The Journal The Authority on Global Business in Japan



Homecare and the Role of Telemedicine
New frontiers in healthcare delivery

By Marc Fuoti and William Bishop

The growing crisis surrounding Japan’s “super-aged” society—with more than one quarter of the population already aged 65 or over—has created an increasing need for new healthcare delivery systems.

Future developments will hinge on finding cost-effective solutions to provide uninterrupted patient access and undiminished treatment outcomes, with the same quality of healthcare as patients currently enjoy. Achieving this will be a tall order.

This challenge was the subject of the joint ACCJ–EBC event “Telemedicine as a Means of Delivering Sustainable Quality Home Healthcare in Japan,” held on July 15 at the Tokyo American Club.

The ACCJ and EBC hosted three executive members of the Japan Telemedicine and Telecare Association (JTTA). The JTTA has a long history of advocating best practices, as well as sponsoring and publishing research, including with the Ministry of Health, Labour and Welfare.

Presenting were Takeshi Hasegawa, MA., the JTTA’s managing director; Dr. Koichi Sampei, Ph.D., chair of the JTTA International Exchange Committee; and Dr. Masatsugu Tsuji, Ph.D., a founding member of JTTA’s International Exchange Committee.

This groundbreaking program was the ACCJ’s first telemedicine event, and attracted over 60 attendees. It followed the ACCJ’s November 2013 publication of a viewpoint, “Utilizing Telemedicine to Deliver More Efficient and Effective Healthcare in Japan.”

The practice of telemedicine began almost 30 years ago in Japan. After years of advocacy, most of the regulations restricting its practice have now been removed. Yet social obstacles, medical traditions, lack of comprehensive guidelines, as well as existing reimbursement policies continue to limit its utilization.

Teleradiology represents the most common practice, with over 20,000 patients seen per month in Japan. Other growth areas are telepathology and implantable cardioverter defibrillator (ICD) monitoring. Obstetrics and emergency services via telemedicine are still in the trial stage.

The future of telemedicine will almost certainly include dramatic increases in the use of teleconsulation, as technology and capabilities continue to improve, and the need to serve rural areas grows.

Remote monitoring and the use of home healthcare devices to monitor chronic illness and the elderly is another anticipated high-growth sector.

The government of Japan seeks to provide 60 percent of healthcare for children and the elderly, as well as chemotherapy, as part of home healthcare by 2025.

Much of the JTTA’s presentation focused on the growing demand to provide healthcare for the elderly. Japan boasts the longest lifespan in the world, with the average life expectancy at an all-time high of 79.6 years for men and 86.4 years for women.

The problem is in the gap between average life expectancy and unhealthy life expectancy, the period during which the elderly experience daily life constraints.

On average, men have 9.2 years and women 12.8 years of unhealthy life expectancy, requiring higher medical and nursing expenses. Nearly 80 percent of all medical expenses come in the last years of a person’s life.

Another reason for raising costs is that today, 80 percent of the elderly die in the hospital, whereas in 1961, when the National Healthcare System was first established, this figure was approximately 20 percent.

At that time, most patients chose to die at home, surrounded by loved ones. Indeed, this is still the desire of most Japanese elderly; however, the current system is lacking in end-life homecare.

Telemedicine can provide solutions to many of the impending challenges facing not only Japan’s increasingly overburdened healthcare system, but also many such systems in the developed and developing world.

It sits at the intersection of Big Data, wearable devices, the Internet of Things, and the growing ubiquity—and benefits—derived from technology. •