In anticipation of 2025, when the baby boomer generation will reach the age of 75 or older, efforts have been made to build the community-based integrated care system. After 2025, the number of working people will decrease and it will be difficult to secure medical and nursing care professionals, while the number of people aged 85 years and older will increase. Furthermore, these demographic trends and regional resources differ by region.

The lives of elderly people in the community are enriched not only through their relationships with medical and nursing care professionals, but also with local residents and industry. Society is being shaped as well. Within these community connections, we encourage the independent activities of local residents and the involvement of diverse local actors. While medical and nursing care professionals are involved, elderly people themselves can choose appropriate activities. The elderly can connect with the local community and medical/nursing care professionals while they are still healthy, and continue social activities based on these connections; even when nursing care becomes necessary, each resident can be themselves while receiving the necessary support. There is a need to aim for the realization of a “community coexistence society” where people can continue to live.

The care prevention and daily life support project that took its current form due to the revision of the long-term care insurance system in 2014 is positioned as the basis for community development; municipalities, which are insurers, play a central role, and medical and nursing care professionals become more specialized. There is a need to design and enrich the region from the perspective of combining the strengths of the region, including the elderly and diverse actors, while demonstrating the power of the community.

A community-based integrated care plan (long-term care insurance plan), formulated by each insurer every three years, serves as the basis for insurers to construct community-based integrated care systems tailored to local circumstances. However, plans by many local governments simply list individual projects in accordance with the guidelines of the Ministry of Health, Labour and Welfare, and the descriptions of the ultimate goals and how each project works together to achieve the goals are also abstract. In reality, we have not been able to adequately explain how we are moving toward this goal.

This paper summarizes the methods and issues that insurers should face in steadily promoting the construction of community-based integrated care systems while improving their insurance functions in the future, based on the concept of “community design.”

Community design is a method of designing a combination of initiatives that are necessary at the current stage using the backcasting method while setting a long-term image of what the community will achieve.

The goal images that insurers aim for are defined as “continuing to live in the familiar area” and “independent daily life/living one's own way,” and the prerequisites for achieving this are intermittent changes in the recipient's living environment. A situation in which a person's behavior is affected is classified as a situation in which deterrence is required. This is seen as a shift from “a system that matches people to care” to “a system that matches care to people.” It also introduces several survey and analysis tools such as the “Home Care Improvement Survey” that are used to quantify the evaluation of system changes.

In addition, community support programs implemented to achieve the goals of the community-based integrated care system can be categorized into two types: “multidisciplinary collaboration/medical and nursing care collaboration” and “community development” and the principles of each approach are different. These are explained with reference to the “flowerpot of community-based integrated care.” Finally, the conditions necessary for insurers to exercise their community design functions and future challenges are discussed.

Since the FY 2006 revision of the long-term care insurance system, this system has been promoted in Japan. Initiatives toward this system can be explained in the context of integrated care, which is now being pursued internationally, including in developed countries where societies are aging. Japan’s approach is unique; however, municipalities, which are the insurers of the long-term care insurance system, are positioned as the main actors in building this system.

From the perspective of correcting regional differences in long-term care insurance management, ensuring the sustainability of the system, and strengthening the prefectural governance of the system, a grant system for promoting the strengthening of insurer functions was established in FY 2018. Under this system, the functions of insurers by municipalities and support to insurers by prefectures are evaluated, and grants are provided according to the results of these evaluations. This system encompasses a mechanism expected to lead to a cycle in which the insurer functions of all municipalities are evaluated annually with uniform nationwide standards, and the functions are strengthened based on the results of this evaluation. In addition, the system is multi-layered, and the same cycle is expected for support by prefectures to municipalities.

Since FY 2009, the authors have conducted research on the evaluation and utilization measures of insurer functions, and the results have served as the basis for the evaluation methods used in the Grant System for the Promotion of Strengthening Insurer Functions. Therefore, we first explain the concept of the insurer function in municipalities. Second, we present an overview of research studies on the evaluation of the insurer function prior to the start of the system and clarify the evaluation approach obtained from the research results. Third, the progress of the review of evaluation items after the start of the system will be presented, and the current status of issues and responses after the system is operationalized will be explained. Finally, based on the above, the significance of the utilization of insurer function evaluation and its future perspectives will be discussed.

Objective: Municipalities must possess community management capabilities. Community management is the function of understanding the actual conditions of the community, analyzing issues, and working together with various stakeholders in the community to address these issues.

This paper introduces the concept of community management required of municipalities and the role that prefectures should play, based on the results of the author’s research and other studies.

Concept of Community Management: Community management is the process of building a Community-Based Integrated Care System, as described by the Ministry of Health, Labour and Welfare (MHLW). It is also a means of realizing the philosophy of the Long-Term Care Insurance System through cooperation and collaboration with diverse entities in the community. In order for municipal officials to work with different stakeholders to create a community that supports older people, they need to have ‘Awareness to think about issues and try to solve them,’ ‘Reviewing initiatives from the perspective of supporting livelihoods’ and ‘Ability to identify regional issues that really need to be solved.’

Key Points for Improving Community Management Capabilities in Municipalities: We have identified the key points of community management that municipal officials should consider. First, it is important to imagine the state a region aims to achieve. Community management is a means to an end, so , it is important to imagine the desired state that one wants to achieve through community management. Second, it is important to understand the current situation in a region with respect to the desired state. There are three perspectives for understanding the current situation: the difficulties faced by the elderly living in the area, the actual state of local support, and the strength of the local community. Third, it is important to identify regional issues. The issues are organized as things that need to be addressed to fill the gap between the aspired image and the current situation.

What is required of prefectures?: Prefectures are expected to support municipalities based on their actual situation. The situation, history, and local resources of the initiatives vary from region to region. Therefore, uniform support does not work when the prefectures support the municipalities. Therefore, we have organized a process for prefectures to understand the actual situation of municipalities and develop support.

Social marketing, originally designed to address social issues, has found significant application in the field of public health. The effectiveness of this approach has been increasingly supported by evidence accumulated over time.

Social marketing operates within a structured framework comprising the following key stages: “preliminary research,” “strategy,” “program development,” “implementation,” and “evaluation”. In the preliminary research phase, a SWOT analysis was utilized to assess the current situation. This involves an examination of both internal “Strengths” and “Weaknesses” within the organization, as well as external “Opportunities” and “Threats.”

Subsequently, the entire population is segmented into multiple subgroups, with priority groups identified using methodologies such as the TARPARE model. Members of these prioritized groups are interviewed to explore their perspectives, values, and to identify potential benefits or barriers to behavior change (potentially facilitating a “value exchange”). Any conflicts (“competition”) with recommended behaviors are also pinpointed through these interviews. The insights gathered from the target audience guide the formulation of intervention strategies by integrating the 4Ps into the marketing mix: Product, Place, Price, and Promotion. These strategies are then put into action according to the established plan. After the intervention phase, an evaluation was conducted to determine the actual degree of behavioral change.

This paper provides an overview of social marketing and its associated processes. The subsequent discussion illustrates the incorporation of social marketing into preventive measures for long-term care at the municipal level using a hypothetical case study as an example. This study highlights how social marketing can strengthen long-term care insurers' function, offering a comprehensive understanding of its potential applications in the field.

Municipalities, which are the insurers of long-term care insurance, are expected to manage long-term care insurance systems using a data-based PDCA cycle. There is also a data environment in place that municipalities can utilize, one of which is “Hokenja-sheet” which collects basic data related to long-term care insurance. However, an analysis of the status of setting indicators for long-term outcomes in the 8th Long-Term Care Insurance Plan revealed that many municipalities face difficulties in managing the PDCA cycle and utilizing data. Logic models make it possible to visualize the relationship between the outcome and the program, clarifying indicators, and making it possible to analyze programs for improvement. Therefore, we have developed a logic model for the field of long-term care insurance and community comprehensive care systems, and have developed measures for effective utilization of “Hokenja-sheet.”

The logic model was developed through discussions with academic experts and local government officials, with reference to related laws, regulations, and official documents regarding long-term care insurance, comprehensive community care systems, and so on. The final outcome was one item related to the quality of life of the elderly, and the intermediate outcomes included three items: continuation of living at home, preventive care/social participation, and sustainability of long-term care insurance. Direct outcomes included 14 items related to service systems and support as well as long-term care insurance programs and costs. While the final and intermediate outcomes were highly versatile, it was considered desirable for the other outcomes to be set according to region and era.

We developed an evaluation tool that enables regional assessment by setting indicators from the “Hokenja-sheet” in the long-term care insurance basic logic model and displaying the data on the logic model. The data were formatted to allow for comparisons by country, prefecture, city, town, village, and time series. A training program has also been developed and tested.

We demonstrate a general-purpose logic model in the field of long-term care insurance. Together with the “Hokenja-sheet”, it is expected that the tools will be used to help administrative staff learn the basics of management using the PDCA cycle. It is expected that the effectiveness of using logic models will be verified and more effective tools and training programs will be developed.

To establish a community-based integrated care system, municipalities must function as insurers and build a system that considers the community’s actual conditions. To achieve this goal, prefectures must provide appropriate support to municipalities.

The National Institute of Public Health has been planning and operating a training program for prefectural officers since FY2017 to strengthen insurer functions in long-term care insurance and has expanded the scope of attendance to designated city officers since 2018 and to core city officers since the FY2010 training program. The program for this training is based on the content presented in the survey and research project conducted in FY2016; however, it is planned based on the training needs of the prefectures and municipalities that are the target participants, which are identified through hearings and other means.

In this report, we review the results and changes in the content of the training program to date, the training needs of the prefectures and municipalities identified for planning the training program, and the systems and approaches required by local government officers to promote the strengthening of the insurer’s function in long-term care insurance.

The results suggest the need for an intra-agency coordination system between departments in charge of community support projects and departments in charge of long-term care insurance business planning, as well as an extra-agency coordination system between municipalities, prefectures, and other related organizations. In addition, it was confirmed that, although municipalities had been developing projects by building face-to-face relationships and collecting qualitative information through visits and hearings to strengthen insurer functions, they were required to evaluate projects and set priorities based on data to implement projects effectively and efficiently.

To promote the strengthening of insurer functions in the future, as stipulated in the guidelines of the 9th Long-Term Care Insurance Business Plan, local government officers are expected to promote the PDCA cycle by linking various data and measures using logical models and considering more effective community support measures based on the results of these efforts. The results of this study indicate that local government officers should consider more effective local support strategies.

The enactment of Act on Anonymized Medical Data That Are Meant to Contribute to Research and Development in the Medical Field (the Next Generation Medical Infrastructure Law) has initiated of operations of the certified anonymized medical data-producing agents. However, the awareness of these agents and the significance and potential benefits of using anonymized medical information remain limited, possibly hindering the utilization of using agents. This study aimed to understand the current awareness pertaining the Act the agents, and to subsequently identify key areas for future awareness campaigns and recommendations for the policy. We conducted the web-based survey targeting potential users, including academic stakeholders and local government. The results revealed that the overall awareness of the Act and the agents was low. To improve awareness and promote the utilization of accredited entities, support for both the users and the agents is imperative.

Objectives: We conducted a descriptive survey using claim data from the National Health Insurance and the Late-Stage Senior Citizen's Health Care System of three municipalities where permission for use was obtained to understand the background and characteristics of patients prescribed PCSK9 inhibitors for hypercholesterolemia. Patients prescribed statin maximum tolerated dose and ezetimibe combination, the phase before PCSK9 inhibitor initiation on the guidelines were also extracted as reference.

Methods: Based on the claim data from April 2015 to March 2021, we defined the “PCSK9 group” as patients who were not prescribed a PCSK9 inhibitor from April 2016 to March 2017 and were first prescribed a PCSK9 inhibitor between April 2017 and March 2020. Ezetimibe with maximum-tolerated dose statin was also selected by the same procedure and defined as the “ezetimibe maximum-tolerated statin group”. We also compared the two groups in terms of lifestyle-related medications, cardiovascular events, and coronary catheter intervention (PCI) procedures observed in the 12 months before (pre-index) and 12 months after (post-index) the start date.

Results: There were 184 subjects in the PCSK9 group (mean age 74 years, 57.1% male) and 1,307 subjects in the ezetimibe maximum-tolerated statin group (mean age 71 years, 60.5% male). A comparison of the changes in medical care and treatment status before and after the index date (pre-/post-index period) showed no significant difference in the pre-index period but a higher rate of ischemic heart disease in the PCSK9 group in the post-index period (85.3% vs 76.1%, p=0.005). For PCI, the PCSK9 group had a significantly higher proportion of patients who underwent surgery than the ezetimibe maximum-tolerated statin group in both the pre-/post-index periods (pre-index period: 40.8% vs 24.0%, p<0.001; post-index period: 13.6% vs 8.1%, p=0.014), (post-index period: 13.6% vs 8.1%, p=0.014). Prescription discontinuation was observed in 44.6% of patients in the PCSK9 group but not in the ezetimibe maximum-tolerated statin group.

Conclusion: Analysis of the claim data showed that PCSK9 inhibitors were used in higher-risk patients than ezetimibe with maximum-tolerated dose statin. The rate of discontinuation of PCSK9 inhibitors was high (approximately 45%). Although a causal relationship cannot be established, it is suggested that patients may have been burdened financially by PCSK9 inhibitor therapy and providers to hesitate in using the expensive drugs for prophylactic purposes. High-cost medications for treating high cholesterol are expected to be launched shortly. Further studies to identify cost-effective patients and more appropriate drug prices are expected.

After the formulation of “Japan's Strategy on Global Health Diplomacy” in 2013, the global health field was positioned as an important diplomatic issue for Japan. This paper provides an overview of the trends in global health diplomacy over the past 10 years, describes specific examples of public-private partnerships in Japan, the roles of major actors in global health diplomacy, and discusses challenges for public-private partnerships in Japan's global health diplomacy.

The Japanese government is making efforts to activate public-private partnerships in global health, with companies playing a more active role in achieving the Sustainable Development Goals (SDGs). However, few Japanese companies effectively utilize public-private partnerships and integrate them into their corporate value within the global health sector. The government of Japan needs to develop individuals who are familiar with global health diplomacy and can support the appropriate connection between international organizations and companies. Simultaneously, it is essential for companies to train personnel capable of negotiating with international organizations in the field of global health. Understanding global health diplomacy is a particularly crucial element in promoting private company investments in the global health field, as exemplified by the “Impact Investment Initiative for Global Health: Triple I for Global Health” adopted at the Hiroshima Summit in 2023.

Furthermore, as global health diplomacy trends become increasingly complex, the Japanese government needs to carefully consider which international organizations to leverage its limited official development assistance more effectively and how to demonstrate Japan's presence in the global health arena. By proactively disseminating Japan's contributions and direction in global health diplomacy and engaging a wider participant, Japan can effectively collaborate with various stakeholders in the global health sector.