In order to respond the expanding needs of health and ADL care for the aged, the Japanese government has implemented a series of health and social programs for the aged. The author thinks that the political populism is the most important cause of current difficulty of re-organizing the Japanese health system. For example, the introduction of free medical program for the aged in 1972 was decided as a result of political rivalry between the Ruling party and the left-wing Opposition parties. This program made our system too much medicalized and caused a rapid expansion of medical expenditures. The Long-term care insurance scheme (LTCI) was introduced in 2000 in order to de-medicalize the system by expanding home care capacity, but has not reduced medical expenditures as estimated before. In order to re-organize the system for the aged, the new scheme of health insurance for the aged has been introduced in 2008. However, just before the introduction of the new health insurance scheme, there started very strong opposition against the introduction of new scheme. Mass media launched a tremendous volume of negative campaigns and the Opposition parties has been criticizing the responsibility of government and Ruling parties. The two main points of critics are ageism and heavy financial burden for the aged, especially for those of lower economic status. According to the author's perspective, the most important cause of mistake for the introduction of new scheme is insufficient consideration for QOL and clinical outcomes. The debate has too much focused on cost sharing and financial burden. The philosophy of social security policy must be QOL issue, not financial control. The well organized health insurance scheme for the aged must be one of basic infrastructures in order to construct an active aged society. More creative debate is necessary.
Cancer has been the leading cause of death in Japan since 1981. In order to tackle this situation, the Cancer Control Act was approved in June 2006 and the law has been implemented since April 2007. The basic concepts of the low are 1) promotion of cancer research and utilization of research outcomes, 2) equalization of cancer medical services, and 3) development of cancer medical services to satisfy patients. In order to implement the appropriate cancer policy, the objective data of cancer treatment is indispensable. The DPC (Diagnosis Procedure Combination) scheme can contribute to the development of more appropriate and evidence based cancer policy. In this article, the authors will indicate the usefulness of DPC data in health service planning for cancer medicine, using the data of the Fukuoka Health Care Region.
This paper is the first one of a series of our epidemiological studies exploring the long-term relationship between depressive symptoms and developments of lifestyle-related diseases in middle-aged and older Japanese population. Our strategy for exploring the long-term relationship is to fully utilize the annual health checkup data in a Japanese manufacturer for 14 years from 1995. The health checkup data includes answers to the questions about subjective symptoms, but does not include any of the established and generally accepted set of depression scale questions. In order to confirm that the level of depressive symptoms can be estimated by the answers to the subjective symptom questions in the existing dataset, we selected 13 questions about subjective symptoms from the questionnaire for review and asked to fill in Zung Self-rating Depression Scale questions to the people randomly sampled from the checkup population in 2008. A positive correlative relationship between the result of the selected 13 questions and SDS is confirmed by simple linear regression with a positive coefficient (p<0.001). The internal consistency is also confirmed with Cronbach's alpha 0.8871. This strongly supports our further study design examining the long-term relationship with the existing checkup data for 14 years.
In order to successfully manage the new Japanese Disease Management program, so called "Health checkups and healthcare advice with a particular focus on the metabolic syndrome program", it is essential to implement PDCA cycle into the system. This requires measurement for evaluation. According to our hearing of the eight advanced health insurance societies and two health support service providers, efficiency and continuity seem two key indices for a successful program. Most of the companies and municipal governments seem to pay little attention to these aspects, because of lack of PDCA cycle. It is indispensable to develop sets of indicators to evaluate efficiency and continuity in order to continuously improve the quality of health support activities.