JETRO Invest Japan

New Trends for Hospital Business

On March 27, 2007, a press conference was held in

advance of the opening at the end of said month at
Tokyo Midtown Medical Center. This medical cen-
ter, comprising a clinic (that is, not a full-fledged
hospital but a primary-care provider), albeit one
with the latest medical equipment such as Magnetic
Resonance Imaging (MRI), Computed Tomography
(CT) and other expensive medical equipment, a
ÒMedical Concierge ServiceÓ and a tie-up with
U.S.-based Johns Hopkins Medicine International,
caters to the well-to-do expatriate community, but in
the process has stirred up much interest concerning
the hospital business in Japan. One of Siemens’ Angio Systems (see P.3).

Policy Initiative in Hospital Business Looking at the dispensary at this hospital, there are
Though it is an exception based upon the special 13 pharmacists; though the hospital seeks to shore up the
zones for structural reform system propelled by the Japa- nurse corps, it has not been so energetic when it comes to
nese government, there have been moves to establish bringing in additional personnel for the dispensary. This
hospitals founded upon a joint-stock basis, that is, may be in reflection of the fact that MHLW allots Òhealth
Òmedical care provision for a profit.Ó Diagnoses and pre- insurance pointsÓ (diagnosis fees) to institutions with
scriptions, perhaps the main activities to be found ongo- more nurses but this does not hold true when it comes to
ing at medical institutions, can be turned into profit-mak- an increased number of pharmacists. Hospital manage-
ing endeavors. But even without such set-ups, there are ment thus has no incentive to enhance the dispensary
opportunities related to hospitals, as can be seen below. staff as it gains no direct benefit.
In addition, the Ministry of Health, Labour and Wel-
fare (MHLW) has in place the policy of having hospitals
handle advanced medicine such as emergency and hospi- Increasing Responsibility on
talization while clinics are delegated to the role of offer- Drug Safety Management
ing primary care. But some hospitals, especially in regio- Recently, with outpatient-basis cancer chemotherapy
nal cities with a rapidly aging population, have becoming a conventional treatment method, for example,
difficulties adhering strictly to this policy upon offering the role of the pharmacist
treatment services. Ñ in maintaining the can-
cer treatment agent or
monitoring side-effects Ñ
Scene at a Hospital has been expanding.
Tokyo Medical UniversityÕs Kasumigaura Hospital, Moreover, responsibilities
located about an hourÕs ride away from Tokyo on an ex- that may be borne by phar-
press train, is in Tsuchiura, Ibaraki Prefecture. It has macists such as preventing
some 500 beds and is designated as a ÒRegional cancer diseases from being com-
diagnostics cooperation hospitalÓ aimed at providing a municated within the hos-
high level of advanced medicine in the region. Neverthe- pital or taking charge of
less, it does not limit itself to advanced medical care, and Toshiyuki Takahashi, drug safety management
has a very busy outpatient waiting room, as can be wit- Chief of Pharmacy Department,
Tokyo Medical University are to be found throughout
nessed oft in the morning hours. Kasumigaura Hospital the Japanese medical sys-
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tem. According to Mr. Toshiyuki Takahashi, Department
Chief, Pharmacy Department, Tokyo Medical University
Kasumigaura Hospital, ÒThough talk abounds as to im-
provement of the quality of medical treatment, Ôeasier
said than doneÕ is the phrase that reflects the current real-
ity.Ó
The drugs in use within the hospital are selected by
an in-house Òdrug deliberations committeeÓ comprising
doctors, pharmacists and nurses at the hospital, but the
task can be daunting. MHLW now has some 14,000
products recognized for use upon medical treatment, a
number that can be considered to be fairly high. Mr. Ta-
kahashi notes that hospitals generally line up almost all
types of a line of drugs with the same ingredients and ef-
ficacy because the doctors ask that they be able to use
these. The head pharmacist figures, ÒOur hospital carries
at least 1,800 items at all times.Ó
Demand for Efficient Medical Care
Japan, in reflection of recent regulatory changes, has
seen an increase in use of generic drugs. The adoption,
centered upon major hospitals estimated to number
about 370 (MHLW), of the Diagnostic Procedure Com-
bination (DPC)* method added an extra boost to this in-
crease. DPC put a cap upon the fee levels for medical
treatment provided a patient in a day, and has led hospi-
tals to look for methods of keeping costs down. The use
of generic drugs is now attracting attention as one means
of cutting costs.
Actually, the Tokyo Medical University Kasumigaura
Hospital has not yet adopted DPC, so generic drugs are
not being used much. Mr. Takahashi sees the relative
lack of clinical data as one of the reasons for not bring-
ing in generic drugs under current circumstances. De-
spite MHLW efforts to have generic drugs become more
prevalent, since drugs constitute about a third of all
medical costs in Japan, there is a need for more informa-
tion about generic drugs by doctors and pharmacists as
to generic drugs.
The hospital dispensary is also in charge of maintain-
ing the drug information system within the hospital. An
in-house LAN (Local Area Network) is used by the dis-
pensary to provide information on the drug in use at the
hospital on a unified integrated basis. Hospital staff can
input the designated ID and password to browse the in-
formation via terminals located throughout the hospital
grounds. However, the overall electronic information
system at the hospital does not have patient information
integrated therein (exemplified by the Electronic Medi-
cal Records system, it is said that only a tenth of all
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JETRO Invest Japan
medical institutions in Japan have an all-encompassing
electronic information system at this time), so though it
is possible to track prescription drugs, this is not the
case when it comes to details concerning the prescrip-
tions process itself.
* DPC is the new calculation method for diagnosis in Japan. It com-
bines the costs per patient per diem. The calculations use a formula
based on an integrated assessment portion (prescriptions, shots and
other forms of drug delivery, treatment, hospitalization, etc.) and an
actual provision assessment portion (surgery, anesthetics, rehabilita-
tion work, direction charges, etc.), as specified by MHLW.
How to Utilize IT in Medical Care
There are changes tak-
ing place at the medical
scene, where information
technology (IT) is taking
hold within the Japanese
hospital. This is also in
line with the Japanese gov-
ernment strategy, which
places as one of the top IT-
related policy priorities the
need for ÒStructural re-
form of medicine through Isao Nakajima,
the use of information Emergency and Critical Care
Professor of Department of
technology.Ó Medicine, Tokai University
One Japanese doctor School of Medicine
who is concerned about the need to improve the lot of
those suffering from the Digital Divide as well as other
gaps that hamper the way to well-being by many is Dr.
Isao Nakajima (M.D. and Ph.D. in Engineering), Profes-
sor, Tokai University School of Medicine Department of
Emergency and Critical Care Medicine. Dr. Nakajima is
renowned for his promotion of medical applications of
ICT, and in addition to having established the ITU Tele-
medicine Experts Training Course at his university, has
set up tele-centers (using electrocardiography (ECG)
equipment via Public Switched Telephone Networks
(PSTN)) for medical use in Ethiopia, Bhutan and other
Overview of Tokai University Isehara Hospital
2007 Spring
 JETRO Invest Japan

developing countries. Dr. Nakajima, who is also Vice-
Rapporteur for e-health of ITUÕs Development Sector
(ITU-D), sees costs as being one of the main problems
being faced upon providing medicine as a ÒUniversal
ServiceÓ via channels such as telemedicine.
He says, ÒThe facilities and maintenance costs are
exorbitant when it comes to systems (such as Picture Ar-
chiving & Communicating System (PACS)) using radi-
ological equipment. I think since as a system it is just a
LAN system for PCs that are enabled to handle images
using a middleware, and thus can be said to be operable
with just one CD-ROM, there must be ways to make it
much less expensive. This is one reason why ITU-D has
asked that, from last year through the year 2009, teleme-
dicine-related items have patent-royalty fee payments
suspended, and a similar type of arrangement put in place
as well for copyrights of medical system programming.Ó
Challenge to Japanese Medical Culture
On the other hand, one foreign company which has
the Japanese market in mind with the ongoing develop-
ment of a ÒHospital Information SystemÓ is Siemens,
the German multinational. Siemens-Asahi Medical
Technologies Ltd., established in 1979, launched its
Healthcare Services Division in 2004, in order to em-
Medical workplaces are being reformed structurally
through IT
phasize the total commit-
ment it has to this sector
(in Japan), built upon the
medical equipment such
as CT, MRI, PET, and An-
gio Systems and so on,
import/sales as well as
maintenance services.
At the German parent
company, an improved
quality of medicine based Kazuhiro Sugimoto,
upon analysis of accumu- Managing Director and
lated treatment data is to Healthcare Services Division
be attained through devel- Manager of Siemens-Asahi
Medical Technologies Ltd.
opment of a workflow
ÒengineÓ for managing hospital operations overall, just
as corporations use Knowledge Management/Enterprise
Resource Planning as well as risk control. In 2000, Sie-
mens acquired U.S. IT firm Shared Medical Service to
start development of this next generation Hospital Infor-
mation System, which can be said to be a Òworkflow en-
gine.Ó Siemens launched it in 2003 and it has been in-
stalled at over 300 locations in the U.S. and Europe.
This system is to be sold in Japan as the next-generation
Hospital Information System.
Said Mr. Kazuhiro Sugimoto, Managing Director and
Healthcare Services Division Manager, Siemens-Asahi
Medical Technologies Ltd., ÒWe are now preparing the
groundwork upon introducing our new system into the
Japanese market. This is not only localization in terms of
language but also in terms of Japanese culture related to
medicine.Ó Asserts Mr. Sugimoto, ÒEven in the Japanese
market, the medical IT market is bound to grow. It is ho-
ped that this will lead to improved efficiency and low-
ered costs.Ó
Publisher : Japan External Trade Organization
Editor : Three ÒIÓ Publications, Ltd.
Writers : Kaoru Sakai / Megumi Sakai

For more information, please contact

Tokyo Medical University Tokai University School of Siemens-Asahi Medical

Kasumigaura Hospital Medicine Technologies Ltd.
http://ksm.tokyo-med.ac.jp/ http://www.med.u-tokai.ac.jp/ http://www.siemens.co.jp/medical/
Te l : +81-29-887-1161 Te l : +81-463-91-3130 Te l : +81-3-5423-8340
Fax: +81-29-888-2837 Fax: +81-463-91-0780 Fax: +81-3-5423-8494

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