For working people with health issues, visiting a clinic has long meant taking hours off work on a weekday and spending more time in the waiting room than talking with a doctor.
But such days might be approaching an end. Reversing a longtime aversion, Japan is quickly embracing telemedicine, with young doctors leading the way in introducing consultations over the internet.
The turning point came in August 2015, when the health ministry issued a notice and removed regulatory barriers. Now many clinics offer online consultations for busy workers who cannot afford a long wait at the doctor’s office.
Dr. Kensuke Igarashi, 32, who runs Ochanomizu Naika, an internal medicine clinic in Tokyo, started offering telemedicine in the fall of 2015. From his previous experience working at a cardiovascular hospital, he saw many patients fall victim to second heart attacks after they stopped taking medication.
“Many patients knew the importance of continuing their treatment but were too busy to visit doctors during the day on weekdays. Then they quit taking their medication,” Igarashi said at the clinic, where around half of his patients work in the business district. “People who have had a heart attack are prescribed anti-platelet agents pretty much for life to prevent another attack, but the effect of the treatment — having no event — is an intangible. My motto is to help patients with chronic conditions stick to their treatment by lowering their hurdles to do so.”
So far, 200 or so of Igarashi’s patients have switched to telemedicine, he said. Igarashi has developed an iPhone video app that allows patients to make appointments and chat with him. They can also use email, Skype or Facebook messenger, he said.
But the first consultation with a patient is offered only face-to-face. Igarashi also limits telemedicine to patients with chronic but stable conditions, and with risk factors such as high blood pressure, diabetes, or a history of heart attacks or strokes.
“Many doctors think they should only see patients face to face. I think it comes down to a generation gap. They say it’s important to observe the patients’ demeanor and smell and feel them, but I think it depends on their illnesses. Watching a patient’s face for an hour does not give a doctor a hint of the person’s hemoglobin A1C figures,” he said, referring to blood sugar levels.
After Igarashi sees patients online, he keeps records the same way he handles records from face-to-face consultations, and fills out a prescription to be sent by mail.
Telemedicine can also be useful for patients with illnesses that make it hard for them to visit hospitals.
In late July, Juntendo University Hospital announced it will start offering telemedicine to patients with Parkinson’s disease.
“As their symptoms progress, they become vulnerable to trips and falls, making it hard for them to visit the hospital,” said Dr. Taku Hatano, associate professor at the university’s department of neurology. When such patients do visit the hospital, he said, it can take several minutes for them to move to the consultation room.
Juntendo has tied up with IBM to use their telemedicine applications. Patients have to buy an iPad to connect to doctors by video, but the frequency of consultations can be increased with the service, the university said, adding that it aims to introduce telemedicine to roughly 10 percent of its 3,000 patients.
Medley, a Tokyo-based medical venture, launched a telemedicine platform called Clinics in February 2016. More than 500 medical institutions have introduced the app-based service, enabling patients to make appointments with doctors contracting with the firm, seek medical consultations via video chat and settle fees with credit cards.
Doctors are using Medley’s services to treat a wide range of conditions, including high blood pressure, diabetes, depression, pollen allergies and atopic dermatitis, according to the firm.
Medley co-CEO Goichiro Toyoda, 33, who formerly worked as a brain surgeon, sees telemedicine as a means through which the nation’s health care can become more efficient and convenient.
But the system needs further reform, Toyoda argued, noting that doctors offering telemedicine are not adequately rewarded under the current health insurance system, where every two years, a government panel decides and reviews the price of every procedure performed and medication prescribed.
Prescriptions are also required to be sent by post — not email — and patients must physically visit a pharmacy to get their medicine.
“The situation with online medicine has changed quite a bit compared with a year ago, with many doctors now thinking that telemedicine is not a dubious practice,” Toyoda said. “Now a similar debate is beginning to take place over prescriptions, where many people are questioning why the prescription part remains unchanged.”
The government is well aware of the need to promote telemedicine. Industry interest spiked after Prime Minister Shinzo Abe announced in April that telemedicine will be covered in the next medical fee review, set to take effect next April.
Another firm is promoting the idea that through telemedicine, health insurance unions run by corporations or industry-wide unions can save money.
Medcare, based in Tokyo’s Mejiro district, provides medical services to corporate health insurance unions run by employers or industry-wide unions of employers. These unions, called kenpo, number 1,400 across Japan and insure a total of 30 million workers and dependents, a quarter of the nation’s population. Under the public health insurance system, the unions pay 70 percent of medical bills incurred at the clinics and hospitals for the insured workers, with the remainder paid by the patients.
Medcare asks kenpo unions to submit detailed breakdowns of their medical expenditures and calculates the total medical costs shouldered by the companies. When companies switch to Medcare, using doctors offering telemedicine, the costs go down, largely because face-to-face visits can be more expensive. Medcare then takes 75 percent of the money saved as service fees.
Beyond online consultations, employees who use Medcare’s services receive dietary and exercise advice. They are also given a wearable health device — either an Apple Watch or a Fitbit — and the data is monitored by Medcare for analysis. Employees are free to visit non-Medcare doctors if they prefer.
“Under the current system, medical institutions are incentivized to offer unnecessary care to stay financially afloat,” said Medcare CEO and President Hideyuki Akashi, a 34-year-old former heart doctor. “As such, the care and exams the patients receive are often influenced by arbitrary decisions by doctors. Patients don’t have a way of knowing whether the price they pay for their health care is reasonable and hardly ever complain about the cost.”
He said the firm decided to target kenpo unions after considering who will benefit from savings.
Like other services, Medcare also regards people with chronic lifestyle diseases as core users. The firm has won the contracts of a few major corporate health insurance unions since launching in April. It now covers 130,000 people.
Whether treatment in early stages and preventive services make people healthier and reduce the nation’s medical outlays has yet to be proven. But as the number of Medcare subscribers grows, so will the mountain of health data collected through wearable devices, giving the firm insight into what kind of care and services work to reduce costs, Akashi said.
A Matter of Health covers current research, technology or policy issues relating to health in Japan.
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