JANUARY

JAPAN
Force: Japan Pharmaceutical Manufacturers Association 2012). The criteria for coverage include clinical
effectiveness but not economic appraisal. Since 2012, the agency has been discussing the possible application
of comparative cost-effectiveness studies in its decision-making (described below).
Nonprofit organizations work toward public engagement and patient advocacy, and every prefecture establishes
a health care council to discuss the local health care plan. Under the Medical Care Law, these councils must
have members representing patients.
The Japan Fair Trade Commission, an independent governmental administrative commission, promotes fair
competition in health care as well as other sectors.
What are the major strategies to ensure quality of care?
By law, prefectures are responsible for making health care delivery “visions,” which include detailed plans on
cancer, stroke, acute myocardial infarction, diabetes mellitus, psychiatric disease, pediatric, and home care, as
well as emergency, prenatal, rural, and disaster medicine. These plans include structural, process, and outcome
indicators, as well as strategies for effective and high-quality delivery. Prefectures promote collaboration
between providers to achieve them, with or without subsidies as financial incentives.
Waiting times are generally not monitored by government, although there is cause for concern in some clinical
areas, such as palliative care. Although there are structural health care delivery regulations, relatively few apply
to process and outcomes.
Prefectures are in charge of the annual inspection of hospitals. Sanctions include reduced reimbursement rates
if staffing per bed falls below a certain ratio. Hospital accreditation, on the other hand, is voluntary and
undertaken largely as an improvement exercise; roughly one-third of hospitals are accredited by the Japan
Council for Quality Health Care. However, there is no disclosure of names of hospitals that fail the accreditation
process. The Ministry of Health, Labor and Welfare organizes and financially supports a voluntary benchmarking
project, in which hospitals report quality indicators on their websites.
In order to practice, physicians are required to obtain a license by passing a national exam, but they are not
subject to revalidation. However, specialist societies have introduced revalidation for qualified specialists.
Clinical audits are voluntary. Public reporting on performance has been discussed but is not yet implemented.
Every prefecture has a medical safety support center for handling complaints and promoting safety. Since 2004,
advanced academic and public hospitals have been required to report adverse events to the Japan Council for
Quality Health Care.
Disease and medical device registries have been developed on a voluntary basis, possibly to be used for quality
improvement in the future. Surveys of hospital patients’ experiences are conducted every three years.
What is being done to reduce disparities?
Reducing health disparities between population groups has been a general goal since 2012. The two explicit
targets are a reduction of disparities in healthy life expectancies between prefectures and an increase in the
number of local government entities that make efforts to solve health disparity issues (MHLW, 2012b). There is
another plan to reduce disparities among prefectures in cancer treatment delivery, with each prefecture setting
treatment targets. Health variations between regions are regularly reported by government. Health variations
between socioeconomic groups and variations in health care access are occasionally measured and reported by
researchers, some of them funded by the Ministry of Health, Labor and Welfare.
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