surgeries traveled farther than those with other diseases to reach hospitals conducting a large volume of such surgeries. Our results indicated the feasibility and the effectiveness of the arrangement of regional health care delivery plans based on the DPC case mix system and national patient database.
The prevention of death due to overworking, so called "Karoshi" is one of the most important issue for the Japanese occupational health policy. Most of the Karoshi cases are closely related to coronary heart diseases (CHD). Thus it is very important to assess the coronary risk level of workers. In 2001 the Japanese government implements a new screening program for Karoshi under the Occupational Accident Compensation Law. A worker with all four conditions (hypertension, hyperlipidemia, hyperglycemia and obesity, so called "deadly quartet" must receive the in-depth health examination. However, it has been suggested that deadly quartet model has high false negative rate and that it might be better to adapt more appropriate screening method for the prevention of Karoshi. In this study we compare the appropriateness of several screening models for CHD risks. The results of our study indicated that the screening method based only on the deadly quartet is insufficient. The use of supplementary screening standard such as the CHD Risk Model is considered to be necessary.