In order to realize a healthier nation, the Ministry of Health, Labor and Welfare (MHLW) launched the Health care reform plan in 2006. According to the law, a new health promotion program called “Health checkups and healthcare advice with a particular focus on the metabolic syndrome” has been introduced for the insured over 40 yr old since 2008. Many private organizations have implemented a new health promotion program. However, the last two year’s experience has resulted in a disappointed result. It seems that the market is rapidly shrinking. The most important problem that blocked the smooth implementation of new system was the ambiguity of definition of e-claim format. The complexity of format has resulted in the high cost of developemnt. The system must be simpler in order to make the health market more active. Other problems are related to the lack of social marketing concept. Especially, the current system has problems for philosophy, place (accessibility) and promotion (public awareness and motivation). In order to realize a healthy and active aged society, we have to create a culture of healthy lifestyle. This requires the social marketing approaches that will change the social values. Considering the importance of new program, the philosophy and strategy must be re-considered.

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Japan is famous for its long Length of Stay (LOS) of in-patient services. One of the reasons of this long LOS is the long stay of aged patients. It is estimated that one third of hospitalized aged patient stay in the hospital because of social reasons not by medical needs. In order to clarify the factors associated with longer LOS among the aged patients, we have conducted a patient survey in September 2006. A questionnaire survey has conducted at all long term care hospitals (220 facilities) in Fukuoka in September 2006. All aged patients who had stayed in the institution more than 180 days were investigated. We investigated the background factors of long LOS among the 4,862 hospitalized aged, by the logistic regression analyses. Results showed that female, no care giver at home, existence of dementia, no residence to discharge, no willingness to discharge, were associated with longer length of stay. On the contrary, live alone, higher medical needs, and living in Ariake and Yame-Chikugo regions were associated with shorter length of stay. The present results have suggested the importance of housing policy for the frail elderly in order to solve the longer LOS problem in Japan.

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In order to clarify the importance of diabetes control, the authors examine the impact of diabetes mellitus on resource consumption among the angina pectoris patient institutionalized in the Japanese acute hospitals. We used the 2009 DPC database. The DPC database is a discharge summary and administrative claims database that represents approximately 50% inpatient admissions to acute care hospitals in Japan. Among 2,553,283 acute in-patient cases of 855 hospitals, we extracted 115,868 patients with the diagnosis of angina pectoris (DPC code with six digits=050050). Based on this dataset, we compared the resource consumption measured by length of stay and charged cost between the angina pectoris patients with diabetes and those without diabetes. The diabetic patients showed lower mean ages (male: 68.1 vs. 67.2, female: 73.0 vs. 71.4), longer length of stay (male: 6.4 vs. 6.9, female: 7.6 vs. 8.3), higher charged cost (male: 140,314.0 vs.145,206.9, female: 143,305.1 vs. 149,252.1; 1 point = 10 JPY) and higher CCI (male: 1.3 vs. 1.6, female: 1.3 vs.1.5) with statistical significances. Furthermore, there was a wide regional variation among the diabetes prevalence among the observed population. The present analysis has clarified that diabetes increase the resource consumption among the angina pectoris patients. In order to control the health expenditures and ameliorate the population’s health status, the preventive activity of diabetes must be put more emphasis.

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The demographic situation and disease structures are very influential for medical services delivery system and its finance. A rapid ageing is on goimg in Japan. The population of aged more than 65 yr old accounts for 22% and Total Fertility Rate (TFR) was 1.37 in 2008. The total population is decreasing since 2006. This demographic change means the increase in users of social and health services and the decrease of tax payers, which requires the Japanese government to re-organize its social security system. The mortality has been also dramatically decreased during the past 50 decades. It is considered that this improvement in health status was caused by the following factors; improvement of general hygiene, medical system and nutrition, relatively small incidence of violence, relatively moderate climate and so on. On the other hand, the ageing and westernization of the lifestyle have changed the disease structure from the acute to chronic diseases dominant patterns. For example, diabetes mellitus and mental disorders have become new health threats for the Japanese population. Because of this dramatic change in demography and disease structures, we face to a fundamental problem concerning how to make our social system sustainable.

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