Blurred lines in Japan's vision for healthcare in next two decades

Japan Health Minister Yasuhisa Shiozaki

Japan's efforts to blend cost savings and innovation are so tied up in broader national goals to revive the deflation-hit economy that a plan had to be drawn up for the next two decades--but the documents and slides to describe the ideas seem to deftly avoid any look at the hard choices needed.

The release of the Japan Vison: Health Care 2035 by the Ministry of Health Labor and Welfare this past week was broad brush and more to the point provided little detail about the how to tackle issues that affect the world's second most valuable country drug market. Instead of deep discussion about how to care for a rapidly aging society and change sclerotic public finance models--there are goals akin to beauty pageant calls for World Peace.

"A sustainable health care system that delivers unmatched health outcomes through care that is responsive and equitable to each member of society and that contributes to prosperity in Japan and around the world."

But wait--there are principles too--"fairness," "solidarity built on autonomy" and--again--"shared prosperity for Japan and the world."

Still, MHLW at least mentions the need to "tackle fiscal deficits"--a laudable goal in a country where public debt is more than twice GDP, the industrial world's heaviest burden. What's more, the country's budget is a record $812 billion for the fiscal year starting on April 1 that is in no small part paid for by the central bank announcing it October it would buy ¥80 trillion ($650 billion) of mostly government bonds annually.

At the same time, the government hopes a burst of funding for innovative research in stem cells and other cutting-edge therapies and a push to use more generic drugs works out a magic formula that will pay for a demographic mountain just down the road.

Japan's population will see in one in three people reaching age 65 or older in 2035, the Japan Times noted in a recent story.

But the Vision has an answer there too that again seems out of touch. "Position Japan as the authority on healthy longevity by addressing population ageing and a low birth rate."

To be sure, the flow chart type documents released are backed up by official data and leading experts across healthcare in the country.

But "a health care system built for the next 20 years and designed for all lifestyles and people--from children to older people, from patients to providers"--probably means steps like opening immigration for care workers, and cutting a host of services and having patients pay more out of pocket.

However, there was mention of the need to build clinical development through patient registry, a fast-track the regulatory process for experimental therapies as well as quicker regulatory harmonization for Japan-approved medicines, which presumably means those approved abroad may also get faster nods domestically.

MHLW's Pharmaceuticals and Medical Devices Agency has responded to multinational critics that a lag in approvals for drugs already sanctioned by the U.S. FDA and/or European Medicines Agency is unfair and said that 60% of new drugs were reviewed in just under 12 months in the last fiscal year, beating its target and on track for a goal of 70% for the year started April 1, 2015.

- here are the MHLW Japan Vision 2035 slides and summary