World watches how Japan manages its ageing citizens

Japanese companies from Hitachi and Toyota to Daiwa Securities are turning to digital medical records to tackle the dilemma of how to sustain one of the world's most generous healthcare systems while trying to cope with a rapidly ageing population.

Similar experiments are under way in Europe and the US, but Japan is a closely watched test case as the nation grapples with an increasingly older population and a shrinking pool of younger people.

Healthcare is a pillar of Prime Minister Shinzo Abe's "Abenomics" economic revival programme, and one that may prove to be one of the most challenging.

At Uchida Yoko, a Tokyo-based education and office equipment supplier, its health union - an insurance scheme to which all employees of private-sector companies belong - started storing the results of workers' medical examinations on a cloud-based database last year. Data analysis allows the union to spot those at risk of diabetes and other illnesses and ensure they see medics before conditions become serious.

They also ensure employees follow medical instructions, such as additional check-ups or dietary changes, to prevent symptoms from worsening.

By promoting such use of digitalised patient records, the government hopes healthcare resources will be allocated more efficiently and medical costs reduced through preventive care.

While Japan does not have cradle-to-grave medical records, large amounts of data exist since companies and the state are responsible for ensuring employees and citizens undergo yearly health checks.

"The problem is the data are not integrated," says Yuji Yamamoto, chief executive of MinaCare, a healthcare start-up. His company provides healthcare consulting services and developed the medical database system at Uchida Yoko and Lawson, a Tokyo-based convenience store operator.

Such initiatives are also being promoted by large technology companies such as Hitachi, Toshiba and NTT Data, which offer services to manage medical data. If health data are used more efficiently by companies and by the state, Japan should be able to prevent more diseases.

Before the changes at Uchida Yoko's health union, one nurse was looking after 7,600 employees and their families. The nurse would notify members about upcoming health examinations but did not have the time to follow up on whether or not they went and whether any additional treatment was necessary.

To tackle these problems the company raised insurance premiums and also received a government subsidy of $125,000, which covered the cost of creating the database used to analyse medical costs and results of health check-ups.

"It's an effective system to support speedy and precise health services at controlled costs," says Yoshio Nakaie, secretary-general of Uchida Yoko's health insurance union. The number of Uchida Yoko's employees and families receiving medical examinations hit a high of 92 per cent last year, compared with 86 per cent in 2009. Efficiency improved and staff costs were reduced.

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The country introduced universal health coverage in 1961, making the system especially generous for older people. In 2000, it introduced mandatory insurance funded by taxation for long-term care services, as the country began to worry about its ageing population.

Total health spending accounted for 10.3 per cent of GDP in Japan in 2012, compared with 9.3 per cent in the UK and 16.9 per cent in the US, the Organisation for Economic Co-operation and Development has said.

"In the US, healthcare is not a right but something you have to purchase," says John Traphagan, a professor at the University of Texas and an expert on Japan's ageing population.

Prof Traphagan adds: "In Japan, there is a cultural mindset that a healthy, well-educated population is a form of national security."

However, he says Japan's ageing society and the smaller number of younger people are disrupting existing structures. Already one in four of Japan's 130m population is aged over 65. This will rise to one in three in 20 years. And, while spending on healthcare per capita has been among the lowest of advanced nations, that is also starting to change.

Dr Yamamoto and others say Japan must address concerns about patient privacy and train more health professionals - including people who can analyse the data - so that preventive care can spread beyond a small number of Japanese companies.

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