With the development of information and communication technology (ICT) over the past few years, large amounts of data can easily be collected in all fields. In the healthcare field, large-scale data or big data, which have various advantages over epidemiological/statistical data, are becoming available as scientific evidence. Additionlly, data on medical costs such as receipt information, for example, are included among these large-scale data allowing cost-effectiveness analysis. Therefore, with the increase in the amount of data that can be handled due to the evolution of ICT, the approach to data utilization in the field of health and medical care gradually changes. This means that "evidence-based health care" can be changed from the viewpoint of data utilization.
Regarding the utilization of scientific data in the field of health and medical care, the importance of epidemiological and statistical methods will remain unchanged. However, by significantly increasing the range and amount of data, it is possible to utilize data with very significant advantages from a statistical point of view. Meanwhile, for the utilization of these data, securing quality as scientific data and evaluating the validity of analysis methods will become important issues for the future.
Health Japan 21 (2nd edition) released by the Ministry of Health, Labour and Welfare, Japan, contains health-related data. It is important to develop methodology for using existing data and action plans to achieve an effective plan-do-check-act (PDCA) cycle that will boost health, food, and nutrition promotion. Attention should be paid to means by which public health nutritionists in local governments can help lower medical costs.
We used existing data in three ways to consider methods for evidence-based action planning. First, a training course from the Japanese National Institute of Public Health, and study and training projects of the Japan Dietetic Association and Japan Public Health Association, were brought together to concretize them and formulate an action plan for policy.
Second, we set up a working group (WG) to function at local levels. This was coordinated to analyze prefecture health and nutrition status with regard to preventing disease incidence and aggravation and improving nutrition, at the local level. The WG analyzed acquired data and identified priority health issues and nutritional status as well as residents’ personal characteristics as evidence for planning a health and nutrition action plan within local governments.
Third, activities were undertaken to examine the competency of administrative dietitians (ADs) for promoting the activities. This took place in a training session held by the Public Health Division of the Japan Dietetic Association. ADs were grouped into three categories based on years of professional experience: management level (15 years), mid-level (5-10 years), and newcomers (3 years). We found that mid-level ADs needed better understanding of regional characteristics, documentation that uses data, and presentation skills. Ways to implement human resources development of ADs needed to be studied.
Through those challenges, we found that the National Institute of Public Health had a role of linking national and local governmental policies, and the function of linking professional organizations and public health in society to promote Health Japan 21 (2nd edition).
The importance of data application for the control measures against lifestyle-related diseases in Japan has increased. An effective utilization of data is required to develop, implement, and evaluate a plan in Health Japan 21 (2nd edition), specific health examination and health guidance, a data health plan, and so on. At the same time, various kinds of data have become available in relation to health examination and guidance, medical cost, care insurance, and so on. However, only a limited number of local governments and health insurers utilize the enormous quantity of data sufficiently. To improve the current situation, we developed "the Data Application Manual to Promote Control Measures against Lifestyle-related Diseases in Local Governments" and related training materials and tools to easily analyze data, and posted them on the National Institute of Public Health website. The data application manual explains the concrete process of collecting data, utilizing materials and tools, and interpreting the results for practical use rather than analytic theory. We hope the manual and tools are helpful for the promotion of measures against lifestyle-related diseases in the local governments and health insurers in Japan.
In many developed countries, along with the development of medical technologies, the increase in medical costs has now become a pressing social issue. Under such circumstances, cost-effectiveness analysis is increasingly being used in decision-making to allocate limited medical resources more efficiently. In many countries, there exist research institutes that specialize in health technology assessments (HTA), which include this kind of cost-effectiveness. Particularly in countries where costeffectiveness analysis is used in decision-making concerning pharmaceuticals and medical devices, such HTA agencies are involved in the decision-making process. It is necessary to put such a system in place in Japan as well. There are three main types of data used in cost-effectiveness analysis: (1) clinical efficacy and safety, and long-term prognosis and disease-state transition, (2) quality of life, and (3) cost.
Quality of life values and cost data are necessary for the purpose of conducting cost-effectiveness analysis, and it is desirable to use domestic data if possible. Costs are especially difficult to extrapolate from overseas data. Therefore, to implement cost-effectiveness analysis for use in decision-making, it is important to accumulate research that can be utilized.
Annual medical expenditure in Japan reached 40,000 billion yen in 2013 and have been increasing. One reason for the increase is population aging. However, another big reason would be technology advancement including new medical procedures and pharmaceuticals. Those new technologies contribute to peopleʼs health by prolonging life expectancy and improving quality of life, though it may require more expenditure. In some countries like England, coverage decisions and reimbursement pricing are made upon the cost effectiveness evaluation for procedures or pharmaceuticals under publicly funded health care system.
In Japan, a new subcommittee on cost effectiveness evaluation was established under the Central Social Insurance Medical Council in 2012. Many issues such as selection criteria of the target technologies, methods of evaluation, and use of evaluation results have been discussed in the subcommittee. Based on such a discussion, a pilot program of cost effectiveness evaluation of pharmaceuticals and medical devices started from April 2016. In the pilot program, some of the existing products, not new products, are selected for evaluation in order to avoid any delay for insurance coverage. The results of evaluation will be used to adjust reimbursement prices.
In the pilot program, manufacturers of the selected products submit primary analyses and data of cost effectiveness according to the analytical guideline. The analyses are reviewed, and re-analysed if necessary, by a public organization in collaboration with external specialists. Both analyses are reported to the Special Organization for Cost Effectiveness, a new organization for appraising the results. Finally the results will be used for adjustment of reimbursement prices in the next price revision. In the near future, medical procedures with advanced equipment will be also evaluated.
Cost effectiveness evaluation of new health technologies would be essential to keep balance between technology advancement and increasing medical expenditure, in order to sustain universal coverage health insurance system. It is important to evaluate those technologies based on appropriate methods and data.
With respect to cost-effectiveness evaluations of vaccination, a comprehensive review of the quality of analysis, in particularly, the handling of productivity losses, was conducted based on existing evaluation results of each country’s decision-making bodies and the WHO guidelines. The review revealed an extreme diversity of estimation methods as well as a slight discrepancy between the content described in the guidelines and the actual situation.
Instead of prescribing a single method for estimating productivity losses as a guideline when implementing studies on cost-effectiveness of vaccination for policy applications (examination of periodic vaccinations) in Japan, it is important to conduct further research to narrow down the options. In this regard, the following two points are indispensable: (1) specifying the method for estimating productivity losses (whether losses due to vaccinations, morbidity, and death, as well as employment rate considerations and non-absenteeism are included) and (2) presenting results when productivity losses are not included.
Objectives: A decrease in rubella antibody retention ratio has been observed among Japanese women of reproductive age. In 2004, the Ministry of Health, Labour and Welfare in Japan recommended postpartum vaccination to women with low titers noted on hemagglutination inhibition (HI) test results (≤16) to prevent congenital rubella syndrome in their next pregnancy, as a strategy for elimination of rubella. However, the status of recommendations and rates of rubella vaccinations during the postpartum period remain unclear. Thus, the aim of this review was to confirm postpartum rubella vaccination rates and to identify the factors related to postpartum rubella vaccination in Japan.
Methods: A database search (Ichu-shi, CiNii, MEDLINE, PubMed, and CINAHL) was conducted for relevant publications after 2004 in English and Japanese. Two individual reviewers screened the results： with inclusion and exclusion criteria, as well as with a risk of bias assessment tool.
Results: Eight articles were included in this review. The rates of pregnant women with low titer (HI≤16) were 14.0%─46.6%. Postpartum rubella vaccination rates among women with low titer (HI≤16) were 18.1%─98.7% in six articles that recommended rubella vaccination in the postpartum period. However, the rates were 8.0%─10.2% in two articles that did not recommend vaccinations. Postpartum rubella vaccination rates of 4 articles that recommended vaccination during postpartum hospitalization were 20.7%─68.1%, and those of 2 articles that recommended vaccination at one month postpartum were 18.1%─56.3%. These integrated data analyses showed that vaccination recommendation by medical facilities and recommendation during postpartum hospitalization significantly led to higher rubella vaccination rate. In addition, one article reported that public subsidy for the cost of rubella vaccination was useful to increase postpartum vaccination rates. Additional related factors of postpartum rubella vaccination were as follows： desire for further pregnancies, judgment of patients as unsuitable for vaccination owing to physical problems, and lack of confirmation of women with low HI titer by healthcare professionals.
Conclusion: Recommendation of rubella vaccination and the timing, and public subsidy for the cost of rubella vaccination were identified as factors related to postpartum rubella vaccination. Proactive approaches such as recommendation of rubella vaccination by medical facilities, recommendation during postpartum hospitalization, and provision of information on public subsidy for rubella vaccination should be considered for increasing postpartum rubella vaccination rates.
Objectives: Evidence-based or evidence-informed policy making is encouraged in health fields, but the use of research evidence is limited actually. Previous studies about barriers to and facilitators of the use of research evidence focused on the policy process, in which policy-makers utilized evidence that had already existed, not on the "research process", in which researchers were producing evidence. Therefore, the case study was conducted to describe the research process and to identify factors necessary to facilitate the use of evidence through the research process.
Methods: The case of this study was the research project which was titled "a study of the application of social capital in community health" and funded by Research on Health Security Control in Health and Labour Sciences Research Grants. This project was implemented in fiscal year 2013 and 2014, and the products of the project were disseminated to all the local governments with ministerial announcements and were published on the home page of Ministry of Health, Labour and Welfare. Using minutes of meetings related to this project, data about events that happened in the research process and actions of those concerned with the project, who included principal investigators, government officials, and a program officer, were collected. And then, factors facilitating the use of products of the project were identified.
Results: The following factors were identified : (1) since goals and products of the research project were clearly specified, principal investigators, government officials, and reviewers were able to play their own roles on the basis of the concensus on them; (2) the program officer played the role of a knowledge broker, who built a relationship of trust between researchers and government officials indirectly by getting trust of each and who communicated the concensus of researchers to government officials continuously and efficiently; (3) a network of principal investigators, like an epistemic community, was established through meetings, conferences, and the symposium jointly held by them; (4) a ministerial announcement was able to be utilized as the method to disseminate the products, which was derived from the knowledge for the administrative management that researchers did not have.
Conclusions: It is suggested that four factors described above may be facilitators of the use of research evidence not only in the policy process but also in the research process. This study is a case study, therefore it is necessary to collect and analyses the other cases and to conduct the further resaerch.
In this study, the characteristics of medical device review and approval system of Republic of Korea, the U.S., and Japan were analyzed by researching on the related statistical data. Followings are the research areas: (1) medical device classification system, (2) the number of product codes for each device class, (3) approval or notification process for each device class, (4) the number of approvals, (5) the average number of review cycles after acceptance of submission for review, approval or clinical trials, (6) third party review program (The Accredited Persons Program), (7) mandatory list of medical devices required clinical trial, (8) the time period of review and approval process. From the analysis of those areas, the common things and differences of medical device review and approval system of Republic of Korea, the U.S., and Japan were found.
Background: Seven years have passed since the implementation of the Specific Health Checkups and Specific Health Guidance scheme in Japan, and now it is possible to investigate long-term factors relating to medical expenditures at a local level by comparing data from Specific Health Checkups with health insurance claims. The aim of this study is to investigate long-term relationships between outpatient medical expenditures and questionnaire responses concerning lifestyle that form part of the Specific Health Checkups scheme, accumulated during a 5 year period. Methods: A cumulative total of 43,740 recipients of Specific Health Checkups (representing 14,848 unique individuals) collected between 2008 and 2012, in Mishima City in Shizuoka Prefecture, Japan were included in this study. The average age was 65.3±7.8 of which 60% were female. Questionnaire responses concerning lifestyle forming part of the Specific Health Checkups scheme, along with health insurance claims data accumulated over 5 years were used. Long-term relationships between outpatient medical expenditures and patient’s lifestyle were analyzed using panel data analysis. Results: Medication of low blood pressure, blood glucose or cholesterol levels, a history of stroke or heart disease along with weight change (gain or loss of ≥3kg) exhibit a relationship with increases in outpatient medical expenditures. Lifestyle factors such as physical activities, fast walking and good sleep patterns each displayed relationships with reductions in outpatient medical expenditures. Further, Health Guidance is also seen to have an association with lowering outpatient medical expenditures in the same year that the guidance was given, as well as the following year.Background: Seven years have passed since the implementation of the Specific Health Checkups and Specific Health Guidance scheme in Japan, and now it is possible to investigate long-term factors relating to medical expenditures at a local level by comparing data from Specific Health Checkups with health insurance claims. The aim of this study is to investigate long-term relationships between outpatient medical expenditures and questionnaire responses concerning lifestyle that form part of the Specific Health Checkups scheme, accumulated during a 5 year period. Methods: A cumulative total of 43,740 recipients of Specific Health Checkups (representing 14,848 unique individuals) collected between 2008 and 2012, in Mishima City in Shizuoka Prefecture, Japan were included in this study. The average age was 65.3±7.8 of which 60% were female. Questionnaire responses concerning lifestyle forming part of the Specific Health Checkups scheme, along with health insurance claims data accumulated over 5 years were used. Long-term relationships between outpatient medical expenditures and patient’s lifestyle were analyzed using panel data analysis. Results: Medication of low blood pressure, blood glucose or cholesterol levels, a history of stroke or heart disease along with weight change (gain or loss of ≥3kg) exhibit a relationship with increases in outpatient medical expenditures. Lifestyle factors such as physical activities, fast walking and good sleep patterns each displayed relationships with reductions in outpatient medical expenditures. Further, Health Guidance is also seen to have an association with lowering outpatient medical expenditures in the same year that the guidance was given, as well as the following year. Conclusions: Low-cost and easily executable questionnaires as part of the Specific Health Checkups scheme enable not only risk assessments of lifestyle-disease of the targeted individuals but also the prediction of long-term trends in outpatient medical expenditures. Physical activities, fast walking, good sleep patterns and Health Guidance have an association with lowering medical expenditures.