Comparative Health Care Policy Research Project


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Principal Investigator
Senior Fellow, Emeritus
  • Professor, Political Science, Emeritus
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Jamie Hwang

The Comparative Health Care Policy Research Project was initiated by APARC in 1990 to examine issues related to the structure and delivery of health care in Japan by utilizing contemporary social science. Further, the project was designed to make the study of Japan an integral part of international comparative health policy research. Yumiko Nishimura, the associate director, under the supervision of Daniel I. Okimoto, the principal investigator, leads the project.

During 2000-2001, Ms. Nishimura and her team created a computerized health promotion practitioner support system and implemented pilot studies with NTT Corporation of Japan to test the system's efficiency and effectiveness. The technology was developed based on research findings from an earlier project (1998-2000) that focused on the applicability of U.S. wellness programs in Japan.

In general, the computerized support system assists practitioners in delivering comprehensive health promotion programs in an efficient manner. It utilizes data from employee health examinations and answers from questionnaires on health-related behavior, lifestyle, and readiness for change to retrieve appropriate, preprogrammed intervention protocols. These protocols consist of a combination of intervention strategies, including face-to-face and phone consultations, information fliers, and email communication. At the beginning of each day, practitioners are shown lists of tasks to perform. For each task, the system displays information, such as scripts to use in consultations and templates for emails, faxes, or fliers. By using this system, practitioners can provide comprehensive health promotion programs without extensive education or training in the procedures. Programs include individual-based smoking cessation, and stress and weight management.

The system was designed to respond to the tremendous need for health promotion programs that are effective both in controlled experimental environments and in real settings. The Comparative Health Care Policy team concluded, based on their research, that contemporary information technology would be a viable solution. Japan was selected as the field research site for two major reasons. First, the tradition of life employment at one corporation means that long-term data is available for analysis. Second, the system is designed for use by health professionals, whom most Japanese corporations employ at the worksite.

Prior to developing this system, the team conducted literature reviews and informal interviews with health professionals in Japan. They identified the following challenges:

  • Dominance of disease screening effort
  • Targeting a limited segment of employees with specific risk
  • No standardization of programs
  • Lack of theory/model-based programs
  • Lack of training among health professionals in behavioral science

Along with these challenges, other factors were identified that would potentially promote the delivery of the health promotion programs:

  • Availability of health professionals in the workplace
  • Mandated annual physical check-ups for all employees under the law
  • Availability of corporate support for funding for medical services
  • Well-established communication networks within the workplace

These findings suggested that a computer-based staff support system could help overcome challenges and also capitalize on the factors with potential. The key functions for the staff support system include:

  • Increasing personal interaction between health promotion staff and employees by automating administrative tasks (filing, scheduling, etc.)
  • Ensuring quality of services provided by health professionals
  • Standardizing program by preprogramming protocols for services
  • Providing appointment reminders to minimize human error
  • Computer-prompting of behavioral objectives for health professionals to accomplish in each session
  • Training health practitioners to become health promotion experts
  • Collecting and storing process and outcomes data to help establish future evidence-based health promotion programs

In 2001, the team filed to patent the idea and technology of this system in both the United States and Japan.