Koichi Kawabuchi: Putting the patient at the center of medical reform
by Kirk R. Patterson
Koichi Kawabuchi (46), a native of Toyama, graduated from Hitotsubashi University in commerce and received his MBA from the University of Chicago. He is a professor at Tokyo Medical and Dental University, with his main teaching and research interests being health economics, health policy, and hospital management. He writes and lectures regularly on various aspects of Japanese medical reform.
With an undergraduate degree in commerce, how did you develop your interest in medical reform?
After graduating from college, I wanted to enter the restaurant business, so to study the restaurant industry in other countries, I hitchhiked and took Greyhound buses around the U.S., Canada, and Mexico. I quickly realized that the restaurant business was not so interesting, but, on the other hand, I became very interested in healthcare as a business.
After completing my MBA in healthcare management, I returned to Japan and became a managing director of a company that operated retirement housing facilities, nursing homes, and hospitals. I became frustrated, however, by dealing with government regulations, so I decided to get more involved in policy-related research.
What is the main focus of your research?
My research looks at the Japanese and U.S. healthcare systems. Specifically, I gather and analyze data in the World Health Report 2000, issued by the World Health Organization (WHO) to determine which system best meets the needs of its citizens. According to the World Health Organization data, the Japanese healthcare system is ranked first in the world, while the U.S. system ranks 15th. That is based on such macro-level factors as access to treatment, healthcare expenditures as a percentage of GDP, infant mortality, and life expectancy. Nevertheless, many Japanese are very dissatisfied with the level of medical care that they receive. In other words, at the micro-level — the patient level — there are many problems with Japanese healthcare. To understand what is behind this macro/micro dichotomy, I am gathering data that sheds light on the patient experience in the U.S. and Japan. While there are significant challenges in gathering data in Japan and in getting data that permit ‘apple-to-apple’ comparisons, what I have been able to analyze so far reveals that the U.S. is far superior to Japan with respect to patient outcomes and the quality of patient care. For example, the mortality rates for major medical procedures, such as heart-bypass surgery, are significantly higher in Japan. The higher mortality rates, in turn, point to such problems as a lower level of surgical techniques and inadequate ambulance services. Also, the level of care across the U.S. is more consistent than in Japan, where the quality varies significantly from hospital to hospital.
What do you hope to accomplish through your research activities?
My goal is to convince physicians and hospitality managers to cooperate in the creation of a benchmarking system that permits comparison of patient outcomes. In such a system, a wide range of data related to the experience of the patient would be gathered and then aggregated and disaggregated in various ways. The results would help highlight areas for improvements in medical treatment. Furthermore, if the information were publicly available, it would allow patients to select the most appropriate physicians and hospitals for the treatment that they need. It would also allow the government to provide incentives and recognition for physicians and hospitals that have better patient outcomes, thereby moving Japan closer to the ‘pay for performance’ model that is increasingly common in the United States. Of course, the medical establishment is opposed to such a benchmarking system.
What are some of the other major medical issues that Japan needs to address?
Certainly, Japan’s fast-aging population creates a host of healthcare-related issues, foremost among them being the high cost of care — more expensive drugs, more expensive technology, and more expensive facilities. Other issues range from the challenge of maintaining service quality to allowing the immigration of healthcare workers. Another related issue is the impact of a declining population on the number of people to staff the healthcare industry.