Waseda WeeklyWaseda Weekly

Japan's rare and valuable medical and nursing care big data is one of the largest in the world in terms of scale and comprehensiveness

Professor Noguchi, please tell us about your research area.

I specialize in health economics. It is an interdisciplinary field of medicine and economics, but in the narrow sense, there is pharmacoeconomics, which examines the cost-effectiveness of drugs, and in a broader sense, it also covers policy evaluation to determine whether the cost-effectiveness system itself is truly improving the efficiency of medical services and whether it is useful to patients. Furthermore, in the broadest sense, there is even a concept of health economics, which analyzes from an economic perspective what role medical and nursing care services play in people's health and lives, and what socio-economic factors (such as education and income) affect people's health and lives.

One of my long-standing research themes is the evaluation of medical policies, and I conduct empirical analysis of medical policies implemented by the government using big data on the medical and nursing care of citizens.

Health Economics

What is medical and nursing care big data?

There are several databases owned by the government, but the most basic database is the "Receipt Information and Specific Medical Examination Information Database (commonly known as the NDB)," which contains information on receipts (medical fee statements) and specific medical examinations that you receive when you receive medical treatment at a hospital, including the name of the injury or illness, the name of medication, the results of the examination, medical expenses incurred, etc. Additionally, nursing care receipts can tell you the type of nursing care service and the level of nursing care certification required.

A database other than the "Database of Medical Insurance Information and Specific Medical Examination Information (commonly known as NDB)" owned by the government. From the materials of the 176th Social Security Council Medical Insurance Subcommittee of the Ministry of Health, Labor and Welfare

​By linking these databases to various anonymized information such as insured person numbers and personal information, the scope of analysis can be expanded and they are being used in medical policy planning and various research projects. By tracking the information linked to anonymized identification numbers, it is possible to find out what illness a person had, what treatment they received, how long it took to recover, and how much it cost in total. In addition, by linking it to nursing care receipts, it is possible to analyze the relationship between illnesses that occurred before the person became dependent on nursing care.

Similar data collection began in the United States in 1984, while in Japan it began operations in 2009. In both cases, the background was that with the burden of enormous medical expenses becoming a social issue, it was necessary to consider how to utilize limited financial resources to provide efficient medical services, and empirical analysis was required as evidence for that decision.

In addition, Japan's medical and nursing care database is one of the world's largest and most comprehensive, making it extremely valuable. Unlike the United States, Japan has a universal health insurance system, so data on all age groups, from infants to the elderly, is available. In addition, because Japan has a larger population than the Nordic countries, which have made early use of medical information, we can expect a reasonable number of samples for intractable diseases and disabilities with low incidence rates.

(*) The only public health insurance systems in the United States are Medicare, which covers people aged 65 or over and people with disabilities, and Medicaid, which covers low-income people.

"Public benefit" is the key to utilizing health and nursing care big data

What are the challenges facing medical and nursing care databases?

When using databases, while ensuring anonymity and protecting personal information is a basic premise, a very important issue is how to ensure public benefit. In the past, only government agencies and researchers were allowed to use the data for the purposes of formulating and examining medical policies, but nowadays, private companies such as pharmaceutical companies and insurance companies are also allowed to use the data, provided they comply with compliance requirements.

For example, pharmaceutical companies can analyze the subsequent medical history of patients who have used a specific drug from medical receipts, and use the data in new drug development. At first glance, this may seem like a case where public benefit would be easily recognized, but depending on the data items provided, it could also be used for commercial purposes, such as to market to medical institutions or regions that do not use the drug in question. As such, extremely careful judgment is required when granting permission to use data. The Ministry of Health, Labour and Welfare has established a strict review system that includes experts for applications for use, and only the minimum amount of data necessary is provided.

Currently, in the United States, a large fee is required when a third-party organization applies to use big data related to healthcare. The fee is the same regardless of whether the organization is a university institution, pharmaceutical company, or insurance company. This is a reasonable response in the sense that part of the fee can be invested in improving the data management environment, but on the other hand, there is an undeniable risk that the way data is used and its public benefit will be distorted depending on financial capabilities.

Tackling social issues caused by a declining birthrate and aging population through data analysis

What specific types of analyses are being carried out using medical and nursing care big data?

Since the beginning of this century, there has been a global trend in analyzing medical information in relation to social background such as income and educational environment. Health and medical issues are now being actively approached from the perspectives of economics and sociology, which were previously seen as unrelated to medical research.

At present, while medical receipts can tell us what illnesses an anonymous individual has and what treatments they have received, we cannot learn about that person's social background. However, to get a true picture of their health, it is essential to know their social background, such as their family structure, whether they have a support system, and their economic situation. Without this, it is impossible to distinguish whether a person's health condition is being affected by a medical policy or whether other social or economic factors are to blame. If it becomes possible to combine​ ​medical and nursing care big data with social backgrounds for analysis, more precise policy evaluations will become possible.

What do you find fascinating about health economics research?

The research we are working on provides evidence in the form of​ ​data, which can help push through sometimes stagnant policy debates and promote better medical policies. It's rewarding when you feel a positive response after influencing medical policy.

For example, when the Health Insurance Act was partially revised in October 2022, and the self-pay rate for medical expenses for elderly people aged 75 and over with a certain income increased from 10% to 20%, our research team decided to analyze how the health status and actual use of medical services changed according to the income of the elderly. In this study, the analysis showed that elderly people who had a 20% burden rate tended to refrain from using medical services for a while, but returned to normal usage rates after six months. Although it is necessary to verify how the period when the use of medical services was refrained from affected health, this pattern of medical demand was reported by the Social Security Council (Medical Insurance Subcommittee), and will likely have an impact on future policy discussions.

​If we can prove with data, as in this case, that there are efforts that can reduce the burden on society as a whole without worsening the health of the elderly, I believe we can make at least some improvement to the social security system, which is currently facing concerns about its sustainability.

In business and social policy, we often hear the term "triple benefit," but personally, I think it is unrealistic. The increase in the burden on the working generation in the field of social security is one example of this, and since there is a budget limit, we have to say that there is no solution that satisfies both the elderly and the working generation 100%. However, even in the real world where we face a trade-off where someone gains and someone loses, I would like to continue this research so that only young people, who will lead the future, do not suffer disadvantages, and to create a society where all members of society can live on the same starting line.

Lastly, please give a message to Waseda University students.

Data-based analysis is applicable not only to science but also to the humanities. Just as text mining, which extracts useful information from huge amounts of text data, is gaining attention, the ability to handle data can be applied to any academic field. Furthermore, in this day and age, learning data science should be a great advantage no matter what career you choose. I hope that you will acquire the ability to correctly organize, analyze, and interpret data while you are at our school.

However, working with data requires more than just technical skills such as analysis. The ability to listen to and empathize with what others say, and the imagination to think about the society and environment that surrounds them are also important. In terms of cultivating empathy and imagination, it is also important to read novels, engage seriously with friends and loved ones, and even go on a trip to experience something out of the ordinary. I believe that the power of data utilization truly comes to life only when you have respect for others and for societies different from the one you were born and raised in. Keep this in mind and try all sorts of different things.