Presenting the ACCJ-EBCHealth Policy White Paper 2013May 31, 2013Lengthening Healthy Lifespansto Boost Economic Growth
Laurence W. BatesACCJ President
About American Chamber of Commerce inJapanEstablished1948Committee structure drives Chamberactivities around three pillars...
Achieving Growth TogetherJapan EconomicGrowthACCJ MembershipGrowthACCJ MemberPersonal GrowthACCJ’s Three Primary Areas for...
Preventive Health Investment Drives GrowthJapan’s aging is rapidly increasing healthcare utilizationWorker productivity is...
• Gaps between average life expectancy and healthy life expectancyrepresent an unhealthy period with daily life constraint...
ACCJ-EBC Health Policy White Paper 2013Promoting economic growth in Japanthrough policies to lengthen healthylifespans and...
Duco B. DelgorgeEBC Chairman
About European Business Council in JapanTrade policy armof 17 EuropeanNationalChambers ofCommerce andBusinessAssociations ...
Rise in Non-Communicable Diseases Is aLeading Threat to Global Economic GrowthWHO report: each 10% rise in non-communicabl...
NCDs account for about 30% of national healthcareexpenditure andabout 60% of total deathsHealthcareExpenditureCancers11.1%...
“Every 1 year increase in lifeexpectancy is linked to a 4.3%increase in global GDP.”Sources: Stuckler D. “Population cause...
William BishopChair, ACCJ Healthcare Committee
20102010 Health Policy White Paper2010
2011 Health Policy White Paper2011Scope:• 27 Topic Sections• 124 RecommendationsResults:• 46 of 124 recommendations (rough...
Source: InhibitexNearly 6 million HAIsannually in U.S., Europe andJapan1.7 million cases and 99,000deaths annually in th...
Q. How important do you think it is for the government to have a nationalprogram to reduce the risk of infections associat...
20132013 ACCJ-EBC Health Policy White PaperScope:• 36 Topic Sections• 156 RecommendationsChapters:1. General Health Themes...
Danny RisbergChair, EBC Medical Equipment Committee
Deaths Caused by and Patients ofCerebrovascular Diseases10012515017520002505007501,0001,2501,5001,7502,0001996 1997 1998 1...
76.8%13.3%2.4% 7.5%Cerebral hemorrhageCerebral infarctionSubarachnoid hemorrhageOthers19601999Source: Ministry of Health, ...
Vessel Wall Imaging Done by MRI
Sleep Apnea Syndrome(over 3 million patients)13% have diabetes(390,000 patients)21% have cardiovascular diseases(630,000 p...
Eriko AsaiChair, ACCJ Health IT Subcommittee
71.5% of Japanese Back Introduction of ElectronicHealth Records at Hospitals, ClinicsSupport/Agree Slightly Support/Agree ...
Supporters of EHR System ExpectMore Efficiency, Safer Medical Service(n=3,574)Q: Why do you support the introduction of an...
24.3%70% 75%Breast Cancer Screening Rates Lower ThanOECD AverageSources:http://www.mhlw.go.jp/stf/houdou/2r9852000001igt0....
 Has a 28% survivalrate over five years Costs up to ¥4million to treat Has 96% survivalrate over fiveyears Costs about...
Bruce EllsworthACCJ GovernorHealthcare Committee Liaison
Two Thirds Support a Mandated IndoorWorksite Smoking BanQuestion: What would you think if the national or local government...
70% of Indoor Workers: Legal Smoking BanWould Not Negatively Impact BusinessQuestion: How would your business be impacted ...
322011 MHLW’ National Survey on Getting-tested status of Hepatitis Screening (Interviewed 74,000 Japanese people aged 20 t...
Large CompanyEmployersSmall and MediumCompany EmployersSelf-Employed andOthersType of healthinsurance in whichemployee enr...
2013 ACCJ-EBC Health Policy White Paper• Paradigm shift from treatment to prevention Focusing on prevention, screening, e...
Presenting the ACCJ-EBCHealth Policy White Paper 2013May 31, 2013Lengthening Healthy Lifespansto Boost Economic Growth
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Presenting the ACCJ-EBC Health Policy White Paper 2013

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  • 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.
  • Presenting the ACCJ-EBC Health Policy White Paper 2013

    1. 1. Presenting the ACCJ-EBCHealth Policy White Paper 2013May 31, 2013Lengthening Healthy Lifespansto Boost Economic Growth
    2. 2. Laurence W. BatesACCJ President
    3. 3. About American Chamber of Commerce inJapanEstablished1948Committee structure drives Chamberactivities around three pillars:• Information• Networking• AdvocacyApproximately2700 membersrepresenting1000 companiesOver 500 eventsper year in threechapters acrossJapanApproximatelyhalf of membersare Japanese
    4. 4. Achieving Growth TogetherJapan EconomicGrowthACCJ MembershipGrowthACCJ MemberPersonal GrowthACCJ’s Three Primary Areas for Growth成共長就
    5. 5. Preventive Health Investment Drives GrowthJapan’s aging is rapidly increasing healthcare utilizationWorker productivity is key to sustain healthcare and growthe economy• Disease costs Japanese economy 3.3 trillion yen per year in lostproductivity (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. 6. • Gaps between average life expectancy and healthy life expectancyrepresent an unhealthy period with daily life constraints• There may be medical andnursingexpenses during this period70.4279.646073.6286.3965 70 75 80 85 90Year9.22years12.77yearsAverage life expectancy Healthylifeexpectancy(Nodailylifeconstraints)GapbetweenaverageandhealthylifeexpectancyMaleFemaleSource: Healthy Japan 21 (Second Version)Importance of Healthier Life Expectancy
    7. 7. ACCJ-EBC Health Policy White Paper 2013Promoting economic growth in Japanthrough policies to lengthen healthylifespans andreduce economic burden of preventable,detectable and treatable diseases36 healthcare topicsOver 150 policyrecommendations
    8. 8. Duco B. DelgorgeEBC Chairman
    9. 9. About European Business Council in JapanTrade policy armof 17 EuropeanNationalChambers ofCommerce andBusinessAssociations inJapanWorking to improve the trade andinvestment environment for Europeancompanies in Japan since1972Approximately 3000 local Europeancorporate and individual membersApproximately400 companiesparticipatingdirectly
    10. 10. Rise in Non-Communicable Diseases Is aLeading Threat to Global Economic GrowthWHO report: each 10% rise in non-communicable diseases is linked to a0.5% dip in annual economic growth;recent global rise in NCDs is“economically unsustainable.”The World Economic Forum forecaststhat 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. 11. NCDs account for about 30% of national healthcareexpenditure andabout 60% of total deathsHealthcareExpenditureCancers11.1%Hypertension-relateddiseases7.1%Cerebralvasculardiseases6.3%Diabetes4.4%Cardiovasculardiseases2.9%Others68.3%Cancers29.5%Cardiovasculardiseases15.8%Cerebral vasculardiseases 10.3%Diabetes1.2%Hypertension-relateddiseases0.6%Others42.6%MortalitySource: Healthy Japan 21 (Part 2)Non-Communicable Diseases in Japan areCostly, Deadly and Often Preventable
    12. 12. “Every 1 year increase in lifeexpectancy 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 GoodEconomic Investment
    13. 13. William BishopChair, ACCJ Healthcare Committee
    14. 14. 20102010 Health Policy White Paper2010
    15. 15. 2011 Health Policy White Paper2011Scope:• 27 Topic Sections• 124 RecommendationsResults:• 46 of 124 recommendations (roughly 37%)fulfilled “in part" or in wholeAreas of Progress:• Continued government funding of nationalcancer screening• Substantial increased funding to enhanceinfection prevention and control at hospitalsin Japan (four fold for hospitals with >300beds).• Expanded use of IVD Rapid Diagnostics• Diabetes Management• Osteoporosis Prevention• Chronic Pain Research Funding• Vaccination Policy• Hepatitis Screening & Awareness Initiatives
    16. 16. Source: InhibitexNearly 6 million HAIsannually in U.S., Europe andJapan1.7 million cases and 99,000deaths annually in the U.S.In some developing countries,more than 25% of patientsadmitted to hospitals acquireHAIsHundreds of millions ofpatients impacted worldwideeach yearHealthcare Associated Infections (HAIs):A Global Healthcare IssueMillions of Infections864202002 2005 2009 2010 20155.6 5.96.3 6.46.9JapanEuropeU.S.
    17. 17. Q. How important do you think it is for the government to have a nationalprogram to reduce the risk of infections associated with hospitals, clinicsor other healthcare facilities?75.7% of General Public in Japan Think it isImportant to Have a National Program to Reducethe Risk of HAIs (80% for population over 65)■Important ■Slightly important■Neither nor ■Do not know ■Not very important ■Not important52.448.948.543.037.331.429.440.840.240.527.430.632.936.236.439.238.135.934.435.27.712.911.212.115.917.618.614.414.214.310.65.65.65.97.47.97.46.37.26.81.91.41.22.11.82.56.62.02.22.10% 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 Important75.7%74.6%76.6%67.4%70.6%73.6%79.2%81.4%79.5%79.8%Not Important3.3%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 inJapan. Internet survey conducted October 31 – November 2, 2011. 5,000 respondents from Rakuten Research’s registry that representthe Japanese population.
    18. 18. 20132013 ACCJ-EBC Health Policy White PaperScope:• 36 Topic Sections• 156 RecommendationsChapters:1. General Health Themes2. Non-communicable Disease(NCD) Topics3. Women’s Health Topics4. Key Infectious Disease Topics5. Importance of Enhanced Safety& Infection Control6. Special Focus Needed onHealthcare Worker Safety
    19. 19. Danny RisbergChair, EBC Medical Equipment Committee
    20. 20. Deaths Caused by and Patients ofCerebrovascular Diseases10012515017520002505007501,0001,2501,5001,7502,0001996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008# of death(1,000 ppl)# of Patients(1,000 ppl)# ofPatients# ofDeathSource: Ministry of Health, Labor, and Welfare (Trend of Medical Institution)
    21. 21. 76.8%13.3%2.4% 7.5%Cerebral hemorrhageCerebral infarctionSubarachnoid hemorrhageOthers19601999Source: Ministry of Health, Labor, and Welfare (Vital Statistics)DeathsCaused By CerebrovascularDiseases23.0%62.7%10.8% 3.5%
    22. 22. Vessel Wall Imaging Done by MRI
    23. 23. Sleep Apnea Syndrome(over 3 million patients)13% have diabetes(390,000 patients)21% have cardiovascular diseases(630,000 patients)41% no complication(1,230,000 patients)51% have hypertension(1,530,000 patients)UndergoingTreatment(250,000 patients)Increase Sleep Apnea Syndrome Screening
    24. 24. Eriko AsaiChair, ACCJ Health IT Subcommittee
    25. 25. 71.5% of Japanese Back Introduction of ElectronicHealth Records at Hospitals, ClinicsSupport/Agree Slightly Support/Agree NeitherDon’t know SlightlyOppose/Disagree Oppose/Disagree50.048.252.442.240.335.936.137.948.743.123.628.024.328.428.333.429.831.625.028.414.416.117.122.222.820.420.821.817.219.610.15.14.45.45.96.68.35.96.26.00.51.91.51.22.32.52.92.21.72.00% 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 Oppose2.9%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 athospitals and clinics in Japan?Source: ACCJ National Survey on Prevention, Early Detection & the Burden of Disease in Japan, Nov, 2011.
    26. 26. Supporters of EHR System ExpectMore Efficiency, Safer Medical Service(n=3,574)Q: Why do you support the introduction of an electronic health record (EHR) systemat hospitals and clinics in Japan? (multiple answers)Source: ACCJ National Survey on Prevention, Early Detection & the Burden of Disease in Japan, Nov. 2011.
    27. 27. 24.3%70% 75%Breast Cancer Screening Rates Lower ThanOECD AverageSources:http://www.mhlw.go.jp/stf/houdou/2r9852000001igt0.html, http://www.oecdtoMammographyscreening ratesin Japan rising,but still low62.2%Free National Breast Cancer ScreeningLaunched in 2009Scope: Women aged 40, 45, 50, 55, and 60Funding: 100% by central governmentJapan Goal: 50% screening rate by 2011Recruitment: Send coupons to eligible women
    28. 28.  Has a 28% survivalrate over five years Costs up to ¥4million to treat Has 96% survivalrate over fiveyears Costs about¥760,000 to treatBreast cancer diagnosedin early stagesBreast cancer diagnosedafter it has metastasizedBreast Cancer Screening:Cost Effective and Saves Lives Sense no need, as have nolump Lack of opportunity High feesTop three reasonswomen do not havea mammogram
    29. 29. Bruce EllsworthACCJ GovernorHealthcare Committee Liaison
    30. 30. Two Thirds Support a Mandated IndoorWorksite Smoking BanQuestion: What would you think if the national or local governments legally requireda complete smoking ban in all indoor workplaces and public spaces, includingrestaurants, 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. 31. 70% of Indoor Workers: Legal Smoking BanWould Not Negatively Impact BusinessQuestion: How would your business be impacted if national or local governmentslegally required a total smoking ban in all indoor workplaces and publicspaces, including restaurants, bars and taxis, to protect the health of non-smokingworkers?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. 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 BeenScreened for HepatitisJapanese government has provided free hepatitis screening since 2002 as thetime of regular health checkup services by municipal governments. Freescreening was first provided at public health centers and later also available athospitals 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 timeofsurgery, pregnancy, blooddonation 40%No, I havenot or donot know42%Yes, I havebeen tested(self-reported)18%Yes, I havebeen tested(self-reported)18%No, I havenot or donot know52%Tested at timeofsurgery, pregnancy, blooddonation 30%
    33. 33. Large CompanyEmployersSmall and MediumCompany EmployersSelf-Employed andOthersType of healthinsurance in whichemployee enrollsManaged by healthinsurance societies orassociationsManaged by membersof Japan HealthInsurance AssociationManaged bymunicipalities, NationalHealth InsuranceassociationsProvision of healthcheckups based onIndustrial Safety &Health ActYes, required(Employers are required to provide)Not requiredProvision of specialhealth checkups basedon Law for the Welfareof the Elderly (aged 40or over)Yes, provision is required(Insurance provider is required to provide)Rate at which hepatitisscreening is part ofspecial health checkupApprox. 50% Approx. 95%Individuals must pay ¥595as co-payment and applyseparately for this optionalhepatitis virus testing.Approx. 80%Free but implementationvaries by town, city.Screening notices usuallygo 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.htmlProvision of Hepatitis Screening VariesWidely According to Type of Insurer
    34. 34. 2013 ACCJ-EBC Health Policy White Paper• Paradigm shift from treatment to prevention Focusing on prevention, screening, early detection and early treatment ofdisease• 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 growthDisease prevention • Cost effective interventions• Better patient outcomes and quality of life •Enhanced labor productivity
    35. 35. Presenting the ACCJ-EBCHealth Policy White Paper 2013May 31, 2013Lengthening Healthy Lifespansto Boost Economic Growth

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