Land of the Setting Sun…

With no disrespect to Japan at all, the population is aging so quickly, that new healthcare technologies must be deployed to navigate this dilemma….  

Over the past four days I have been meeting with government officials and executives of some of the leading healthcare companies in Japan (I am traveling with Governor Deval Patrick of Massachusetts as he promotes the extraordinary healthcare technology community in the Commonwealth). Meeting with Japanese leaders who are tasked with solving many of the same problems we have in the US – aging populations, role and costs of advanced medical technologies, novel insights into disease progression, etc – has been fascinating. But the Japanese have a unique set of challenges which profoundly defines their healthcare technology agenda.

First some context. Many entrepreneurs I met with this week talked about the “Lost Two Decades” of economic vitality. Imagine an entire generation experiencing nominal economic growth – how dispiriting, and frankly, quite damaging to the entrepreneurial community. Notwithstanding the current genuine enthusiasm for Prime Minister Abe’s economic policies to finally spur demand – “Abenomics” recently levied a 3% point increase in national sales tax rate concurrent with the pending termination of a massive $130 BN fiscal stimulus program – early results are mixed. Recent quarter trade balances swung to a deficit as import growth spiked. Many of these initiatives are structured to address the extraordinary levels of government debt which looms frighteningly over the rapidly aging population. Real income per worker is falling quickly which makes the future cost of healthcare more daunting to the next generation.

It is this economic background which now frames the healthcare technology agenda. Often executives in Japan referred to their society as a “super aging” society. Some analysts forecast that two-thirds of the population is older than 50; in 1970 that would have been well below 20%. In urban centers 18% of the population is over 75 years old. There does not appear to be significant investment in new hospitals, and given it costs roughly one-third to provide in-home care, new technologies are being deployed to both rationalize healthcare costs and improve remote care.

Due to recent natural disasters like the earthquake that crippled the Fukushima nuclear facilities, and the ever-present threats of future disasters, across the country the Japanese healthcare system is encouraged to provide more innovative and distributed care coordination systems. For example, nearly three years since the devastating tsunami hit Ishinomaki City, one third of the residents still live in compromised housing. This is exposing a debilitating set of social costs as well – 40% of residents have experienced a reduction in household income, 25% are reporting social issues, and 6% are at imminent risk of suicide.  

The healthcare priorities most referenced in Japan this past week tended to center around a few key themes:

  • Connected Health:  given the demographics cited above, lack of hospital capacity forecasted, and the constant fear of the next natural disaster, distributed systems to manage patients are paramount. Being able to provide “end-of-life” care in the home, manage patients in a rapid response manner, intelligent remote monitoring all appear to be top of mind with healthcare executives. Industry leaders demonstrated a wide range of platforms from voice activated psychological assessment tools, “quantified self” peripherals (wristbands, sensors, etc), to a “check-up” toilet by Toto – not kidding, Toto has developed a medical screening and monitoring system which is used exclusively in the bathroom – the ultimate connected device.
  • Robotics:  Not surprisingly, given strength of the Japanese robotics industry, there were numerous fascinating robotics platforms on display from motion-assist systems (like the “robot suit”) to rehabilitation devices.
  • Personalized Medicine:  But not necessarily in the manner VC’s in the States but think of it. There is the concept of “Me-Byo” which is a continuum of one’s state of health from “Healthy to Sickness.” New care models are forming which rely on more sophisticated IT infrastructure and are data centric and tend to be very consumer-centric (mostly app’s).

There was little discussion around predictive modeling and population analytics which is all the rage in the US today, in part driven by the advent of accountable care and the new healthcare insurance exchanges. The Japanese have a Universal Health coverage system which in 2016 will adopt a universal identifier numbering system which will serve as both one’s social security and tax ID; once this has been rolled out perhaps we might expect to see a greater emphasis on population management tools.

Only around the periphery of conversations was there discussion of a more holistic, population-centric approach to Japanese healthcare.  It does increasingly appear that there is a movement toward (as John Halamka, CIO of Harvard Medical System suggested) a system that is a health care system, not a sick care system.

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