Archive for the ‘Healthcare’ Category

Some local governments think health checkups save money, and some don’t

Saturday, April 5th, 2014

Preemptive stride: If you do have metabolic syndrome you can guess what the doctor will tell you to do

Preemptive stride: If you do have metabolic syndrome you can guess what the doctor will tell you to do

Though there’s a minority opinion to the contrary, conventional wisdom says that regular health checkups are the only way to prevent the development of major illnesses, so, logically, they should also help reduce healthcare costs in the long run. This is the concept behind tokutei kenko kensa, or “special health checkups,” that were started six years ago by the Ministry of Health, Labor and Welfare. The main target is metabolic syndrome, the inevitable gain in fat that accompanies midddle age and which, unchecked, is thought to be the gateway to many so-called lifestyle diseases, like diabetes.

The idea is that local governments would provide checkups to insured residents between the ages of 40 and 74 with national insurance, which, in principle, doesn’t cover regular general health checkups since Japan’s public health system is designed to treat existing problems. If the special checkups uncover unhealthy situations, then the individuals are advised with regard to better diets or exercise regimens, or even pharmaceutical assistance, so as to head off costly treatment down the road, like, for instance, dialysis, which can cost on average ¥5 million a year, most of which ends up being paid for by the government, both local and central.

CONTINUE READING about health checkups →

Aging boomers may prove to be just as tight with savings

Tuesday, September 17th, 2013

Praying is free (but the incense will cost you)

Praying is free (but the incense will cost you)

The media has been all over the new figures related to seniors that were released by the Ministry of Internal Affairs and Communications to coincide with Respect for the Aged Day. To recap, the number of Japanese people over 65 increased by 1.12 million from the previous year, which marks a 0.95 percent rise.

The big news is that this brings the total number of seniors to about 32 million, or one-fourth of the entire population. This was expected since the huge cohort of baby boomers — which in Japan refers only to people born during a brief period in the late 1940s — is now passing the 65-year mark, and the projection is that seniors will make up a third of the population by 2035. To break down these portions even further, 18 percent of the population is over 70, 12 percent over 75 and 7 percent over 80.

What hasn’t been discussed as widely is the economic ramifications of these developments. In 2012 there were 5.95 million people over 65 who were still in the work force, or 9.5 percent of all workers over the age of 15. The average amount of savings — whether bank accounts, annuities or securities — of households with more than one person where the householder is at least 65 is ¥22.57 million. The average savings of all households is ¥16.64 million. Also, 16 percent of over-65 households have savings of more than ¥40 million, while only 10 percent of all households have saved that much.

The hope has been that once they retire boomers will spend their savings more readily than did previous generations, but so far that doesn’t seem to be the case. The ministry’s statistics indicate that more money is being spent by seniors who are still working. Those who aren’t working, meaning they are on fixed incomes provided by government or company pensions, are spending much less.

In either case, working or not, the seniors are not touching their savings. They are only spending their income. In the parlance of economists, they are asset rich but cash poor. The average income of an over-65 household is ¥2.96 million (that of an average household in general is ¥5.8 million), but the median income of an over-65 household is ¥2.29 million, meaning the majority of these households are within the ¥1 to ¥3 million income range, and that’s what they are living on.

A Cabinet Office survey conducted in 2011 asked seniors what the purpose of their savings was. About 62 percent said it was for sudden illnesses and future care and 20 percent said it was for “maintaining existence” in case of an unexpected financial problem. Only 5 percent said they would spend it on leisure, and a mere 1.6 percent wanted to use it for travel. It should be noted that 90 percent of these respondents owned their own homes or did not pay rent, so housing, at least, was not a primary concern. However, given the cost of private nursing homes, which charge upwards of ¥20 million just to move in, it’s perfectly reasonable to think that seniors believe they have to save for those final years. Until that sort of anxiety is addressed, it will always be difficult to get seniors to part with their savings.

Men start taking advantage of nursing shortage

Friday, September 6th, 2013

Two posts ago we talked about how difficult it is for men to become flight attendants in Japan, where the job is still considered women’s work. However, another occupation that in the past was solely associated with women, nursing, is now openly encouraging male applicants, and the men are signing up. In the West, of course, there have been male nurses for decades, but because of tenacious gender roles and the fact that nursing is still a poorly paid position, Japanese men until recently have never tried to break into the field. That’s changing.

Web ad for Komatsu Nursing School in Ichikawa Prefecture with representative gender ratio

Web ad for Komatsu Nursing School in Ichikawa Prefecture with representative gender ratio

According to health ministry surveys, there were 63,000 male nurses working in Japan in 2012, which is two-and-a-half times the number ten years ago and six times the number 20 years ago. Nevertheless, this number only accounts for 6.2 percent of all the nurses in Japan. It is still overwhelmingly considered a woman’s job, but the numbers are increasing. Asahi Shimbun reports that 17 percent of the 112 students who enrolled last spring at a nursing school in Atsugi, Kanagawa Prefecture, were male. The portion of men among the new class was even larger at a nursing school in Osaka City — 28 out of 118.

What’s significant, however, isn’t the portion, but the age range. The youngest are just out of high school or college, while the oldest is in his mid-40s. Since nursing schools are essentially technical schools (senmon gakko), they don’t follow the archaic university custom of effectively limiting enrollment to recent high school graduates, and many men who want to change career paths are opting for nursing.

One 31-year-old student at the Atsugi school told Asahi that he worked in the administrative department at a preparatory school after graduating from university, but he was always a contract worker and his salary never rose the whole time he worked there. Now that he’s married and has a child, he wants something more stable and potentially lucrative.

A 22-year-old fourth-year student at the Osaka school, which opened in 2010, thus making him a future alumnus of the school’s first class, said he originally wanted to be a paramedic, but his mother suggested nursing because she had read that local governments were cutting budgets for ambulance service. He’s already been offered a full-time job at a general hospital in Osaka.

Almost all nurses are hired as full-time regular employees with benefits, because the demand for nurses remains high. In 2013, the health ministry estimated a nationwide nursing shortage of 42,000. The projection for 2014 is 30,000, which takes into consideration the number of people who will be graduating from nursing schools next year, though it doesn’t necessarily factor in turnover, which is high.

The annual turnover rate nationwide is 10.9 percent, but in major cities, where most nurses work, it’s over 14 percent. The reasons are obvious: long and late hours, demanding work conditions and pay that many don’t think is fair compensation. Almost all nurses are women, and when they get married or have children they often decide to quit the business altogether.

The chief nurse at a hospital in Otaru, Hokkaido — a woman, it should be noted — told the Asahi that her department was actively recruiting male nurses because they are perceived as looking at the occupation in the long term, as a real career, as if women didn’t. “We can reduce turnover,” she said. The health ministry says that there are 550,000 “hidden nurses” in Japan, meaning women with nursing licenses who no longer work as nurses.

According to the National Personnel Authority, the average monthly pay for a 37-year-old nurse in Japan is ¥346,000, while that of a 35-year-old general office worker is ¥320,000, so actually the pay is slightly above average. Moreover, the Japan Nursing Association says that pay for nurses were not adversely affected by the recession five years ago. Starting salaries tend to be pegged to educational level: though all nurses must go to nursing school and pass a test, those who went to university beforehand usually start at higher salaries than those who are only high school graduates.

This is another area where men have the advantage. Men who enter nursing now tend to be college graduates, while women usually go to nursing school right out of high school, or even junior high school. Traditionally, many women became nurses by going to high schools with nursing programs. Another change that has made nursing more attractive is lighter work loads. In 2006 the health ministry implemented guidelines that mandated one nurse per seven patients in a hospital. Previously, the ratio was one to ten.

Blood pressure medication huge cash cow

Thursday, July 25th, 2013

Low enough for you?

Low enough for you?

Earlier this month Kyoto University revealed that a study one of its researchers carried out to evaluate the effectiveness of the drug Diovan, which lower blood pressure, was probably “erroneous.” Though the university did not say the drug itself was ineffective, it did admit that the data of “those involved in the research” did not always agree with the conclusions of the lead researcher, Hiroaki Matsubara, which said that Diovan is “more potent in reducing angina and brain strokes than any other hypertensive medicines.” There are suspicions that Matsubara may have changed some of his data. In December 2012 he asked that his papers on the study be withdrawn.

Diovan, which is also sold generically as valsartan, was developed by the Swiss pharmaceuital giant Novartis Pharma K.K., which reportedly gave Matsubara a ¥100 million grant for his study. It wouldn’t have the first time the company has been accused of bribing doctors. Diovan is one of the company’s biggest moneymakers, especially in Japan where it generates ¥100 billion in sales.

Novartis isn’t the only drugmaker who does well with high blood pressure medications in Japan. Sales of hypertensive drugs amounts to more than ¥1 trillion a year, so even if Novartis had been trying to get researchers to post better results for their medicine, it seems that there’s enough of a market for every pharmaceutical company to make a lot of money with HBP medication. Some doctors, in fact, question the ease with which their colleagues prescribe HBP drugs.

In his bestseller, Isha ni korosarenai 47 no kokoroe (“47 Tips to Prevent Being Killed by Your Doctor”), controversial radiologist Dr. Makoto Kondo points out that there are 40 million people in Japan being treated for high blood pressure compared to 16 million in 1998. Why the big increase? In 2000, the health ministry, on recommendation from a panel of blood pressure specialists, changed the index for diagnosing HBP from 160/95 to 140/90, which is more in line with world standards. The new index immediately added 21 million people to the ranks of patients with high blood pressure, and almost all were prescribed hypertensive medication. Before the change, sales of HBP medicines was about ¥200 billion a year. Revenues have since climbed by more than fivefold. Kondo claims in his book that the specialists association from which the advisory panel was selected received an “anonymous” donation from a group of pharmaceutical companies beforehand.

Kondo believes that the dangers of high blood pressure have always been exaggerated, since blood vessels naturally become less elastic as people age and therefore the heart has to pump harder to achieve proper circulation. Reducing blood pressure too much can actually be dangerous, he says, since that could mean blood not reaching the brain and extremities in proper amounts, which may lead to senility and chronic loss of equilibrium. He cites a study in Finland that found elderly men with blood pressure over 160 lived longer than did those with blood pressure under 140. (Though it should also be noted that a more recent study in Finland found that people diagnosed with HBP who fail to take their meds have a higher chance of stroke.)

Kondo’s theories are generally dismissed by the medical community, but the Kyoto University scandal highlights an inconvenient truth about the financial connections between medical providers and pharmacuetical companies. Kondo says he has studied the literature extensively and cannot find reliable data that actually shows that a reduction in blood pressure leads to a reduction in the incidence of heart disease and stroke. Meanwhile, the Japanese government spends ¥37 trillion a year on medical care in the form of taxes and insurance payments, ¥6.14 trillion of which goes to drugs. That means hypertension medications account for one-sixth of all prescription drug sales in Japan.

Kanebo recall illustrates built-in resilience of cosmetics industry

Monday, July 8th, 2013

White is might: The Sex and the City cast plug their second movie in Tokyo, 2010

White is might: The Sex and the City cast plug their second movie in Tokyo, 2010

Last week, cosmetics giant Kanebo, along with two subsidiaries, announced it was recalling 54 skincare products that are believed to cause unsightly blotches. The merchandise under scrutiny contains an active whitening ingredient called Rhododenol that the company first started marketing in 2008, and it estimates that some 250,000 women in Japan alone use it on a regular basis. Since 2008, 4.36 million units have been shipped and probably about 450,000 may still be in use, including in foreign countries like Thailand and Taiwan. The Philippines, in fact, reacted to the recall by banning all Kanebo products that contained Rhododenol.

On the surface, the size of the problem sounds formidable, since Kanebo will lose some ¥5 billion on account of the recall. Asahi Shimbun reports that the company has not released sales figures for the disputed line of products, but it is believed Kanebo’s annual revenues for skin whitening agents is around ¥190 billion. Consequently, the company is not losing that much, and if one wanted to make a gambling analogy, it obviously pays to market substances that aren’t guaranteed in the long run since so much money can be made in the short run. It all depends on what people want and how badly they want it.

Women’s cosmetics, and whitening products in particular, are no-lose propositions in Japan. The main market right now is middle aged consumers, who, according to a recent article in Aera, buy almost any anti-aging product that goes on the market. This practice is now called keshohin kurujingu, or “makeup cruising.” The article profiles several women, housewives and working women, all in their 40s and 50s, who spend an average of ¥50,000 a month on cosmetics.

Continue reading about the strength of the cosmetics industry →

Insurance companies main beneficiaries of scheme to protect obstetricians from malpractice suits

Thursday, June 13th, 2013

In late May, 1,041 former obstetrics patients of 28 medical facilities submitted a plea to the National Consumer Affairs Center (NCAC) to arbitrate a settlement with the Japan Council for Quality Health Care (JCQHC) that would partially refund money they had paid during their pregnancies for insurance purposes. The JCQHC is a foundation that carries out third-party evaluations of hospitals and clinics, but it also oversees a special compensation system enacted by the government in 2009 to protect obstetricians from career-threatening malpractice suits.

The system allows for a form of insurance that all obstetrics patients, meaning pregnant women, pay into. If a fetus or baby suffers brain damage before or during delivery, the insurance pays up to ¥30 million in damages over the next 20 years to the child and his or her parents. This no-fault insurance system was put in place because fewer medical students were opting to become obstetricians, partially because the dwindling birthrate has made obstetrics less profitable, but mainly because malpractice awards in the cases of babies born with disabilities have been extremely high. It was just too financially risky to go into the field.

Pink is the color of the obstetrics department

Pink is the color of the obstetrics department

Unless a pregnancy threatens the well-being of the mother, childbirth is not covered by national health insurance. Though in theory the obstetrics insurance is optional, if a pregnant woman patronizes a medical facility that pays into the insurance system (meaning 99.8 percent of them) they automatically charge her the ¥30,000 premium and incorporate it into her bill. What complicates the matter is the so-called “public aspect” of the system, according to a recent article in Aera magazine.

To encourage women to have babies, local governments compensate them for the money they spent on childbirth after the fact with something called shussan ikuji ichijikin (one-time payment for childbirth), a handout administered by the National Health Insurance Union (NHIU) of up to ¥420,000 per birth, regardless of how much money the patient spent.

This amount includes the ¥30,000 premium that the woman paid for the obstetrics insurance, so in effect the public is paying for the insurance since the NHIU uses taxpayer money as well as national health insurance funds for payments. In that regard, Aera has characterized the JCQHC as an amakudari institution; in other words, a bureaucratic entity whose main purpose is to justify its own existence.

Since the insurance system was launched in 2009, it has paid out about ¥4.1 billion in compensation for damages suffered during childbirth. At the end of the last fiscal year there was still about ¥80 billion in the reserve pool of funds and it is estimated the pool, which is controlled by the five insurance companies, will increase to ¥100 billion by the end of the present fiscal year.

According to Aera, the JCQHC originally estimated that between 500 and 800 babies would suffer brain damage every year out of the country’s 1.2 million births, but real statistics for fiscal 2012 show that only about 200 babies suffered such damage. The mothers who requested arbitration from the NCAC are claiming they overpaid for the insurance and are demanding ¥20,000 each in refunds from the JCQHC. If they win, the organization will have to pay a total of ¥20.8 million. As Aera notes, more than 50 million women have paid this premium since 2009, though, strictly speaking, it is the public who has paid the premiums.

One obstetrician interviewed by Aera says that the reason all medical institutions sign up for the insurance is that part of the law mandates that any medical facility which applies for “high-priced medical care” compensation to the NHIU cannot be approved if it doesn’t pay into the obstetrics compensation insurance plan. Otherwise, the facility can only receive maximum compensation of ¥400,000 for each delivery, regardless of what it cost the facility. That’s too risky for smaller clinics.

The main beneficiaries of the system are the private insurance companies that participate. The premiums are practically free money since the companies are allowed to collect and administer the funds. Also, brain damage resulting in cerebral palsy is difficult to diagnose in an infant, and there is a five-year time limit for insurance claims.

In many cases, developmental disorders arising from brain damage don’t manifest themselves until the child is older and the time limit has passed. However, the insurance companies are also using this aspect to explain why they need such a huge pool of money.

Of children born in 2009 who were eventually found to suffer from cerebral palsy due to brain damage, 12 were discovered in 2009, 100 in 2010 and 158 in 2011. Diagnoses are thus progressive, so the insurance companies say they need this huge surplus to meet future claims. But there has already been discussion in the Diet that the funds should be administered by a government body so as to relieve some of the public burden associated with medical care.

In any event, as some pediatricians have noted, ¥30 million over 20 years is insufficient to take care of most people who suffer from cerebral palsy. They tend to require 24-hour care the older they get. As one mother who is part of the arbitration claim told Aera, a system for compensating brain damage victims directly would be cheaper, more efficient and more humane than the obstetrics compensation insurance, which benefits administrators more than doctors or patients.

Should healthy people pay less for health insurance?

Saturday, April 27th, 2013

Finance Minister Taro Aso has been shooting his mouth off again. Tokyo Shimbun reports that at a recent “meeting” he said it “wasn’t fair” that the country had to pay for the medical costs of people who “eat as much as they want and drink as much as they want and then end up with diabetes.”

Japan’s national health insurance does not discriminate between people who maintain good health and those who don’t. You pay according to your income. “Of course, if you have an inherent weakness, that’s another story,” Aso added, obviously recognizing that some people will take offense at his opinion.

Hospital bill for specified elderly patient (over 75), who only pays 10 percent out of pocket.

Hospital bill for specified elderly patient (over 75), who only pays 10 percent out of pocket.

But apparently it’s something he’s thought about a lot. The Asahi Shimbun reports that during opening remarks at a Lower House “party” of some kind Aso said, “I think we should make an incentive for people who are making an effort to stay healthy.”

The government is trying to reduce medical costs, and he believes if someone over, say, 70 continually foregoes treatment for minor complaints that person should be rewarded. “Maybe give them ¥100,000 in cash,” Aso suggested. Then, those people who think they might as well go to the hospital for something small will think twice.

This idea has been floated before, but doctors’ groups, which would suffer financially from such a change in the public mindset, have protested, saying that discouraging people from seeking medical advice for anything is tantamount to killing them.

Aso claims that the average medical cost for a person over 70 is a million yen a year. We couldn’t corroborate that statistic, but fellow Liberal Democratic Party lawmaker Taro Kono, in his email newsletter, said that the average Japanese person costs the government ¥24 million in health care during his/her lifetime — paid for through both insurance premiums and taxes — and that 49 percent of all medical outlays are spent on persons 70 and over.

Then we thought of our own situation. We’ve been paying into the national health insurance scheme for 26 years and reckon we’ve spent almost ¥10 million. We can also count on the fingers of one hand how many times we’ve actually gone to the doctor in those 26 years for something that falls under our coverage, so obviously we aren’t getting our money’s worth — so far.

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