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.
According to the Asahi Shimbun more than half the nation’s local governments are struggling with deficits in their health insurance programs, and thus usually have to shift money from other sectors to pay for them. Consequently, many are intensifying their checkup programs in the hope that it will reduce these costs in the future. The tricky part is that with such programs you have to spend money to save it. As of 2012, Soja in Okayama Prefecture was only seeing 27 percent of residents eligible show up for the special checkup, so they came up with a scheme.
The special checkup and the locally sponsored cancer screening each cost ¥5,000, so if anyone who undergoes the checks and doesn’t use their insurance for a year afterward, the money will be refunded. Though it may not sound like much of an incentive, the main idea is to spread awareness of the checkups. Kiyosu, a city in Aichi Prefecture, increased its checkup rate to 46 percent after offering coupons that can be used for substantial discounts at over 100 stores and restaurants in the area to people who come in for the checkup. People who undergo the checkup are told not to eat anything that day beforehand, so the coupons are a kind of reward, though one has to wonder if it’s wise to encourage people who really do have metabolic syndrome to go out afterwards and partake of the town’s meibutsu (special local product), fried pork cutlet in sweet brown sauce.
Kumagaya in Saitama Prefecture saw its participation rate rise from 23 to 27 percent after it started offering travel coupons. Takanabe in Miyazaki Prefecture partnered with a local bank to offer participating residents a 0.05 percentage point bonus in interest on savings accounts, and the rate of participation jumped from 32 to 40 percent. Six separate districts in Higashi, Okinawa Prefecture started a competition to see which one could raise their participation rate the most, with the winning districts receiving cash bonuses ranging from ¥30,000 to ¥100,000, but since it was the district offices themselves getting this money it was difficult to pass the excitement of competition on to individual residents. In fact, after an initial spurt in participation the rate has fallen back down again, so the local governments are thinking of a new scheme that directly rewards residents.
Nationwide, however, the idea hasn’t been very successful. The health ministry aimed for a 65 percent participation rate, but latest figures show it’s only about 34 percent, a rise of only 2.8 percentage points since the checkup scheme was launched. For the most part, according to Asahi, local governments have no choice but to raise premiums on health insurance to address their deficits. The reasons for non-participation are not complicated. In surveys, people say they already visit a doctor regularly or don’t feel sick or just think it’s too much trouble, especially since many municipalities charge a nominal fee for the checkup.
In any case, there isn’t any real consensus on the efficacy of regular checkups on long-term medical costs. The city of Amagasaki did a study from 2008 to 2011 that found during these four years the average amount of money spent by the health insurance system on a resident who had undergone the checkups “and received medical advice” — about 65,000 people — was ¥990,000 less than the money spent on a resident who didn’t receive the checkup. However, Kure, in Hiroshima Prefecture, managed to decrease its outlays for medical care by ¥160 million in 2011-12 by eliminating “unnecessary” examinations, meaning they actively discourage residents from seeing a doctor for routine matters, and didn’t promote the special checkups, either. One bureaucrat told the Asahi that he understands the “significance” of the checkup but wonders if it may actually be a waste of money given that its underlying purpose is economical.