|Implemented in this survey?|
The government revised its strategy for developing ICT that gives priority to the health care sector. The strategy includes conversion to e-billing in public health insurances, development of personalized health information systems and promotion of remote health care, electronic medical records, and comprehensive information systems for health care.
In 2006, the Government established a policy document entitled "New IT Reform Strategy: Realizing Ubiquitous and Universal Network Society Where Everyone can Enjoy the Benefits of IT" (IT Strategic Headquarters 2006). The Ministry of Health, Labour and Welfare subsequently published a related policy document in the field of health care (MHLW 2006). The strategy emphasized ICT as measures to solve social problems rather than as aims in itself and identified health care as a priority area. The policy includes various targets described below.
In the "New IT Reform Strategy", the Government established the following five targets specifically concerned with health care ( IT Strategic Headquarters 2006):
1. Drastically reduce healthcare insurance administrative costs through the complete computerization and online processing of medical insurance claims no later than the beginning of fiscal year (FY) 2011 and use databases of medical insurance claim information for epidemiological purposes to promote preventive treatment and streamlining of national healthcare costs.
2. Build by FY 2010 the foundations for using individuals' healthcare information throughout their lifetimes, supporting self management of individuals regarding their health conditions and efforts to maintain and enhance health;
3. Promote remote healthcare to eliminate disparities in the level of healthcare among different regions, including access to advanced treatments, and employ terrestrial digital broadcasting to provide effective instructions and information to patients during emergencies;
4. Clarify the objectives of introduction and promote the widespread use of healthcare information systems including electronic medical records to enhance the quality of healthcare, ensure the safety of medical treatment, and encourage greater collaboration among medical institutions; and
5. Promote comprehensive and effective computerization throughout the medical, healthcare, nursing, and social welfare fields.
The strategy has lead to various policy measures including both financial and non-financial incentives. Among them are the introduction of new obligations, and the coordination for setting standard codes. As financial incentives, the Ministry of Health, Labour and Welfare has planned to introduce subsidies for IT equipment to providers.
Health Care Providers, Health Care Professionals, The Government
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
Because the IT strategy of the Government is relevant to various issues, it is difficult to rate this policy as in the case of a single concrete policy:
Development of technologies for personalized health information seems rather innovative, but e-billing is not;
Development of standardized coding of procedures is not controversial, but compulsory e-billing is;
Compulsory e-billing will have fundamental impacts in the sense it will make analysis of massive billing data possible, but development of coding will not.
Public visibility has been low because political debates up to now have not been concerned with patients, but with providers. E-billing or electronic transaction of administrative date can be transferred into other health systems with appropriate modification.
The global development of ICT has been a major background of policy development for promoting IT utilization in health care. IT is a major industry in Japan and the Government has tried to enhance competitiveness in that sector as well as to increase productivity in general, which has led to the IT strategies of the Government. Another background worth noting is that there has been pressure to make health care administration more efficient under the financial burden of health care expenditure.
|Implemented in this survey?|
Promotion of the ICT has been a priority of the Government since the late 1990s. In 2001, the Government adopted a national strategy to create a society where "everyone can actively utilize IT and fully enjoy its benefits" (IT Headquarters 2001). According to the strategy, the network infrastructure in Japan has been developed continuously, which made Japan one of the countries where ICT is commonly used in everyday life.
The health care sector, however, has been behind in introducing information technologies particularly in billing. Although pilot studies of e-billing were conducted in the early 1990s and the Government made a plan for using ICT in the health care sector in 2001, the utilization of ICT made slow progress in billing process of public health insurances. On the other hand, most bills of the Long-Term Care Insurance have been transferred electronically since its inception in 2000. Therefore, it was clear that further policy development to promote ICT in health care is needed.
The approach of the idea is described as:
renewed: The policy published in 2001 was renewed.
The Government has promoted IT development at large. In the health sector, the Ministry of Health, Labour and Welfare published "Grand Design" and its revision to discuss particular issues in health care, including electronical medical records, online billing, and security of privacy.
Both the Democratic Party of Japan and the Liberal Democratic Party supported standardization of e-billing in public health insurances. They, however, are concerned with possible unintended
closure of clinics and small hospitals in rural areas.
The Japan Medical Association as well as private hospital organizations have promoted ICT in health care at large. The JMA, however, has insisted that the Government shall allocate additional funds for introducing ICT in health care and conducted a political campaign against the initial government policy. The association argued that if an obligatory online billing was introduced without any exemptions, some clinics and small hospitals could give up providing health services. Private hospital organizations denounced that due to inappropriate regulation of the Government to vendors of IT equipment, many hospitals had recently bought IT systems incompatible with the online billing system, and that the Government should exempt those hospitals from obiligatory e-billing.
|Cabinet Office||very supportive||strongly opposed|
|Ministry of Health, Labour and Welfare (MHLW)||very supportive||strongly opposed|
|Ministry of Internal Affairs and Communication (MIC)||very supportive||strongly opposed|
|Japan Medical Association||very supportive||strongly opposed|
|Private Hospital organizations||very supportive||strongly opposed|
|Liberal Democratic Party||very supportive||strongly opposed|
|Democratic Party of Japan||very supportive||strongly opposed|
In April 2006, the Ministry of Health, Welfare and Labour issued an ordinance obliging almost all health care providers to submit medical insurance claims electronically from FY 2011(MHWL 2006 Ordinance of the MHWL, No. 111). The ordinance included a phased obligatory introduction of online billing for providers according to their scale, i.e., from large hospitals to small clinics.
|Cabinet Office||very strong||none|
|Ministry of Health, Labour and Welfare (MHLW)||very strong||none|
|Ministry of Internal Affairs and Communication (MIC)||very strong||none|
|Japan Medical Association||very strong||none|
|Private Hospital organizations||very strong||none|
|Liberal Democratic Party||very strong||none|
|Democratic Party of Japan||very strong||none|
Since the government developed the obligatory e-billing without developing financial and technical support to providers, small providers, particularly old physicians working at clinics in rural
areas, were afraid of financial and technical difficulties and raised strong opposition.
Meeting the opposition, the government decided to let small-scale providers with difficulties in introducing an electronic claim system to have exemptions from online billing in March 2009 (The Cabinet 2009 The Second Revision of the Three- Year Programme for Promoting Regulatory Reform).
The online billing, however, is believed to decrease administration costs of public health insurances in the long-run. Many providers are now preparing for it.
The Cabinet will monitor the implication of the "New IT Strategy". The strategy sets deadlines for implementation of the policy targets. For example, completion of unexceptional e-billing is
planned to be achieved by the beginning of FY 2011. Policies with time limits includes introduction of e-billing, development of personalized health information utilization, and introduction of
integrated clinical information systems to hospitals with 200 and over beds. Other policies are expected to be implemented gradually.
The strategy sets the following key evaluation points:
A. Percentage of online billing processing and reduction in administrative costs in in the public health insurance system;
B. The status of standardization of healthcare categories and electronic data formats;
C. The number of locations that employ pre-examination healthcare services using terrestrial digital broadcasting;
D. The rate of use of comprehensive clinical information systems and the indices of development of healthcare computerization infrastructure;
E. The establishment of a grand design for promoting IT and the extent of coordination for achieving it in the health and welfare fields.
Generally speaking, ICT is expected to develop in the health care sector as in other sectors. The problem is how it will be achieved. Although ICT is concerned with very broad areas of health
care, here I chose two issues for assessment: obligatory e-billing and personalized health information utilization.
Although e-billing is expected to highly increase efficiency, it seems politically difficult to completely oblige providers, particularly clinics and small hospitals, to introduce it by the announced deadline, 2013. However, the prevalence of e-billing will probably increase up to the extent that administrative efficiency will increase and the Government will collect information to generate evidence for further policy development.
Personalized health information utilization is an attractive idea, but it is difficult to predict whether this policy will succeed in the near future, because we know little about how to efficiently and effectively use such information extending over a long period of time to make us healthier, rather than to do research. Also, information security shall be enhanced if we collect such long-term personalized data.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
This policy has been developed primarily to increase efficiency in health care insurance. Since the proposed obligatory introduction of e-billing may cause unintended closure of clinics and small
hospitals due to its financial and managerial burden, it potentially will be concerned with equity in health care delivery.
Looking at the long term, some kind of information technology, e.g. electronic medical records, will increase efficiency in health care. But for the moment, it will cost in both monetary and managerial terms. One institutional difficulty for making policies to promote ICT is that different providers have different financial sources for capital costs.
IT can be used for quality assurance, which has to be observed further.
Cabinet (2009) The Second Revision of the Three- Year Programme for Promoting Regulatory Reform (in Japanese).
The Strategic Headquarters for the Promotion of an Advanced Information and Telecommunications (IT Strategic Headquarters), the Cabinet@(2001) e-Japan Strategy. Retrieved 5 October 2009, from http://www.kantei.go.jp/foreign/it/network/0122full_e.html.
IT Strategic Headquarters, the Cabinet (2009) New IT Reform Strategy. Retrieved 5 October 2009, from http://www.kantei.go.jp/foreign/policy/it/ITstrategy2006.pdf.
IT Strategic Headquarters, the Cabinet (2009) i-Japan Strategy. Retrieved 5 October 2009, from http://www.kantei.go.jp/foreign/policy/it/i-JapanStrategy2015.pdf.
Ministry of Health, Labour and Welfare (MHLW) (2001) Grand Design for IT Development in Health Care.
MHLW (2006) Ordinance of the MHWL, No. 111.
MHLW(2007) Grand Design for ICT in Health and Welfare Sectors.
Ministry of Internal Affairs and Communication (MIC)(2006) Report of the Committee on ICT Utilization in the Health Care Sector.
Social Insurance Medical Fee Payment Fund (2009) Number of health care facilities operating e-billing systems (in Japanese).
Ryozo Matsuda is a professor in health policy at the College of Social Sciences, Ritsumeikan University. He also serves as an executive board member of the Institue of Human Sciences, Ritsumeikan University.