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Laying tracks for better health in Japan

Posted Jan 14 2009 8:13pm

IMG_0627 This week I’m reporting from Tokyo and Yokohama.  It is the second time in as many years that I’ve been invited to speak at an industry event here in Japan.  Yesterday afternoon, it was my honor to provide a keynote for the 28th Joint Conference on Medical Informatics being held at the convention center in Yokohama adjacent to the InterContinental Grand Hotel.

On my last journey to Japan and again this time, I’ve been particularly impressed by two things.  First, for a country with such densely populated urban centers Japan is spotlessly clean.  Wandering around downtown Tokyo you rarely see even a gum wrapper.  It’s like Disneyland only cleaner.  Contrast that with most American cities.  Second, the public transportation is fast, efficient and always on time.  You can set your watch by it.  So, it is surprising to note that in a country lauded for lean manufacturing and the “Toyota method” of continuous quality improvement, that healthcare and particularly the implementation of e-Health, lags behind many other developed nations.  Japan has too many IMG_0628 hospital beds, and their lengths of stay are notoriously long; often twice that of American hospital stays.  Also according to my hosts here, the Japanese are frequent fliers when it comes to utilization.  Dialing 119 (911) to summon an ambulance for the most minor of complaints is almost a sport.  Hospital based physicians are so overworked they are bailing right and left for outpatient practices leaving higher-paying hospital posts with vacancy signs.  Making things even worse, say the locals, is an overall shortage of medical professionals in the face of a growing population of the elderly and more people with chronic diseases including obesity.

Fall Colors Palace Park To help combat these trends, the Japanese government has launched a campaign that stresses more personal responsibility in maintaining good health.  It also asks employers to take a stance.  For instance, employers must now measure the waistline of each employee and report results to the central health authority.  They must also provide obesity management programs for overweight employees and will be fined if offenders don’t “measure down” appropriately.  Somehow I don’t think this program would fly in America.

The Japanese are also very interested in the idea of promoting personal health records.  Every government official and healthcare executive I meet wants to talk about HealthVault and Google Health.  “When will we have something like HealthVault in Japan?”, they ask.  They seem to agree that aggregating health data around consumers is a good idea and they are making plans to provide every citizen with a PHR. Tracks2

I was also surprised to learn that home health isn’t popular in Japan, even  though it would make perfect sense to move in that direction.  My hosts were really keen to learn what other countries are doing and how home tele-health monitoring is being deployed to manage patients with chronic disease and assist the elderly.

Clearly the Japanese are placing some big bets and laying down tracks for a new approach to healthcare.  If they do it as well as they keep their cities clean and their trains running on time, it should be something worth watching.

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation  

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