eHealth and Patient-Centered Care Processes in Japan: Pre-Study

Japanese health care is of high standard but with some distinct features: high co-payments, extremely many hospitals, universal access and service without gatekeepers. Foremost – Japan spends exceptionally little on their health care system due to a number of social factors.

Micro-management of fees is a central mechanism of the Japanese health care system. This has made the Japanese government able to  contain health expenses at a low level – Japanese health care is lean.

But there is a backside to this micro-management and that is a lack of innovation. The Japanese health care system faces the problem of overutilization because of shrinking and ageing population. Public opinion among Japanese on their health care system is overall positive but there are worries regarding the future.

Japanese Telemedicine and Robotics stand out, but it is in Medical Informatics where the most interesting changes as well as greatest impact on the health care system takes place.

Medical informatics progressed slowly from accounting towards patient-centered applications. Electronic Health Records (EHR) and Computerized Physician Order Entry systems (CPOE) are at the center of Japanese eHealth investments.

Despite the ambition, health care information computerization in Japan is behind schedule and Japan is lagging behind many developed countries. Health care information computerization in Japan is behind schedule because the introductory costs are high. Where adoption of Electronic Health Records has happened, positive results are abundant.  

Standardization and consolidation is needed in Japan as elsewhere and open standards may be a way forward.

Six implications for Sweden and for future studies:

  1. Investigate closer if selected Japanese cost control mechanisms can be introduced in Sweden, but with close attention to risk of reduced innovation. 
  2. Inform Swedish eHealth companies about the large Japanese market, still in a process of adopting eHealth application on a large scale. 
  3. Continue learning from the top examples of running Japanese eHealth applications – these are found in a few major hospitals and also individual clinics.
  4. Follow up on possibilities to introduce a Health-technician certification. The key notion is that medical systems should be  developed in cooperation with medical professionals, not by IT-professionals working alone.
  5. Monitor changes in Japanese law for privacy of patient data in order to strike the right balance of secondary use of clinical data for Evidence Based Medicine practices.
  6. Study and implement lessons from the extensive preventive care and checkups in Japan in order to shift from reactive to preventive care. Special attention should be given to learn what incentives that is most likely to work.

eHealth and Patient-Centered Care Processes in Japan: Pre-Study

Serial number: Report 2010:08

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