Research Areas & Themes ( 2019 ): Social Issues

International comparative research on healthcare reform

Project Leader
Research Objective The Japanese government has announced a variety of projects such as AI hospital, Personal Health record (PHR) and big data to achieve by 2020. However, as these are full-fledged plans, and neither the priority order nor who bears the investment cost is clarified, there is concern that they would disappear as soon as their subsidies expire. Therefore, I will evaluate those projects by investigating similar projects in other countries.
Project Overview - The field surveys of utilization in healthcare of AI, PHR, robot and other new technology will be conducted in US and Australia.
- It turned out that cosmetic medicine has a very wide range of applications and attracts a lot of attention from healthcare business managers in Japan. Therefore, I would like to make policy proposals by conducting surveys on overseas circumstances.
- Analysis of FY 2018 financial statements of social healthcare corporations

Research on the reform of social welfare corporation system

Project Leader
Research Objective We will investigate the reasons for the disparity in light of personnel costs and subsidies.
Project Overview In 2018, I clarified the financial structure of social welfare corporations as a whole by analyzing financial statements for FY2016 of about 20,000 social welfare corporations. Their financial statements for FY2017 are being disclosed. Based on these data, I am planning to investigate the reasons why the disparity in their financial performance is so large despite having the same market location and facility type. Of all of the community-based comprehensive care services, living assistance services are most required. These services are being provided mainly by social welfare corporations instead of medical care institutions. Therefore, I am planning to design and propose new schemes of living support based on social welfare corporations.

Research on population health

Project Leader
Research Objective Population Health is called Data Health in Japan. As the nationwide databases of medical records have been constructed and their analysis has begun, it seems that the accumulation of knowhow is in progress. Therefore, I will make the international comparison in population health and research future issues.
Project Overview - To investigate the actual circumstances of data health in Japan
- To conduct field work on population health in conjunction with health reform in US and Australia

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 identify the agenda and challenges through an initial evaluation.
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: We will conduct economic evaluations and analysis of medical innovations in Japan jointly with Mr. Makoto Kobayashi (Crecon Medical Assessment Inc.), etc.
(2) Publication of papers and books: We will report our research findings in HTA-related academic journals and technical books in Japan and abroad. In particular, we will publish an English version of the HTA workbook (Springer/Adis) and dispatch HTA research findings globally from Japan. We also will publish a new book outlining the necessity of "value-based" reforms as Japan's new medical principle for the general public (Chukoshinsho Book Series).
(3) Domestic/international HTA training programs: Program for fostering HTA experts (basic course, advanced course); HTA seminars for corporate executives; international HTA short-term collective seminars.
(4) The CIGS-HTA Research Interest Group to be continued: We will provide a platform to discuss and exchange practical knowledge and information required from specialists in charge of economic evaluations and analysis for the HTA system to be implemented on a full-scale basis by the Ministry of Health, Labour and Welfare in FY2019..

Research on the national and local government finances

Project Leader
Research Objective In the current economic situation, the national and local governments are forced to review their fiscal policies. We will identify causes of worsened fiscal positions and consider what measures the national and local governments can take to improve the soundness of their finances while severe conditions continue. It is difficult to see the fiscal policies of Japan as a whole and, therefore, it is necessary to visualize all fiscal policies of Japan by summing up the fiscal policies of the national and local governments. It is necessary to look for new fiscal disciplines by consolidating the national fiscal policies and local ones, and simultaneously necessary to review accounting and statistical information. It is also necessary to review inter-government fiscal policies. As the number of government employees decreases in the declining population and aging society, it is essential to make the administration process more efficient and simplified. The national government, as well as local governments, would need to introduce the proper management system and project management approach, because their management skills are currently not sufficient. It is necessary to further introduce digitalization of the national government.
Healthcare expenses are a major issue of government spending. Public hospitals play a role as a safety net, and it is necessary to grasp healthcare expenses from a fiscal point of view. Fiscal studies are necessary for the field of welfare, and we will study what is actually happening in this field.
One of the causes for fiscal difficulties facing municipalities is the issues with the management of publicly owned corporations. Publicly owned corporations include a broad range of entities, such as hospitals and water/sewage companies, and it is necessary to study issues concerning the deterioration of public infrastructures.
Project Overview Based on our field surveys conducted on the relevant municipalities so far, we have sorted out the patterns of falling into fiscal difficulties and clarified how they related to the national government's policies (i.e., national economic policies and the Ministry of Internal Affairs and Communication's individual fiscal measures such as the third-sector bonds and public hospital bonds issued under special law). In 2019, with a focus on several municipalities, we will study fiscal and administrative management by applying viewpoints of operational management, project management and government digitalization. As our ultimate goals are to study new fiscal disciplines through consolidation of the national government and local government finances, as well as reviews of inter-government fiscal policies, we will grasp the local allocation tax, national government subsidies, construction debts, and public accounting (national and local government accounting).

Research on tax reform and tax administration reform

Project Leader
Research Objective In the current global economic situation, countries are looking for efficient and simple tax administration (taxation and collection). Digital transformation is important for the tax administration and sustainable need of people. New technology trends (e.g., cloud services, robotic process automation, virtual assistance using AI, mobile apps) can change the environment of tax payers and reinforce the tax administration. These technologies are expected to provide flexibility and integrity, reliability, openness, people-oriented services, and improve compliance of tax papers. Risks caused by digitalization would be addressed strategically. It is necessary to reach a level that can ensure a taxation system of digital economy through cooperation among tax authorities and with the support of international organizations. The project is intended to grasp digitalization and ruling initiatives of foreign countries and reflect them on the tax systems of Japan’s national and local governments.
Nowadays, issues with the problem of land of unknown owners are often talked about. Land of unknown owners refers to the land of which the owners cannot be readily identified by the register of owners such as real estate register or, even if identified, remain uncontacted. As the amount of land of unknown owners increases, problems with empty houses, acquisition of sites for the use of public projects (deterioration of public infrastructures), agricultural land (land that is no longer cultivated), forestry management (water sources management), and taxation on a deceased person have arisen. These problems should be treated as national land preservation problems, which should be considered by the national government and municipalities. For the taxation system, we will study imposition of the fixed asset tax on a deceased person, issues with house assessment of a high-rise building complex, and simplification of assessment, in connection with the current issues with land of unknown owners.
Japan is frequently attacked by natural disasters and it is also necessary to study the relations between natural disasters and tax affairs.
Project Overview We will continue to study digitalization and efficiency of tax administrations in foreign countries. Digital transformation is important to the tax administration and sustainable need of people. We will review new technology trends (cloud services, robotic process automation, virtual assistance using AI, mobile apps) from the viewpoint of flexibility and integrity, reliability and openness.
We also will study international cooperation such as BEPS (base erosion and profit sharing) and JIPDEC, as well as international initiatives at OECD and IMF.
As it is necessary for tax efficiency to reinforce cooperation between the tax administration and financial institutions, we will propose that they enter into a business alliance. In addition, we will continue to study preparations for ID theft, realization of current year imposition of local tax, centralized treatment of taxation processing, abolition of wage payment reports, electronic issuance of withholding tax slips, and promotion of special collection.
For the taxation system, we will study corrective proposals for the imposition of real estate tax on a deceased person and house assessment by treating them as parts of the national land preservation issues.
We also will study the tax affairs in case of a natural disaster (e.g., disaster victim certificate, tax reduction or exemption, disaster training).

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