In order to realize a healthy aged society, the Japanese government has established a new law for the health promotion in 2006. The new law will make "the specified health checkup and intervention program" for insureds over 40 years old obligatory for public health insurers from April, 2008. It is planned that the outcomes of this health promotion program will be reflected to monetary contribution of each insurer for the newly created health insurance scheme for the elderly. In order to adapt to this scheme, each insurer must have a capacity to monitor the compliance of insured and to analyze the claim data in oredr to establish appropriate strategeis. Considering the limited manpower of each insurer and the large volume of persons who need health education, it is indispensable to use IT system. For this perspective, we have developed the IT based management system for health support program. The base system is constructed on Cognos 8 ^®, one of the most widely used OLAP software. The base system comprises of the three parts: data input and preparing the cubes, data mining, and reporting. The system supports the management of health education and monitoring. As in the USA, this kind of IT based health support system will be developed by the introduction of "the specified health checkup and intervention program" from April, 2008.

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After the introduction of the Long Term Care Insurance (LTCI), the number of persons who received the LTCI services increased very rapidly. This causes a rapid increase in LTCI expenditures and premium. In order to make LTCI scheme sustainable, it is pivotal how to maintain the ADL and health level of the elderly. For this purpose, we have investigated the causes of dependency among the LTCI users in order to establish an appropriate preventive strategy. The materials were LTCI related data (assessment sheet and physician's opinion report) of 2002 whole year of K city, Fukuoka. Total number of data is 30,562 cases. The cases were stratified by diagnosis, LTCI eligibility level, and type of residence. There are interesting differences in causal diagnoses according to the eligibility level. In the case of slightly frail elderly, the osteo-muscular disorders are the most important causes of dependency. On the contrary, among the severely frail elderly, the cerebro-vascular diseases (CVD) were the most important. The number of users with dementia increases along with LTCI level. Considering that the largest increase in LTCI users has been observed in the slightly frail elderly, it is very important to organize a ADL prevention program focusing to osteo-muscular disorders, such as a community based physical fitness class.

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The mechanism for quality management in disease management is one of the issues to be explored within the context of its development. USA has much experience in the development of disease management. This experience will serve as a useful reference and its analysis will bring us many suggestions. We observe in disease management in the USA the feature of robustness of market with huge variety of players and many kinds of purchasers, such as health plans, employers, and governments, service providers such as disease management organization, as well as accreditation organizations, and consultants. The US market benefits from the accumulated experience and practices over the period of a decade or more. Actions in developing the quality management mechanism include accreditation and initiatives by private organizations. Notably, the Disease Management Association of America (DMAA) has labored hard to establish consensus-based outcomes evaluation. US experience tells us that accreditation is useful, but has limitations and requires necessary experiences, and that while consensus on the evaluation of outcomes in disease management has not yet been firmly established, it could be formed through accumulated practices and an exchange of knowledge in a pragmatic approach. Quality management as knowledge management at a societal level or as part of the infrastructure is required. It is no small matter to purposefully create the mechanism of circulation and exchange of expertise and knowledge, and to integrate them.

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In the case of evaluation of health check-up results, it is common to set the criteria of abnormality accoridng to the population distribution. However, the normal range of lab-data of individual person is usually narrower than that of population data. In this article, the authors have evaluated the chrnological chenges of health check-up data in order to evaluate the possibility of "personally set criteria of abnormality". The used data was those of individuals who have received health check-up all year from 1995 to 1999 consecutively in an Occupational health institute. Total number of persons included into the analysis was 97,945 (Male 65,159, Female 22786). The larger means of CV were observed for Triglyceride, GOT, GPT, gamma-GTP. The smaller means of CV were observed for BMI, SBP, DBP, Total-cholesterol, Ureic acid, Fasting Blood Sugar (FBS) and Hemoglobin (Hb). The present results indicated that one has to pay enough attention to evaluate a cross-sectional data for most of health check-up items excluding blood pressure and BMI because of its chronological variability.

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