{"id":64630,"date":"2019-04-19T12:53:52","date_gmt":"2019-04-19T03:53:52","guid":{"rendered":"https:\/\/www.waseda.jp\/top\/en\/?p=64630"},"modified":"2019-04-19T12:55:57","modified_gmt":"2019-04-19T03:55:57","slug":"%e7%89%b9%e9%9b%86-feature-vol-20-1%e3%80%80%e7%92%b0%e5%a2%83%e5%95%8f%e9%a1%8c%e3%81%ae%e8%a7%a3%e6%b1%ba%e3%81%b8%e3%80%81%e7%b5%8c%e6%b8%88%e5%ad%a6%e3%81%ae%e3%83%81%e3%82%ab%e3%83%a9%ef%bc%88-4","status":"publish","type":"post","link":"https:\/\/www.waseda.jp\/top\/en\/news\/64630","title":{"rendered":"Waseda Frontline Research Vol. 21: How should healthcare resources be used? A challenge of health economics (Part 2 of 2)"},"content":{"rendered":"

Professor Haruko Noguchi, Faculty of Political Science and Economics
\nHealth Economist<\/h3>\n

Part 2: Aiming to evidence-based policy making<\/h2>\n

\"\"Since the 1990\u2019s, \u201cEvidence-Based Medicine (EBM)\u201d Has been emphasized in medical science. This concept is now not only taking precedence in medical science but also in the system design of the nation, policy making and evaluation. Lately, Professor Haruko Noguchi of the Faculty of Political Science and Economics has also been trying to figure out how to implement \u201cEvidence-Based Policy Making (EBPM)\u201d to the real world. This time, we cover the recent efforts and outcomes of her projects as well as the overall importance of EBPM. (Date of interview: July 17, 2018)<\/i><\/p>\n

Exploring the idea of \u201ccost effectiveness\u201d through doctoral dissertation research<\/h3>\n

While completing my doctoral course at the Graduate Center of the City University of New York (CUNY), I worked on writing my doctoral dissertation under the guidance of three researchers including Professor Michael Grossman, who I introduced in the first section and who was a contributor to the establishment of the theoretical framework in health economics. Looking back now, I believe the research I conducted for my doctoral thesis was the cornerstone of all my research from then on.<\/p>\n

The theme of my doctoral thesis was \u201cEffects of State Medicaid Policies on the Likelihood of Nursing Home Admission and Length of Stay: an Application of the Competing-Risks Models.\u201d \u201cMedicaid\u201d is a public healthcare and long-term care insurance for low-income and disabled people in the United States, which at the time was administered by the state government. The purpose of my doctoral thesis was to clarify how the demand for facility long-term care would be affected by the Medicaid policy.<\/p>\n

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Photo: Professor Michael Grossman (first from the right) who came to Japan for the Japan Health Economics Association held at HOSEI University in 2011 and Professor Noguchi (second from the right)<\/p><\/div>\n

At the time, there were two factors that influenced my decision to research \u201caging\u201d issues in the United States. The first was meeting Dr. Robert Butler at the hospital where I worked as a research assistant. Dr. Butler is said to be \u201cthe father of gerontology,\u201d and he was keen on employing systematic research for gerontology. The second was the rapid aging of Japan\u2019s population. While conducting my research, Professor Grossman suggested I apply for the federal scholarship for $20,000USD that is offered every year to roughly 10 doctoral students across the United States. So I applied and fortunately I was selected as one of the scholarship recipients, giving me the funds I needed to proceed with my research.<\/p>\n

Through my research for this doctoral thesis, I learned the kinds of viewpoints and approaches I could take when studying aging issues, as well as the kinds of analytical methods that can be employed. As the expenses of long-term care and medical care increased, I was able to figure out what kind of policies were most effective for containing the costs, that is, I learned the fundamental thinking required to achieve cost effectiveness.<\/p>\n

Engaged in the original research of \u201cevidence-based medicine\u201d<\/h3>\n

After acquiring my Doctoral Degree from the CUNY, on the recommendations of Professor Grossman, I got the opportunity to continue my research at Stanford University under Professor Mark McClellan for around four years. Professor McClellan was Director of the Food and Drug Administration (FDA) under the administration of George W. Bush and served as Deputy Assistant Secretary of the Treasury for Economic Policy under the Bill Clinton administration. Through the use of what is called Big Data today, Professor McClellan\u2019s research team analyzed the extent to which medical costs increased and decreased, as well as how much the treatment of patients improved by looking at the mortality and re-hospitalization rates according to drugs and innovations in medical technology for diseases such as acute myocardial infarction, renal failure, and cancer. I was in the team of acute myocardial infarction.<\/p>\n

We conducted this research in the 1990s and since then it has become the origin of \u201cEvidence-Based Medicine (EBM)\u201d that is now regarded to be of high importance in the United States and Japan. Furthermore, \u201cevidence-based\u201d became a major concept that many thought should be applied not only in the medical science but also in systematic design and policy making, especially in the United States. The idea now referred to as EBPM: Evidence Based Policy Making. Today, even in Japan, the significance of EBPM has been emphasizing little by little.<\/p>\n

\u201cEvidence-based\u201d should also by applied to the Japanese healthcare systems and policies<\/h3>\n

In 2000, I returned to Japan and I wanted to make the most of the skills I learned in the United States by applying them to healthcare policies in Japan. However, at the time, Japan did not have enough data to allow for evidence-based decision-making. To be honest, I was shocked. Japan was far behind the United States having collected Medicare claims (medical fee invoices for public healthcare insurance which covers those who are 65 years old and older) since 1984, with researchers already using the information for creating scientific evidence for policy making and evaluation.<\/p>\n

Under these circumstances, I got the opportunity to meet the late Professor Shigekoto Kaihara (1937-2011), a leader of the field of medical informatics and Director of Central Medical Information at the University of Tokyo Hospital. Professor Kaihara and I shared the thought that \u201cmedical claims must be collected in Japan as well and used in policy making.\u201d So in 2001, together with Professor Kaihara and Professor McClellan, \u201cDiscussion on how to use universal health data by researchers: learning from case of the United States how to manage and adminisrate claims data for Medicare (in Japanese)\u201d was publicized in the \u201cSocial Security Review (Shakai Hoken Junpo).\u201d<\/p>\n

As a result, the importance of collecting claims gradually came to be featured more in Japan. With further efforts from Professor Kaihara, who served as chairman at investigative commission on the use of claims data to improve the quality of medical care held by the Ministry of Health, Labour and Welfare, it was finally made possible for claim data to be collected and organized by Japanese government and supplied to researchers for public interests. The provision of this data to researchers was achieved in 2013, about 30 years after that of the United States.<\/p>\n

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Photo: Professor Noguchi proposing issues to participants as a moderator during a seminar workshop held by Waseda University Social & Human Capital Studies (WISH) in July 2018. On the same day, Professor Kensuke Yoshimura (right) of Chiba University Hospital gave a lecture on the \u201cEffective allocation of medical resources according to the Ministry of Health, Labour and Welfare.\u201d<\/p><\/div>\n

\"\"

Photo: Social innovation seminar held by WISH in September 2017<\/p><\/div>\n

Policies determined by the \u201cinclinations,\u201d that is the preferences or perceptions, of politicians and administrators can often lead to great mistakes. You cannot move forward if you don\u2019t acknowledge the reality that is \u201cfact\u201d and only focus on how something \u201cshould be.\u201d There is no guarantee that the current policy will change dramatically. For example, regarding the discussion advocating for the \u201cpreservation of National Health Insurance,\u201d there is no discussion from an objective perspective on the current situation of this system or what needs to be done to maintain it so that it can become a sustainable system in future. For this to happen, it may be necessary for us to look at the \u201cprice\u201d of our life and health in an unemotional, realistic way. In order to ensure the system remains sustainable, we have to establish a political process that develops along with the different ideals of how policies \u201cshould be,\u201d by making full use of scientific evidence, that is, to objectively accept \u201cfact.\u201d<\/p>\n

Feeling the \u201cchanges\u201d at Waseda University<\/h3>\n

I studied at Waseda University for both undergrad and graduate school of economics and have been involved in education and research at Waseda University since 2012. Lately though, I feel the University has gone through some changes. One change is the overall increase in quality of researchers. At the Faculty of Political Science and Economy there is a \u201cThe Center for Positive Political Economy,\u201d of which I am a member. I believe more and more talented young researchers have been applying to Waseda University, even from abroad, especially in the last few years. As a background of this, globalization also has also been progressing in research, and so young researchers have been facing with world-wide fierce competition to get an academic job and so they have to show a good performance in research.<\/p>\n

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Photo: Lecture in a hall on Waseda campus. Many students are keenly listening to the lecture.<\/p><\/div>\n

The attitude of the students has changed greatly. In the past, I felt that Waseda University students were quite strongly motivated to \u201cstruggle and grow individually.\u201d These days however, I feel that the number of singularly stand-out students is decreasing, which can be seen as both positive and negative. The university as a whole, along with each faculty member, has achieved an educational style considered to be of global standards, and lectures and seminars are conducted with enthusiasm in that style. Students can succeed by obediently following this curriculum. Though I do miss the old days on the campus once in a while, these changes may be inevitable for the university itself and the researchers to survive in a globally competitive society. In order for Waseda University to take the next leap forward, we must rid ourselves of nostalgia for the past as there is a long and grueling path ahead. In terms of education, we need to do our utmost to teach students how to have a valuable life and become someone who can contribute to society. In terms of research, we must spare no effort to support healthy competition among researchers so that their achievements can be internationally recognized. These are the philosophy established at the time of Waseda\u2019s foundation to which we must once again return, as this will set us on the right path to take on these new challenges.<\/p>\n

\u261eClick here for Part 1<\/a> <\/strong><\/p>\n

Profile<\/h4>\n

\"\"Haruko Noguchi<\/strong>
\nProfessor Haruko Noguchi graduated from Waseda University Graduate School of Economics and received her Ph.D. in economics from the Graduate Center of the City University of New York in 1997. After working as a researcher at Stanford University and the National Bureau of Economic Research (NBER), she returned to Japan in 2000 and worked at Toyo Eiwa University and the National Institute of Population and Social Security Research. She has been professor at Waseda University\u2019s Faculty of Political Science and Economics since 2012. Currently, Professor Noguchi is a member of the Metropolitan Hospital Management Committee of the Office of Tokyo Metropolitan Hospital Accounting; a public member of the Central Social Insurance Medical Council of the Ministry of Health, Labour and Welfare Health Insurance Bureau; a member of the Expenditure Reform Working Group of the Cabinet Office Administrative Reform Promotion Council; and dean of the Adachi Ward Children\u2019s Facility Administrator Selection Board of the Adachi Ward Education Committee. She is also Director of the Waseda Institute of Social & Human Capital Studies (WISH) and a member of Waseda University\u2019s Center for Positive Political Economy (CPPE).<\/p>\n

Major research achievements<\/h4>\n

Journal articles<\/strong><\/p>\n