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Research Areas & Themes ( 2018 ): Social Issues

International comparative research on healthcare reform

Project Leader
Research Objective We will search for useful hints for Japan's healthcare reform by studying specific approaches to healthcare reforms taken by other countries. In 2018, focus is placed on measures that should be taken if Japan's government bonds are undersubscribed, interrupting the flow of public funds to medical fee payments.
Project Overview - Considering that the two-tier public medical insurance system is gaining more understanding, the project will sophisticate its theory based on examination of literature regarding the latest situation of healthcare systems in other countries.
- The impact that a potential financial collapse in Japan would have on healthcare services for low income people and welfare recipients will be examined.
- FY 2017 financial statements of social healthcare corporations will be collected and analyzed.
- The project leader will attend a conference of ISQua, an international healthcare society, which will take place in Malaysia in September 2018.
- The project will organize a symposium on healthcare reform in the fourth quarter of 2018.
- Many columns will be written and published in English on Aging, Safety-net and Fiscal Crisis, along with associated data, in anticipation of growing international attention on Japan in these fields.

Research on reform of the social welfare service corporation system

Project Leader
Research Objective The project will make policy recommendations on the desirable model of social welfare corporations (SWCs), which play a primary role in regional comprehensive care.
Project Overview - Under the amended Social Welfare Act of 2016, Japan creates a database of the financial statements of all SWCs, approximately 20,000 across the country, from FY 2016 onward. The project makes recommendations on how the database should be analyzed and disclosed.
- A system that allows people with disabilities and the elderly to work on farms with the help of the able-bodied is expected to serve as an important safety net. Some SWCs have already launched initiatives toward this. The project will study challenges for the dissemination of these efforts across Japan.

Research on population health

Project Leader
Research Objective Under a new framework launched in 2018, the authority and responsibility over healthcare, nursing care and welfare systems are concentrated on prefectural governments, and there is a shortage of specialized human resources to support this move. This project will provide useful information for the development of such professionals.
Project Overview - Many countries are accelerating knowledge accumulation in population health as a social science. This project will gather literature in this field again to gain a big picture understanding.
- The project leader will visit selected developed countries to examine the use of population health and ICT firsthand.

Full-scale implementation of the health technology assessment system: Setting the agenda and challenges from an international perspective

Project Leader
Collaborator(s) Makoto KOBAYASHI(Director and Chief Operating Officer, Crecon Medical Assessment Inc.), etc.
Research Objective Assuming that the Ministry of Health, Labour and Welfare will start the full-scale implementation of health technology assessment (HTA) in April 2019, this project will perform a comprehensive evaluation of the pilot program continued until FY 2018, and identify the agenda and challenges for the full-scale implementation.
The project also aims to use its research results for the development of future HTA leaders in Japan in cooperation with the University of Tokyo Graduate School of Public Policy and international academic societies. Emphasis will be placed on making Japan a global leader in the "value-based healthcare" age by enabling Japan to present solutions to problems associated with HTA systems around the world.
Project Overview Specific projects are planned as follows:
(1) Research and analysis: Cost-effectiveness analysis and innovation assessment for new drugs, etc.
(2) Publication of papers and books: We report our research findings in HTA-related journals in Japan and abroad, and publish technical books on HTA in English. We also publish a paperback book for general readers to clarify the myth and crisis of Japanese healthcare , and further suggest the need for value-based approach.
(3) Domestic/international HTA training programs: The program will be co-hosted with the University of Tokyo. One-year training program is held as a domestic one for about 30 working adults as participants, and aims to develop certified HTA experts. International one will be short and intensive workshop for about 20 professionals from industry, government or academia in Japan and elsewhere in Asia, which aims to build a global network.
(4) The CIGS-HTA Research Interest Group to be continued: The Group will discuss practical and real-world issues with which the HTA specialists in charge of economic evaluations would face under the new HTA system of MHLW introduced in FY 2016 on a trial basis.

Research on the rebuilding of local government finances and potential factors for their future deterioration

Project Leader
Research Objective Under the current economic circumstances, local governments need to be increasingly independent in their administration. To help local governments restore a sound financial position amid continued difficulties, the project aims to identify the factors deteriorating their finances and consider improvement measures, while exploring a new form of fiscal discipline that integrates the Act on Assurance of Sound Financial Status of Local Governments with public accounting and local allocation tax.
Project Overview Through on-site visits and literature reviews, the project has identified typical processes for local governments to fall into financial difficulty and has related them to national policies (individual financial measures taken by the Ministry of Internal Affairs and Communications, such as economic policies, semi-public bonds, and special bonds for public hospitals). Ways to improve the financial status of local governments are studied with attention on local allocation tax, public infrastructure and public facilities. How the efficiency of healthcare administration can be improved will also be considered. By ascertaining the situation of public accounting, the project ultimately pursues a new form of fiscal discipline that integrates the Act on Assurance of Sound Financial Status of Local Governments with public accounting and local allocation tax. Public corporation accounting will also be covered. The nation-wide spread of problems involving land plots with unknown owners will also be examined in the project, in relation to the fixed property tax.

Research on tax administration reform

Project Leader
Research Objective Japan and other advanced nations are searching for efficient and streamlined tax administration to cope with the recent economic situation. The aim of our research is to understand efforts made by other countries (e.g., information technologies used and regulations imposed) and help Japan incorporate them into its tax system.
Project Overview In FY 2018, the project will study the fixed property tax and FinTech in relation to the tax system. FinTech is considered to contribute to tax filing and tax collection for its bookkeeping function, as well as its payment function. This project will examine ways to use FinTech in the interest of the tax system because it has the potential to make a major contribution to the tax system if its security and tracing features are employed in addition to currently recognized benefits. Regarding the fixed property tax, taxation on the deceased and issues associated with foreign nationals, as well as house and building valuation, will be examined in connection with land plots with unknown owners.
Considering the need for closer cooperation between tax authorities and financial institutions regarding improvement of the efficiency of the tax system, the project will propose better forms of such partnerships. We will also continue studies to promote safeguards against ID theft, current-year imposition of local taxes, unified taxation procedures for national and local taxes, abolishment of salary payment reports, electronic distribution of income tax withholding slips, and special tax collection.

Research on Japan's healthcare and welfare finances and the UK's healthcare finances

Project Leader
Research Objective Healthcare expenses are a major fiscal challenge not only for Japan but each nation. Japan has been developing a health insurance program that covers all of its citizens by modeling after the British universal national healthcare system. As the UK is due to leave the EU, its national healthcare is entering a new phase, facing difficult challenges, most notably how to secure healthcare professionals. It is helpful for Japan to study the issues that a national healthcare system must overcome when the country changes direction. For this reason, the project focuses on the British national healthcare system before and after Brexit. We will also study facts about Japan's healthcare finances. With an awareness of the need to research the financial aspects of welfare, the financial situation of welfare in Japan will be studied as well.
Project Overview Challenges expected for the UK healthcare system include securing outstanding healthcare professionals and finding new sources of research funds as the UK will no longer be able to obtain such funds from the EU. The project will summarize the challenges currently facing the UK healthcare system by estimating post-Brexit healthcare finances based on healthcare finances under the current Conservative Party administration after the end of the previous Labor Party administration. Regarding Japan's healthcare finances, the situation of municipal hospitals under the Local Public Enterprise Act will be studied. Municipal hospitals are the foundations for regional healthcare and their business environment needs to be improved. Local public enterprise accounting will also be examined.

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