Special Feature: The 30th CMAAO General Assembly & 51st Council Meeting Country Report
JAPAN MEDICAL ASSOCIATION*
1
Yoshitake YOKOKURA1
Japan attained the goal of establishing the universal health insurance system in 1961. In recent years, the Long-term Care Insurance System and Medical Insurance System for the Elderly aged 75 or over were established in 2000 and 2008, respectively to maintain national health in the aging society. Seeing the historical changes of the population ratio of those over 65 years old in Japan, we can estimate that the ratio will be rising from 23% in 2010 to 39.9% in 2060. Thus, Japan will be aging at an unprecedentedly rapid pace. As Japan approaches a super-aged society, what is required is to establish the stronger community health provision system focusing care of the elderly, to improve and strengthen the roles of family physicians in the comprehensive community health care system, and to build a sustainable health care system which meets the needs of the people in communities. To achieve this goal, the JMA requested the national government to bear the financial burden, which led to the General Security Fund for Community Medicine and Long-term Care with 7.5 billion US$ for medicine and 60 billion US$ for long-term care in 2014. Using this fund, we will do our best in supporting any effort by local medical associations that aim to realize effective and quality medical and long-term care. In Japan, we have health check-up systems which totally provide us with a health check-up covering a whole life from infant to the old-old stage of elderly. However, these systems are provided individually and there is no integrated system to manage the personal life-long health
information by connecting these individual systems. The JMA proposes the government to incorporate these in to the plan of “Life-long Health Services.” To manage the personal wholelife health information in an integrated way helps to reduce the gaps between average life expectancy and healthy life expectancy. Having many more healthy elderly in a society may also keep the medical costs lower. The JMA is also endeavoring to increase healthy longevity by incorporating the health check-up programduring the period from childhood, working years to old age in the plan of “Life-long Health Services.” For disaster preparedness by the medical profession, the JMA was appointed as a designated public organization in August 2014 which reviews the government’s Basic Disaster Provision Plan. Dr. Yoshitake Yokokura, President of the JMA was also appointed a member of the Central Disaster Prevention Council in June 2015 which consists of the cabinet ministers with Prime Minister as chair. In the areas of overseas medical assistance, the JMA extended medical support to Nepal which was severely damaged by the great earthquake in April 2015. As requested mainly by the Taiwan Medical Association, the JMA also dispatched six Japanese specialists to Taiwan to provide medical assistance to many patients with a severe burn injury by the accident of dust explosion which occurred in June of this year. The case of Taiwan was carried out based on the iJMAT program which the JMA has been promoting.
*1 This article is base on a presentation made as the Report of Activities by each NMA at the 30th CMAAO General Assembly and 51st Council Meeting, Yangon, Myanmar, on September 23-25, 2015.
1
236
President, Japan Medical Association, Tokyo, Japan ([email protected]).
JMAJ, December 2015—Vol.58, No. 4
JAPAN MEDICAL ASSOCIATION
CMAAO Myanmar General Assembly
Country Report
Social Security System of Japan Oct 1950 Social Security Advisory Council presented Social Security System Recommendations – Recommended that all citizens should be eligible for national health insurance policy Mar 1956 Eligibility status of public health insurance – Approx. 30 million people were still NOT eligible їAbout 30% of the population were NOT insured
September 24, 2015
Apr 1961 Universal Health Insurance System was established Apr 2000 Long-term Care Insurance System was implemented
Yoshitake Yokokura, M.D. President Japan Medical Association
Apr 2008 Medical Insurance System For the Elderly Aged 75 Or Over was implemented
㻝㻌
Transition of the Population of age 65 or over
Ageing speed: International Comparison
45% 39.9%
40% Korea 㡑ᅜ
35%
᪥ᮏ Japan
30%
33.6% 30.1%
Germany
䝣䝷䞁䝇 France 䝗䜲 䝒
25%
26.2% 25.1%
23.0% Sweden 䝇䜴䜵䞊䝕䞁
20%
21.9%
20.4% United 䜲䜼䝸䝇 Kingdom
18.2% 16.8% 16.6%
15%
䜰䝯䝸䜹 United States
13.1% 11.1%
10% 5% 0% 1950
1960
1970
1980
1990
2000
2010
2020
2030
2040
Emergency care in an acute ward
The Fund (medicine) will support functional differentiation and secure human resources training
Community support projects will support the collaboration of medical and long-term care
JMAJ, December 2015 —Vol.58, No.4
The Fund (long-term care) will support long-term care system and train nursing staff
Rehabilitation in a convalescent ward
Community Medicine Plan (Vision) will help differentiate medical functions and secure human resources
doubling period (years)
Japan Japa an Germany man ny U.K. U.K K. U.S. U.S S. Sweden Swede en France
7㸣 197 1970 70 1932 193 32 1929 192 29 1942 194 42 1887 188 87 1864
14㸣 1994 199 94 1972 197 72 1976 197 76 2015 201 15 1972 197 72 1979
7㸣ĺ14㸣 244 400 477 733 855 115
Korea Kore ea Brazil Braz zill Thailannd Thailand Tunisia Tunisi siia China
19999 1999 2011 201 11 11 2003 200 03 2009 200 09 2001
20117 2017 2032 203 32 2025 202 25 2032 203 32 2026
1188 2211 2222 2233 25
2
Toward Comprehensive Medical and Long-term Care Community-based Comprehensive Care System Approach
% of population Ӎ 65 y/o
2050 2060 䠄㼥㼑㼍㼞䠅㻌
Source : United Nations, World Population Prospects 2010, Ministry of Internal Affairs and Communications, Japan
A man fell at home and was h transported by an t tra ambulance
Country
3
Promotion of Community-based Comprehensive Care System z The General Security Fund for Community Medicine and
Long-term Care was established by request from JMA.
Recuperation in chronic ward
z In 2014, Moves to home care
752
million USD or 90.4 billion yen for medicine 602 million USD or 72.4 billion yen for long-term care
The Fund (medicine) will support home care
*JPY-USD exchange rate is as of Sept. 11, 2015.
4
㻶㼍㼜㼍㼚㻌㻹㼑㼐㼕㼏㼍㼘㻌㻭㼟㼟㼛㼏㼕㼍㼠㼕㼛㼚㻌
5
237
Yokokura Y
Disaster Victims Health Support Liaison Council
To Extend Healthy Life Expectancy
After the 311 Disaster in 2011, the Disaster Victims Health Support Liaison Council was established to support the health of disaster victims.
Need to shorten
Average Life Expectancy
JMA’s Roles
㻌 㻌 㻌 㻌 㻌 㻌 㻌 Healthy Life Expectancy
Infant checkups
Health checkups for employees
Industrial Safety and Health Act Maternal School checkups MHLW Labour Standards Bureau and Child School Health Health Act and Safety Act Specific checkups MEXT Sports and Youth Bureau
MHLW Equal Employment, Children and Families Bureau
Age 0
MHLW Health Insurance Bureau & Health Service Bureau
6
[Infancy]
Health insurance Insurers (mandated)
18 22 [School Age]
40
Health checkups for the elderly aged 75+
Assurance of Medical Care for Elderly People Act
Ministry of Health, Labour and Welfare
MHLW Health and Welfare Bureau for the Elderly & Health Insurance Bureau
Ministry of Education, Culture, Sports, Science and Technology
M 70.4 75 F 73.6
[Work Age]
Japan Medical Association (JMA)
䞉Counterpart of the Chair & government Secretary 䞉Keystone in multidisciplinary General collaboration
M 79.6 F 86.3
Reconstruction Agency
[Elderly]
Japan Hospital Association
Japan Dental Association
Association of Japanese Healthcare Corporations
Japan Pharmaceutical Association
Japan Psychiatric Hospitals Association
Japanese Nursing Association
Japan Association of Medical and Care Facilities
Cabinet Office
Systemize as “Life-long Health Services” 6
JMA’s Position in the National Disaster Management
All Japan Hospital Association
Japan Red Cross Society
Association of Japanese Medical Colleges
Conference to Promote Team Medicine (consisting of 16 professional organizations) Rehabilitation support organizations (consisting of 10 rehabilitation and long-term care related organizations) The Japan Association of Radiological Technologists
Secretary General
The Japan Dietetic Association Japanese Paramedics Association Japanese Society of Hospital Pharmacists Japanese Society of Certified Clinical Psychologists Japan Association of Geriatric Health Services Facilities
7
International Relief Activities for Disaster MedicineMay 2006 Central Java Earthquake
ͻ JMA dispatched 1393 teams of 6054 JMAT (Japan Medical Association Team) staff in total in the 311 Disaster. Additional medical teams were also continually sent for months.
The joint reconstruction project of JMA and AMDA after the Central Java Earthquake hit the island on May 27, 2006.
(Aug. 1, 2014) Prime Minister Abe appointed JMA as a Designated Public Organization according to the Basic Act on Disaster Control Measures (June 9, 2015) Prime Minster Abe appointed the JMA President as a member of the Central Disaster Prevention Council
Construction of the Banguntapan Third Health Center in Yogyakarata AMDA: The Association of Medical Doctors of Asia
8
International Relief Activities for Disaster Medicine-
9
Japan Medical Association
International Relief Activities for Disaster MedicineNov. 2013 Philippines Typhoon Yolanda
May 2006 Central Java Earthquake
Leyte Medical Society (LMS) The center plays an important role in the local healthcare infrastructure.
New LMS building located in a hill side was constructed by donations from the JMA and its members. Open ceremony was held on March 8th, 2015.
The average number of patients is about 88 daily. (24,000/year) Japan Medical Association
238
Old LMS building located near the sea and was damaged by the Typhoon Yolanda.
10
Japan Medical Association
11
JMAJ, December 2015—Vol.58, No. 4
JAPAN MEDICAL ASSOCIATION
International Relief Activities for Disaster Medicine-
International Relief Activities for Disaster MedicineApril 2015 Nepal Earthquake
Nov. 2013 Philippines Typhoon Yolanda
After a major earthquake hit Nepal on April 25, 2015, the JMA assisted in disaster relief through AMDA and started a mental health project for schools and communities by the donations from the JMA and its members.
Leyte Medical Society (LMs) Opening ceremony, March 8th 2015
Dr. Suganami, Representative of AMDA visited the Nepal Medical Association requested by the JMA on May 3. Dr. Ojha is a Vice President of the Nepal Medical Association and also the representative of AMDA Nepal.
Plate for appreciation Dr. Saroj Prasad Ojha䚸Dr. Anjani Kumar Jha䚸Dr. Shigeru Suganami (AMDA) Vice President of NMA, President of NMA
Maternity Day Event,Japan March 2015 Medical Association
12
Dispatching of the JMA Burn Care Support Team to Taiwan
Conclusion of iJMAT Agreement
June 2015 Dust Explosion Accident
The Agreement between the Japan Medical Association and the Taiwan Medical Association concerning Mutual Consent on Dispatching Physicians and Assistance Systems for Medical Relief Assistance in Disaster Situations䠄iJMAT Agreement) .
Dr. Yoshitake Yokokura (JMA) Dr. Chung-Chuan Su (TMA)
13
Japan Medical Association
When the dust explosion accident occurred in Taiwan in June of this year, many suffered severe burns. Under the concept of the iJMAT agreement, JMA accepted the request for emergency medical support and sent 6 burn specialists.
Dr. Yoshitake Yokokura (JMA) Dr. Chi-Chun Liu (Taiwan Root Medical Peace Corps)
14
Japan Medical Association
Demonstration Experiment simulating the Great Nankai Trough Earthquake -Disaster prevention training-
15
Japan Medical Association
Thank you for your attention!
Kizuna Internet connection Information sharing by Cloud Type Web conference system JAXA Tsukuba Space Center
HD Video Images Transmission
JMA Mie MA
Kochi MA
Shizuoka MA Other Prefectural Medical Associations
-DSDQ0HGLFDO$VVRFLDWLRQ
Miyazaki MA
16
JMAJ, December 2015 —Vol.58, No.4
17
239
JAPAN MEDICAL ASSOCIATION*
1
Yoshitake YOKOKURA1
Japan attained the goal of establishing the universal health insurance system in 1961. In recent years, the Long-term Care Insurance System and Medical Insurance System for the Elderly aged 75 or over were established in 2000 and 2008, respectively to maintain national health in the aging society. Seeing the historical changes of the population ratio of those over 65 years old in Japan, we can estimate that the ratio will be rising from 23% in 2010 to 39.9% in 2060. Thus, Japan will be aging at an unprecedentedly rapid pace. As Japan approaches a super-aged society, what is required is to establish the stronger community health provision system focusing care of the elderly, to improve and strengthen the roles of family physicians in the comprehensive community health care system, and to build a sustainable health care system which meets the needs of the people in communities. To achieve this goal, the JMA requested the national government to bear the financial burden, which led to the General Security Fund for Community Medicine and Long-term Care with 7.5 billion US$ for medicine and 60 billion US$ for long-term care in 2014. Using this fund, we will do our best in supporting any effort by local medical associations that aim to realize effective and quality medical and long-term care. In Japan, we have health check-up systems which totally provide us with a health check-up covering a whole life from infant to the old-old stage of elderly. However, these systems are provided individually and there is no integrated system to manage the personal life-long health
information by connecting these individual systems. The JMA proposes the government to incorporate these in to the plan of “Life-long Health Services.” To manage the personal wholelife health information in an integrated way helps to reduce the gaps between average life expectancy and healthy life expectancy. Having many more healthy elderly in a society may also keep the medical costs lower. The JMA is also endeavoring to increase healthy longevity by incorporating the health check-up programduring the period from childhood, working years to old age in the plan of “Life-long Health Services.” For disaster preparedness by the medical profession, the JMA was appointed as a designated public organization in August 2014 which reviews the government’s Basic Disaster Provision Plan. Dr. Yoshitake Yokokura, President of the JMA was also appointed a member of the Central Disaster Prevention Council in June 2015 which consists of the cabinet ministers with Prime Minister as chair. In the areas of overseas medical assistance, the JMA extended medical support to Nepal which was severely damaged by the great earthquake in April 2015. As requested mainly by the Taiwan Medical Association, the JMA also dispatched six Japanese specialists to Taiwan to provide medical assistance to many patients with a severe burn injury by the accident of dust explosion which occurred in June of this year. The case of Taiwan was carried out based on the iJMAT program which the JMA has been promoting.
*1 This article is base on a presentation made as the Report of Activities by each NMA at the 30th CMAAO General Assembly and 51st Council Meeting, Yangon, Myanmar, on September 23-25, 2015.
1
236
President, Japan Medical Association, Tokyo, Japan ([email protected]).
JMAJ, December 2015—Vol.58, No. 4
JAPAN MEDICAL ASSOCIATION
CMAAO Myanmar General Assembly
Country Report
Social Security System of Japan Oct 1950 Social Security Advisory Council presented Social Security System Recommendations – Recommended that all citizens should be eligible for national health insurance policy Mar 1956 Eligibility status of public health insurance – Approx. 30 million people were still NOT eligible їAbout 30% of the population were NOT insured
September 24, 2015
Apr 1961 Universal Health Insurance System was established Apr 2000 Long-term Care Insurance System was implemented
Yoshitake Yokokura, M.D. President Japan Medical Association
Apr 2008 Medical Insurance System For the Elderly Aged 75 Or Over was implemented
㻝㻌
Transition of the Population of age 65 or over
Ageing speed: International Comparison
45% 39.9%
40% Korea 㡑ᅜ
35%
᪥ᮏ Japan
30%
33.6% 30.1%
Germany
䝣䝷䞁䝇 France 䝗䜲 䝒
25%
26.2% 25.1%
23.0% Sweden 䝇䜴䜵䞊䝕䞁
20%
21.9%
20.4% United 䜲䜼䝸䝇 Kingdom
18.2% 16.8% 16.6%
15%
䜰䝯䝸䜹 United States
13.1% 11.1%
10% 5% 0% 1950
1960
1970
1980
1990
2000
2010
2020
2030
2040
Emergency care in an acute ward
The Fund (medicine) will support functional differentiation and secure human resources training
Community support projects will support the collaboration of medical and long-term care
JMAJ, December 2015 —Vol.58, No.4
The Fund (long-term care) will support long-term care system and train nursing staff
Rehabilitation in a convalescent ward
Community Medicine Plan (Vision) will help differentiate medical functions and secure human resources
doubling period (years)
Japan Japa an Germany man ny U.K. U.K K. U.S. U.S S. Sweden Swede en France
7㸣 197 1970 70 1932 193 32 1929 192 29 1942 194 42 1887 188 87 1864
14㸣 1994 199 94 1972 197 72 1976 197 76 2015 201 15 1972 197 72 1979
7㸣ĺ14㸣 244 400 477 733 855 115
Korea Kore ea Brazil Braz zill Thailannd Thailand Tunisia Tunisi siia China
19999 1999 2011 201 11 11 2003 200 03 2009 200 09 2001
20117 2017 2032 203 32 2025 202 25 2032 203 32 2026
1188 2211 2222 2233 25
2
Toward Comprehensive Medical and Long-term Care Community-based Comprehensive Care System Approach
% of population Ӎ 65 y/o
2050 2060 䠄㼥㼑㼍㼞䠅㻌
Source : United Nations, World Population Prospects 2010, Ministry of Internal Affairs and Communications, Japan
A man fell at home and was h transported by an t tra ambulance
Country
3
Promotion of Community-based Comprehensive Care System z The General Security Fund for Community Medicine and
Long-term Care was established by request from JMA.
Recuperation in chronic ward
z In 2014, Moves to home care
752
million USD or 90.4 billion yen for medicine 602 million USD or 72.4 billion yen for long-term care
The Fund (medicine) will support home care
*JPY-USD exchange rate is as of Sept. 11, 2015.
4
㻶㼍㼜㼍㼚㻌㻹㼑㼐㼕㼏㼍㼘㻌㻭㼟㼟㼛㼏㼕㼍㼠㼕㼛㼚㻌
5
237
Yokokura Y
Disaster Victims Health Support Liaison Council
To Extend Healthy Life Expectancy
After the 311 Disaster in 2011, the Disaster Victims Health Support Liaison Council was established to support the health of disaster victims.
Need to shorten
Average Life Expectancy
JMA’s Roles
㻌 㻌 㻌 㻌 㻌 㻌 㻌 Healthy Life Expectancy
Infant checkups
Health checkups for employees
Industrial Safety and Health Act Maternal School checkups MHLW Labour Standards Bureau and Child School Health Health Act and Safety Act Specific checkups MEXT Sports and Youth Bureau
MHLW Equal Employment, Children and Families Bureau
Age 0
MHLW Health Insurance Bureau & Health Service Bureau
6
[Infancy]
Health insurance Insurers (mandated)
18 22 [School Age]
40
Health checkups for the elderly aged 75+
Assurance of Medical Care for Elderly People Act
Ministry of Health, Labour and Welfare
MHLW Health and Welfare Bureau for the Elderly & Health Insurance Bureau
Ministry of Education, Culture, Sports, Science and Technology
M 70.4 75 F 73.6
[Work Age]
Japan Medical Association (JMA)
䞉Counterpart of the Chair & government Secretary 䞉Keystone in multidisciplinary General collaboration
M 79.6 F 86.3
Reconstruction Agency
[Elderly]
Japan Hospital Association
Japan Dental Association
Association of Japanese Healthcare Corporations
Japan Pharmaceutical Association
Japan Psychiatric Hospitals Association
Japanese Nursing Association
Japan Association of Medical and Care Facilities
Cabinet Office
Systemize as “Life-long Health Services” 6
JMA’s Position in the National Disaster Management
All Japan Hospital Association
Japan Red Cross Society
Association of Japanese Medical Colleges
Conference to Promote Team Medicine (consisting of 16 professional organizations) Rehabilitation support organizations (consisting of 10 rehabilitation and long-term care related organizations) The Japan Association of Radiological Technologists
Secretary General
The Japan Dietetic Association Japanese Paramedics Association Japanese Society of Hospital Pharmacists Japanese Society of Certified Clinical Psychologists Japan Association of Geriatric Health Services Facilities
7
International Relief Activities for Disaster MedicineMay 2006 Central Java Earthquake
ͻ JMA dispatched 1393 teams of 6054 JMAT (Japan Medical Association Team) staff in total in the 311 Disaster. Additional medical teams were also continually sent for months.
The joint reconstruction project of JMA and AMDA after the Central Java Earthquake hit the island on May 27, 2006.
(Aug. 1, 2014) Prime Minister Abe appointed JMA as a Designated Public Organization according to the Basic Act on Disaster Control Measures (June 9, 2015) Prime Minster Abe appointed the JMA President as a member of the Central Disaster Prevention Council
Construction of the Banguntapan Third Health Center in Yogyakarata AMDA: The Association of Medical Doctors of Asia
8
International Relief Activities for Disaster Medicine-
9
Japan Medical Association
International Relief Activities for Disaster MedicineNov. 2013 Philippines Typhoon Yolanda
May 2006 Central Java Earthquake
Leyte Medical Society (LMS) The center plays an important role in the local healthcare infrastructure.
New LMS building located in a hill side was constructed by donations from the JMA and its members. Open ceremony was held on March 8th, 2015.
The average number of patients is about 88 daily. (24,000/year) Japan Medical Association
238
Old LMS building located near the sea and was damaged by the Typhoon Yolanda.
10
Japan Medical Association
11
JMAJ, December 2015—Vol.58, No. 4
JAPAN MEDICAL ASSOCIATION
International Relief Activities for Disaster Medicine-
International Relief Activities for Disaster MedicineApril 2015 Nepal Earthquake
Nov. 2013 Philippines Typhoon Yolanda
After a major earthquake hit Nepal on April 25, 2015, the JMA assisted in disaster relief through AMDA and started a mental health project for schools and communities by the donations from the JMA and its members.
Leyte Medical Society (LMs) Opening ceremony, March 8th 2015
Dr. Suganami, Representative of AMDA visited the Nepal Medical Association requested by the JMA on May 3. Dr. Ojha is a Vice President of the Nepal Medical Association and also the representative of AMDA Nepal.
Plate for appreciation Dr. Saroj Prasad Ojha䚸Dr. Anjani Kumar Jha䚸Dr. Shigeru Suganami (AMDA) Vice President of NMA, President of NMA
Maternity Day Event,Japan March 2015 Medical Association
12
Dispatching of the JMA Burn Care Support Team to Taiwan
Conclusion of iJMAT Agreement
June 2015 Dust Explosion Accident
The Agreement between the Japan Medical Association and the Taiwan Medical Association concerning Mutual Consent on Dispatching Physicians and Assistance Systems for Medical Relief Assistance in Disaster Situations䠄iJMAT Agreement) .
Dr. Yoshitake Yokokura (JMA) Dr. Chung-Chuan Su (TMA)
13
Japan Medical Association
When the dust explosion accident occurred in Taiwan in June of this year, many suffered severe burns. Under the concept of the iJMAT agreement, JMA accepted the request for emergency medical support and sent 6 burn specialists.
Dr. Yoshitake Yokokura (JMA) Dr. Chi-Chun Liu (Taiwan Root Medical Peace Corps)
14
Japan Medical Association
Demonstration Experiment simulating the Great Nankai Trough Earthquake -Disaster prevention training-
15
Japan Medical Association
Thank you for your attention!
Kizuna Internet connection Information sharing by Cloud Type Web conference system JAXA Tsukuba Space Center
HD Video Images Transmission
JMA Mie MA
Kochi MA
Shizuoka MA Other Prefectural Medical Associations
-DSDQ0HGLFDO$VVRFLDWLRQ
Miyazaki MA
16
JMAJ, December 2015 —Vol.58, No.4
17
239
