The document summarizes the 2013 ACCJ-EBC Health Policy White Paper. It begins with introductions from the ACCJ and EBC presidents. It then discusses key topics covered in the white paper such as non-communicable diseases, women's health, infectious diseases, healthcare safety, and more. Survey results are presented showing public support for initiatives like infection control programs, electronic health records, and smoking bans. The white paper contained 156 policy recommendations across 36 topics to promote health and economic growth in Japan.
3. About American Chamber of Commerce in
Japan
Established
1948
Committee structure drives Chamber
activities around three pillars:
• Information
• Networking
• Advocacy
Approximately
2700 members
representing
1000 companies
Over 500 events
per year in three
chapters across
Japan
Approximately
half of members
are Japanese
4. Achieving Growth Together
Japan Economic
Growth
ACCJ Membership
Growth
ACCJ Member
Personal Growth
ACCJ’s Three Primary Areas for Growth
成 長 共 就
5. Preventive Health Investment Drives Growth
Japan’s aging is rapidly increasing healthcare utilization
Worker productivity is key to sustain healthcare and grow
the economy
• Disease costs Japanese economy 3.3 trillion yen per year in lost
productivity (2011 ACCJ National Survey)
A shift to prevention and early detection is necessary to:
Increase healthy life years
Lower economic burden of disease
Support economic growth
6. • Gaps between average life expectancy and healthy life expectancy
represent an unhealthy period with daily life constraints
• There may be medical and nursing expenses during this period
70.42
79.64
60
73.62
86.39
65 70 75 80 85 90
Year
9.22 years
12.77 years
Average life expectancy Healthy life expectancy (No daily life constraints)
Gap between average and healthy life expectancy
Male
Female
Source: Healthy Japan 21 (Second Version)
Importance of Healthier Life Expectancy
7. ACCJ-EBC Health Policy White Paper 2013
Promoting economic growth in Japan
through policies to lengthen healthy
lifespans and
reduce economic burden of preventable,
detectable and treatable diseases
36 healthcare topics
Over 150 policy
recommendations
9. About European Business Council in Japan
Trade policy arm
of 17 European
National
Chambers of
Commerce and
Business
Associations in
Japan
Working to improve the trade and
investment environment for European
companies in Japan since
1972
Approximately 3000 local European
corporate and individual members
Approximately
400 companies
participating
directly
10. Rise in Non-Communicable Diseases Is a
Leading Threat to Global Economic Growth
WHO report: each 10% rise in non-
communicable diseases is linked to a
0.5% dip in annual economic growth;
recent global rise in NCDs is
“economically unsustainable.”
The World Economic Forum forecasts
that NCDs will cost the global economy
$47 trillion over the next 20 years.
• Stuckler D. “Population causes & consequences of leading chronic diseases: a comparative analysis of prevailing explanations.”
Milbank Quarterly, 2008, 86:273–326. Reported in Global Status Report on Noncommunicable Diseases 2010,” WHO,
http://www.who.int/nmh/publications/ncd_report2010/en/
• Working Towards Wellness: The Business Rationale. World Economic Forum, Geneva, 2008. Bloom, et al., 2011.
11. NCDs account for about 30% of national healthcare expenditure and
about 60% of total deaths
Healthcare Expenditure
Cancers 11.1%
Hypertension-related
diseases 7.1%
Cerebral vascular
diseases 6.3%
Diabetes 4.4%
Cardiovascular
diseases 2.9%
Others
68.3%
Cancers
29.5%
Cardiovascular
diseases 15.8%
Cerebral vascular
diseases 10.3%
Diabetes 1.2%
Hypertension-related
diseases 0.6%
Others
42.6%
Mortality
Source: Healthy Japan 21 (Part 2)
Non-Communicable Diseases in Japan are
Costly, Deadly and Often Preventable
12. “Every 1 year increase in life
expectancy is linked to a 4.3%
increase in global GDP.”
Sources: Stuckler D. “Population causes & consequences of leading chronic diseases: a comparative analysis of prevailing explanations.”
Milbank Quarterly, 2008, 86:273–326. Reported in Global Status Report on Noncommunicable Diseases 2010, WHO,
http://www.who.int/nmh/publications/ncd_report2010/en/.
Spending to Promote Health is a Very Good
Economic Investment
15. 2011 Health Policy White Paper
2011
Scope:
• 27 Topic Sections
• 124 Recommendations
Results:
• 46 of 124 recommendations (roughly 37%)
fulfilled “in part" or in whole
Areas of Progress:
• Continued government funding of national
cancer screening
• Substantial increased funding to enhance
infection prevention and control at hospitals
in Japan (four fold for hospitals with >300
beds).
• Expanded use of IVD Rapid Diagnostics
• Diabetes Management
• Osteoporosis Prevention
• Chronic Pain Research Funding
• Vaccination Policy
• Hepatitis Screening & Awareness Initiatives
16. Source: Inhibitex
Nearly 6 million HAIs
annually in U.S., Europe and
Japan
1.7 million cases and 99,000
deaths annually in the U.S.
In some developing countries,
more than 25% of patients
admitted to hospitals acquire
HAIs
Hundreds of millions of
patients impacted worldwide
each year
Healthcare Associated Infections (HAIs):
A Global Healthcare Issue
Millions of Infections
8
6
4
2
0
2002 2005 2009 2010 2015
5.6 5.9
6.3 6.4
6.9
Japan
Europe
U.S.
17. Q. How important do you think it is for the government to have a national
program to reduce the risk of infections associated with hospitals, clinics
or other healthcare facilities?
75.7% of General Public in Japan Think it is
Important to Have a National Program to Reduce
the Risk of HAIs (80% for population over 65)
■ Important ■ Slightly important ■ Neither nor ■ Do not know ■ Not very important ■ Not important
52.4
48.9
48.5
43.0
37.3
31.4
29.4
40.8
40.2
40.5
27.4
30.6
32.9
36.2
36.4
39.2
38.1
35.9
34.4
35.2
7.7
12.9
11.2
12.1
15.9
17.6
18.6
14.4
14.2
14.3
10.6
5.6
5.6
5.9
7.4
7.9
7.4
6.3
7.2
6.8
1.9
1.4
1.2
2.1
1.8
2.5
6.6
2.0
2.2
2.1
0% 20% 40% 60% 80% 100%
80+ yrs old (n=208)
70-79 yrs old (n=790)
60-69 yrs old (n=882)
50-59 yrs old (n=779)
40-49 yrs old (n=800)
30-39 yrs old (n=863)
20-29 yrs old (n=678)
Female (n=2599)
Male (n=2401)
Overall (n=5000)
Is Important
75.7%
74.6%
76.6%
67.4%
70.6%
73.6%
79.2%
81.4%
79.5%
79.8%
Not Important
3.3%
3.9%
2.6%
6.6%
3.9%
3.2%
2.9%
1.8%
2.0%
1.9%
Survey on Prevention, Early Detection and the Economic Burden of Disease in Japan (2011) by The American Chamber of Commerce in
Japan. Internet survey conducted October 31 – November 2, 2011. 5,000 respondents from Rakuten Research’s registry that represent
the Japanese population.
18. 2013
2013 ACCJ-EBC Health Policy White Paper
Scope:
• 36 Topic Sections
• 156 Recommendations
Chapters:
1. General Health Themes
2. Non-communicable Disease
(NCD) Topics
3. Women’s Health Topics
4. Key Infectious Disease Topics
5. Importance of Enhanced Safety
& Infection Control
6. Special Focus Needed on
Healthcare Worker Safety
20. Deaths Caused by and Patients of
Cerebrovascular Diseases
100
125
150
175
200
0
250
500
750
1,000
1,250
1,500
1,750
2,000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
# of death
(1,000 ppl)
# of Patients
(1,000 ppl)
# of
Patients
# of
Death
Source: Ministry of Health, Labor, and Welfare (Trend of Medical Institution)
25. 71.5% of Japanese Back Introduction of Electronic
Health Records at Hospitals, Clinics
Support/Agree Slightly Support/Agree Neither
Don’t know Slightly Oppose/Disagree Oppose/Disagree
50.0
48.2
52.4
42.2
40.3
35.9
36.1
37.9
48.7
43.1
23.6
28.0
24.3
28.4
28.3
33.4
29.8
31.6
25.0
28.4
14.4
16.1
17.1
22.2
22.8
20.4
20.8
21.8
17.2
19.6
10.1
5.1
4.4
5.4
5.9
6.6
8.3
5.9
6.2
6.0
0.5
1.9
1.5
1.2
2.3
2.5
2.9
2.2
1.7
2.0
0% 20% 40% 60% 80% 100%
80+ yrs old (n=208)
70-79 yrs old (n=790)
60-69 yrs old (n=882)
50-59 yrs old (n=779)
40-49 yrs old (n=800)
30-39 yrs old (n=863)
20-29 yrs old (n=678)
Female (n=2599)
Male (n=2401)
Overall (n=5000) 71.5%
73.7%
69.4%
65.9%
69.3%
68.5%
70.6%
76.6%
76.2%
73.6%
Support Oppose
2.9%
2.9%
2.9%
5.0%
3.7%
2.9%
1.8%
1.8%
2.7%
1.9%
Q: Do you support or oppose the introduction of electronic health records at
hospitals and clinics in Japan?
Source: ACCJ National Survey on Prevention, Early Detection & the Burden of Disease in Japan, Nov, 2011.
26. Supporters of EHR System Expect
More Efficiency, Safer Medical Service
(n=3,574)
Q: Why do you support the introduction of an electronic health record (EHR) system
at hospitals and clinics in Japan? (multiple answers)
Source: ACCJ National Survey on Prevention, Early Detection & the Burden of Disease in Japan, Nov. 2011.
27. 24.3%
70% 75%
Breast Cancer Screening Rates Lower Than
OECD Average
Sources:
http://www.mhlw.go.jp/stf/houdou/2r9852000001igt0.html, http://www.oecdto
Mammography
screening rates
in Japan rising,
but still low
62.2%
Free National Breast Cancer Screening
Launched in 2009
Scope: Women aged 40, 45, 50, 55, and 60
Funding: 100% by central government
Japan Goal: 50% screening rate by 2011
Recruitment: Send coupons to eligible women
28. Has a 28% survival
rate over five years
Costs up to ¥4
million to treat
Has 96% survival
rate over five
years
Costs about
¥760,000 to treat
Breast cancer diagnosed
in early stages
Breast cancer diagnosed
after it has metastasized
Breast Cancer Screening:
Cost Effective and Saves Lives
Sense no need, as have no
lump
Lack of opportunity
High fees
Top three reasons
women do not have
a mammogram
30. Two Thirds Support a Mandated Indoor
Worksite Smoking Ban
Question: What would you think if the national or local governments legally required
a complete smoking ban in all indoor workplaces and public spaces, including
restaurants, bars and taxis, to protect the health of non-smoking workers?
Source: Japan national survey on passive smoking in the workplace for 8,000 indoor workers by Johnson &
Johnson K.K. Consumer Company, released on July 19th, 2012
31. 70% of Indoor Workers: Legal Smoking Ban
Would Not Negatively Impact Business
Question: How would your business be impacted if national or local governments
legally required a total smoking ban in all indoor workplaces and public
spaces, including restaurants, bars and taxis, to protect the health of non-smoking
workers?
Source: Japan national survey on passive smoking in the workplace of 8,000 indoor workers by Johnson & Johnson K.K. Consumer Company, July 2012
32. 322011 MHLW’ National Survey on Getting-tested status of Hepatitis Screening (Interviewed 74,000 Japanese people aged 20 thru 79 years old)
Only Half of Adults in Japan Have Been
Screened for Hepatitis
Japanese government has provided free hepatitis screening since 2002 as the
time of regular health checkup services by municipal governments. Free
screening was first provided at public health centers and later also available at
hospitals and clinics.
Need to further increase screening rate, especially for people aged 40 and over.
HCV Screening Rate: Est. 48%HCB Screening Rate: Est. 57%
Tested at time
of
surgery, pregn
ancy, blood
donation 40%
No, I have
not or do
not know
42%
Yes, I have
been tested
(self-
reported)
18%
Yes, I have
been tested
(self-
reported)
18%
No, I have
not or do
not know
52%
Tested at time
of
surgery, pregn
ancy, blood
donation 30%
33. Large Company
Employers
Small and Medium
Company Employers
Self-Employed and
Others
Type of health
insurance in which
employee enrolls
Managed by health
insurance societies or
associations
Managed by members
of Japan Health
Insurance Association
Managed by
municipalities, National
Health Insurance
associations
Provision of health
checkups based on
Industrial Safety &
Health Act
Yes, required
(Employers are required to provide)
Not required
Provision of special
health checkups based
on Law for the Welfare
of the Elderly (aged 40
or over)
Yes, provision is required
(Insurance provider is required to provide)
Rate at which hepatitis
screening is part of
special health checkup
Approx. 50% Approx. 95%
Individuals must pay ¥595
as co-payment and apply
separately for this optional
hepatitis virus testing.
Approx. 80%
Free but implementation
varies by town, city.
Screening notices usually
go to specific age groups.
Source: MHLW, “Status of implementation of Specific Medical Checkups/Health Guidance in FY2010”
http://www.mhlw.go.jp/bunya/shakaihosho/iryouseido01/info03_h22.html
Provision of Hepatitis Screening Varies
Widely According to Type of Insurer
34. 2013 ACCJ-EBC Health Policy White Paper
• Paradigm shift from treatment to prevention
Focusing on prevention, screening, early detection and early treatment of
disease
• Efficient allocation of healthcare resources
Enhancing productivity and reducing waste
• Evidence-based global best practices
Recommendations with potential to yield significant positive impact
• Alignment with government growth policy goals
Recommendations with potential to boost economic growth
Disease prevention • Cost effective interventions
• Better patient outcomes and quality of life •
Enhanced labor productivity
35. Presenting the ACCJ-EBC
Health Policy White Paper 2013
May 31, 2013
Lengthening Healthy Lifespans
to Boost Economic Growth
Notes de l'éditeur
Established in 1948Approximately 2700 members representing 1000 companiesOver 500 events per year in three chapters across Japan:Tokyo, Chubu (Nagoya), Kansai (Osaka)Approximately half of the members are JapaneseCommittee structure drives Chamber activities around three pillarsInformationNetworkingAdvocacy
In 2013, ACCJ is addressing three primary areas for growth:Japan’s economic growthACCJ membership growthACCJ member personal growth
Japan is an aging society with a declining population.High productivity level of the labor force is a primary source of Japan’s international competitiveness and economic growth.ACCJ’s 2011 national survey shows that disease costs Japanese economy 3.3 trillion yen per year in lost productivity, and higher level of absenteeism and disability. This figure does not include economic loss due to medical expenditure.Investment in health now focuses on lowering the economic burden and supporting economic growth, by reducing the burden of preventable, detectable and treatable disease through prevention, screening, early detection and the early treatment of disease.Such investment will improve patient outcomes, improve quality of life, increase worker productivity and ultimately support economic growth.
There is a significantgap between Japan’s average life expectancy and its healthy life expectancy.People are living longer but many of those life years are spent ill or in need of treatment or care.It is critical to raise the healthy life expectancy to the level of average life expectancy, because:It enhances people’s livesIt increases labor productivity It shifts healthcare expenditure from treatment to prevention, which is an investment in growth
ACCJ and EBC are pleased to offer this white paper in an effort to support economic growth in Japan through policies that lengthen healthy lifespans and reduce the economic burden of preventable, detectable and treatable diseases.Recommendations are aimed at putting a greater emphasis on prevention and early detection and are based on global evidence and best practices.The ACCJ and EBC agreed to work together to issue our first joint Health Policy White Paper, to enhance the scope and quality of our recommendations and to align our recommendations with current government growth policy goalsWe believe the 2013 ACCJ-EBC Health Policy White Paper represents our most comprehensive set of healthcare policy recommendations to date.Now I will turn to Duco Delgorge, our valued partner in this very exciting endeavor.
The European Business Council in Japan (EBC) is the trade policy arm of 17 European National Chambers of Commerce and Business Associations in Japan and has been working to improve the trade and investment environment for European companies in Japan since 1972. The EBC currently works for around 3,000 local European corporate and individual members with some 400 companies participating directly in the EBC’s 30 sector-based committees.The common bond among the members of the EBC and ACCJ is the desire to improve the quality of healthcare in Japan and the wellbeing of the Japanese people.
Globally and in Japan, more people are living longer.However, many of those years are increasingly spent under care for chronic – often preventable --disease.A shift from a purely disease treatment paradigm to a prevention paradigm that focuses on prevention, screening, early detection and the early treatment of disease holds the promise of not only preventing disease and enhancing quality of life and worker productivity, but in yielding cost effective interventions and better patient outcomes.
Many forms of chronic disease can be prevented or detected early, but health policies in Japan have traditionally focused on the treatment of disease after it occurs or grows critical, which can result in higher treatment costs.Here, you can see the significant proportion of healthcare expenditure and deaths that are due to non-communicable diseasesThese are conditions that, if prevented or detected earlier, would pose a much lighter burden on Japanese healthcare system, which is surely a benefit to society.
Finally, not only does preventative health and early detection of disease improve patient outcomes and create efficiencies in the healthcare system, it is an investment in the overall economic output and competitiveness of Japan.A more efficient allocation of healthcare resources that provides better patient outcomes boosts the economy in two important ways: it enhances labor productivity and reduces waste. Our goal is to provide recommendations founded on evidence-based global best practices and to offer these as examples of the kinds of policies likely to yield significant positive potential impact.
Background Since 2008, the ACCJ Healthcare Committee has released a series of Viewpoints advocating a shift from a purely disease treatment paradigm to a prevention paradigm that focuses on prevention, screening, early detection and the early treatment of disease which holds the promised of not only preventing disease and enhancing quality of life and worker productivity, but in yielding cost effective interventions and better patient outcomes.
Slide #1In 2010, the first Health Policy White Paper was issued as a companion document covering healthcare reform recommendations for the ACCJ white paper “Charting a new Course for Growth – Recommendations for Japan’s Leaders” issued by the ACCJ Growth Strategy Taskforce, which highlighted the initiatives that will enable Japan to achieve the goal of enhancing economic growth.
Slide#2In 2011, the ACCJ Health Policy White Paper was greatly expanded from 12 topic sections to 27 topic sections under the title “Investing in Health as a Competitive Advantage- Proposals to Reduce the Burden of Disease by Promoting Prevention and Early Detection”. Again, the goal was to support Japan’s economic growth strategy. It has been our goal to provide recommendations founded on evidence-based global best practices and to offer these as examples of the kinds of policies likely to yield significant positive potential impact. That being said, to gage the effectiveness of the 2011 white paper recommendations, a review was conducted after the implementation of reforms on April 1, 2012. In brief, forty-six (or roughly 37%) of the one hundred twenty-four (124) recommendations in the 2011 Health Policy White Paper were found to have been fulfilled "In Part" or in whole. Notable progress was made in: Expansion of IVD Rapid Diagnostics; Diabetes Management; Osteoporosis Prevention; Chronic Pain Research Funding; Vaccination Policy and Hepatitis Screening and Awareness Initiatives. The most significant progress was seen in the continued government funding of national cancer screening initiatives and in the substantial increase in government funding to enhance infection prevention and control at hospitals in Japan (four fold for hospitals with >300 beds).
Slide #5To update and further enhance the quality of the Health Policy White Paper and to align our recommendations with current government growth policy goals, the ACCJ and EBC agreed to work together to issue our first joint health policy white paper, “ACCJ–EBC Health Policy White Paper 2013 - Lengthening Healthy Lifespans to Boost Economic Growth”. Several new or expanded topic sections were added to the 2013 white paper including new topics sections for mental health, noncommunicable diseases, infection prevention & control and healthcare worker safety. The 2013 white paper is divided into Six Chapters, covering 36 topic sections and over 150 policy recommendations.General Health Themes Noncommunicable Disease (NCD) TopicsWomen’s Health TopicsKey Infectious Disease TopicsImportance of Enhanced Safety & Infection ControlSpecial Focus Needed on Healthcare Worker Safety Again, our goal is to provide recommendations founded on evidence-based global best practices and to offer these as examples of the kinds of policies likely to yield significant positive potential impact. Thanks to our collaboration with our European colleagues, we believe the 2013 ACCJ-EBC Health Policy White Paper represents our most comprehensive set of healthcare policy recommendations to date.