It is sometimes said in Japan
Japanese people have relatively easy access to medical services because they can choose any medical institution.
All Japanese citizens, permanent residents, and non-Japanese, with a visa lasting one year or longer, are required to be enrolled in either the National Health Insurance or Employees Health Insurance that helps us receive treatment reasonably priced (normally, people under 70 years of age are only required to pay 30% of their medical fee).
Therefore 70% of medical expenses are reimbursed/paid for by both government and insurance.
However, over the past few decades, social security expenses have been increasing.
According to the Japan Ministry of Health, Labour and Welfare（MHLW) report, the expenses in 2018 have increased 2.7 times compared to the level in the 1990s and the rate of the social security in total annual expenditure has also increased by 1.9 times.
It is said that Japan’s provision of good quality medical services to all of its people has been a key contributor to Japan being the world's top country for longevity.
The average medical expenses of 70 and 80 year olds are approx. 6.1 and 8.6 times bigger respectively than that of 30 year olds.
Moreover, Japan faces a gap between ‘life span’ and ‘healthy life span’. There is a 8.7 years gap for men and a 13.3 years gap for women, which is higher than other countries.
These facts suggest mainly 2 key questions. How do we keep our health and how do we solve these problems?
What about the current situation of the medical provider?
According to a 2015 OECD report, Japan has the highest number of MRI and CT scanners per capita amongst the OECD34, 3.4 times and 4.2 times higher than the average OECD 34 respectively and the highest number of hospital beds per capita remains with 13.2 beds per 1000 population in 2016.
On the other hand, the number of medical experts especially doctors is insufficient.
According to this report, the number of new medical graduates in Japan is amongst the lowest amongst the 34 OECD countries, and comparable to Israel.
It is not unknown to have to wait for over an hour to end up with only a few minutes medical examination with a doctor.
Doctors are usually busy with many tasks. The number of consultations per doctor is highest next to Korea (Japan: 13; OECD34 average : 6.9).
Sometimes, this situation makes it difficult to secure a time for a doctor to counsel a patient and ease their anxiety.
How can we solve this problem?
The solution could lie in one of the largest infrastructure components in Japan, the pharmacy.
There are over 56,000 pharmacies in Japan which is a greater number than that of convenience stores.
The number of pharmacists in Japan is the highest across OECD, over 3 million as per the 2016 MHLW report and about 57% of pharmacists (over 1.7 million) work in pharmacies.
In Japan, a patient passes the prescription that a doctor has issued them to the pharmacy and the pharmacist provides the medicine on the basis of the prescription.
The number of prescriptions is about 800 million every year and it means that a large number of face-to-face interactions between patient and pharmacist occur every day.
Pharmacists are educated and well-trained health care professionals who manage the distribution of medicines to patient and help ensure their safety and proper use.
In Japan, pharmacy students receive education for six years since 2006 (was previously 4 years). This range is the same as medical students and longer than nurse students, taking 11 weeks training in both hospital and pharmacy respectively.
They learn specialized subjects such as pharmacokinetics and pharmacology whereas medical student learns pathology, anatomy and diagnostics etc.
Pharmacists therefore have important roles including the prevention of poly-pharmacy which is the condition of taking more than 4-6 medicine at once, often leading to the adverse event.
They also need to make clarification inquiries with the doctor if the prescription looks incorrect.
In addition to that, they sometimes have a social role to play by promoting a generic drug which would decrease the medical expense.
Over the past decades, the need for home medical care service has been increasing and the total supportive healthcare service among doctor and co-medical is expected to keep growing.
Some young active pharmacists have begun thinking about their contribution to the home medical care arena and are trying to get involved. That may prevent the more frail patients from worsening and remain within the remit of primary nursing care.
On the other hand, the pharmacist's role has normally includes many tasks besides dispensing medicine to patients which include the instruction on its use, sometimes inventory control, labor management and profitability evaluation etc.
Some experts say pharmacists have limited opportunity to face the patients normally, such as checking the adherence or passing the medicine because of their many other tasks.
That's why they sometimes receive criticism such as ‘What is the value of a pharmacist?’ especially from Japan Medical Association.
A Japanese HealthTech startup is trying to solve this problem.
Kakehashi was founded by CEO Yutaka Nakao in March 2016.
Their mission is to increase the value of a pharmacist and enable the pharmacist to provide value to their patients who want to keep themselves healthy and better.
They provide a unique electronic medicine history management system, named ‘MUSUBI' to pharmacists. So what is MUSUBI?
Pharmacists have many tasks to complete such as medication counseling and recording. After counseling a patient, pharmacists are required to record the result of counseling such as subjective and objective information, assessment and planning etc. This is usually time consuming. MUSUBI can support the pharmacists through leading through completing both medication counseling and recording at once. That saves a pharmacist's time and helps them focus on spending time with the patient.
In addition to freeing more time, MUSUBI provides the pharmacist with health advice for the patient. Such advice is selected by taking into consideration each patient's conditions. Young pharmacists can also learn from the advice provided by MUSUBI, thus helping them to provide value to their patients.
The role of the pharmacist has changed over recent years. Pharmacists are expected not only to dispense medications but also to provide direct care to patients, both in community pharmacies and as part of integrated health care teams.
There are some success stories that the active intervention of a pharmacist creates important rules to increase a patient’s QOL and controlling adherence.
For example, a patient who receives home medical service but has trouble with serious bedsores for long time in spite of home medical curing. A pharmacist joined the medical team and advised changing mixture ratio of ointments and how to use. This intervention was successful in curing the patient’s serious bedsores within a few months.
Doctors are increasingly expecting pharmacists to play the important role of providing primary care by making use of their expertise.
Dr. Kenji Hazama, who is a cardiac surgeon and the CEO of Pharmedico Co., Ltd., said "If the pharmacist can support the patients after dispensing medicine, the quality of drug therapy should be rapidly increased“
It may be time to fundamentally change the role of the pharmacy in Japan.
Authored by: Emi Maruyama
GGA Country Ambassador Japan
Customer Success - Kakehashi Co.
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