Healthcare Innovation Policy

November 2019

Nishikawa Kazumi

Director, Healthcare Industries Division

Ministry of Economy, Trade and Industry

18

68

18

78

18

88

18

98

19

08

19

20

19

30

19

40

19

50

19

60

19

70

19

80

19

90

20

00

20

10

20

20

20

30

20

40

20

50

20

60

20

70

20

80

20

90

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00

21

10

Under 14

Age 15-49

Over 65

Age 50-64100％

100%

80%

60%

40%

20%

20%

40%

60%

0

Japan’s demographic structure & transition

Present

Source: Sensus, Okazaki estimate, National Institute of Population and Social Security Research 2017 estimate Ｃ T Hasegawa RIFH. Japan

Demographic transition <250 years trend>

Age 50

19th century model

21st century model

1

Progress of aging in the major countries

２

Japan Sweden German FranceU.K. U.A

Japan ChinaIndiaIndonesiaPhilippinesKoreaSingaporeThailand

Europe Asia

Actual EstimatedActual Estimated

2015 2015

Cicero（B.C106-43) How to Grow Old

Pessimistic view on aging,① Less public activity② Weaker bodily function③ Scarce pleasure④ Closer to death

「No！」 to such a pessimistic view① Elderly can contribute to society with prudence,

authority and knowledge.② Elderly can be healthy and active.③ Elderly is not caught by pleasure.④ Death is common issue for all generation.

69

79

USA

72

82

Canada

65

75

Brazil

6169

Russia

5866

India

68

China

75

71

81

Germany

72

82

France

71

81

U.K.

3946

Sierra Leone

4350

Lesotho

‡ Worst

6271

Indonesia

6675

Thailand

72

82

Sweden

AfricaLife expectancy ：58Healthy life expectancy ：50

EuropeLife expectancy ：76Healthy life expectancy：67

Southeast AsiaLife expectancy ：68Healthy life expectancy：59

Eastern MediterraneanLife expectancy ：68Healthy life expectancy：59

Western PacificLife expectancy ：76Healthy life expectancy：68

Life expectancy Healthy life expectancy

75

Japan

84

Japan is the best country in the world in a comparison of life expectancy.（Japan : 85 years old , World Average : 74 years old ）

Japan is the second - best country in the world in a comparison of Healthy life expectancy. （Japan : 75 years old , Singapore : 76 years old, World Average : 63 years old ）

Life expectancy and Healthy life expectancy

4Source : World Health Statistics 2015: materials prepared by WHO

in 2013

‡ Second- Worst

As Japan Gerontological Society and Japan Geriatric Society propose to change the definition of “the elderly” from people aged 65 and older to people aged 75 and older, the rejuvenation of the bodily functions of the elderly and the extension of healthy life are important aspects.

Future Prospects ： Healthy Longevity Society

5

Historical changes in total points of a physical strength test

（Source）Japan Sports Agency

The result summary of the physical

strength/exercise ability test in FY 2015

It is expected that around 2020, thephysical strength of those aged 76-79 willimprove to the level of physical strengthof those aged 66-69 in 1998.

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

MaleMaleMaleFemale

Female Female

6

18 - 64 years old working people support elderly over 65

18 - 74 years old working people support elderly over 75

5.1 working people

1.5 working people 1.3 working people

3.3 working people

Source : Japan’s estimated future population ‡Estimated in April FY2017 : prepared by National Institute of Population and Social Security Research

2.1 working people

2.4 working people

2017 2040 2065

2017 2040 2065

Females

Graduate

Decline(87.9%)

Early

Decline(12.1%)

0

1

2

3

63-65 66-68 69-71 72-74 75-77 78-80 81-83 84-86 87-89

(87.9%)

(12.1%)

Independence

Requiring assistance for instrumental activity of daily living

Requiring assistance for basic & instrumental activity of daily living

Death

Source: Hiroko Akiyama, Science and Social Scheme in the Longevity Era, “KAGAKU,” Iwanami Shoten Publishers., 2010

—Nationwide 20-year Follow-up Survey of the Elderly—

Age

Change in Independence [1]

7

Males

Graduate Decline

(70.1%)

Resilient (10.9%)

0

1

2

3

63-65 66-68 69-71 72-74 75-77 78-80 81-83 84-86 87-89

(70.1%)

(10.9%)

(19.0%)

Independence

Requiring assistance for instrumental activity of daily living

Requiring assistance for basic & instrumental activity of daily living

Death

—Nationwide 20-year Follow-up Survey of the Elderly—

Source: Hiroko Akiyama, Science and Social Scheme in the Longevity Era, “KAGAKU,” Iwanami Shoten Publishers., 2010

Change in Independence [2]

Age

8

Target of Drugs

Effectiveness and Satisfaction of Treatment in Common Diseases

Aging-related Diseases

High

Treatment Satisfaction

Effe

ctiv

en

es

s o

f Dr

ug

s

in T

re

atm

en

t

Dementia（e.g. Alzheimer's Disease）$19 billion

Hypertension$10 billion

Arthritis$2 billion

Communicable Disease$6 billion

Permanent cure of single target agent

Multi target agents, unclear, symptomatic treatment

Multi target agents, unclear, no effective treatment

（Source）Japan Human Sciences Foundation

Life-style Related Diseases

Cancer$38 billion

Complications of Diabetes

Diabetes$15 billion

Diseases with Single Target Agent

○ Effectiveness of drugs in treatment and treatment satisfaction vary across common diseases based on their characteristics.

Low

Low High9

Characteristics of Diseases

Common Diseases

Treatment Plan Healthcare System Needed

Exoge

no

us

Diseases with

Single Target Agents

Communicable Disease

Hereditary Disease

Cancer（with high

target specificity）

Cancer

Dementia

Hypertension

Diabetes

Permanent Cure

Same for everyone(Standard

treatment)

○ Develop drugs with high safety and response rate

・Establish quick and accurate diagnosis methods

・Conduct efficient clinical trial and improve manufacturing tech

・Promote regulatory science

End

oge

no

us

Aging-related

Diseases

Early Diagnosis

Disease Progression

Control

Life support

Depending on

characteris-tics and status of patients

○ Find potential patients in early stages

○ Manage/control the progression of symptoms

・Develop technology for early diagnosis

・Provide lifestyle guidance in addition to prescription of drugs

・Establish progression control methods through data collection

○ Utilize service & equipment to support daily life when diseases

Life-style Related Diseases

Early Diagnosis

Prevention

Behavioral Change

○ Find potential patients in early stages

○ Build prevention-oriented healthcare system

・Be thorough in periodic health checkups and health guidance

・Develop health management tools using IoT / AI

・Strengthen roles of pharmacists and registered dietitians

・Promote self-medication

The Future of Healthcare and Medical System

Considering the increase of Endogenous Disease（Life-style Related Disease／Aging Disease）the establishment of a new prevention / life support type healthcare system is needed.

Traditional Medicine

10

Transitions of Symptoms (image)

（Created by METI based on interviews）

Prevention stage treatment and recuperation stage Terminal stage

Showing the flow of aggravation of diseases

Showing the flow of improvement of diseases

Others

Senility

Death

Cancer

Frailty

Lifestyle related Disease

（Treatment）

※excluding cancer

At high risk of lifestyle related

diseases

・diabetes・hypertension・Dyslipidemia・hyperuricemia

Deterioration of cellular function

Deterioration of vascular function （arteriosclerosis）

Deterioration of renal function

Deterioration of cerebral function

Geriatric syndrome

Renal failure(dialysis)

Cerebrovascular disease (stroke)

Mild Cognitive Impairment

Dementia(Nursing facility, medical

facility)

Healthy person

Cardiovascular disease

prevention of serious condition

Early diagnosis, behavioral change （no smoking）

Prevention

Prevention

Prevention

Prevention

Early diagnosis, behavioral change

companion diagnostics

Palliative care

prevention of serious condition

/ Life support

【medical expenditure, nursing expenditure】

Life support

The Importance of Prevention / P4 Medicine

12

Source: Made by METI, GOJ from Paper of President Nagai( Jichi Medical university)

P４(Predictive, Preventive, Personalized, Participatory) Medicine is important to improve quality of life.

QOL

Death

Outbreak

Needed long-term care

Primary prevention（healthy life） Secondary prevention

（prevention of aggravation）Thirdly prevention

（prevention of recurrence）

Aggravation

Young Meridian Elderly

Onset

Age

Raise the basic level by Health Infrastructure

Providing awareness

opportunities

Don’t repeat rapidly aggravation by using suitable services to be

changed behavior.

13

Economic activities

Re-employment (short time work)

Volunteer activities (social contribution)

Agricultural/gardening activities

Maintenance of physical functions (rehabilitation, etc.)

Utilization of home care services

Health investment: Focus on be healthy and active in Company and Community

Less active participation in the economic activities:

Establishment of the care system that meets the needs

Special efforts should be made to prolong this period (healthy life expectancy)

＜ Full-time activities（Focus on efficiency and Productivity ）＞

＜ Secondary social activities ＞

＜ Utilization of nursing care services/facilities ＞

Home care services can be utilized continuously

Establishment of the flexible system

that enables people to live in

ways they like for a lifetime and meets various needs that they recognize in

their lives

Utilization of nursing care facilities

Comprehensive healthcare contributing to healthy and vibrant society

14

Medical care

Elderly care

Prevention― Meal, exercise, etc. ―

Healthy life― Housing, society development, etc. ―

Providingpersonal care

Supporting the independenceof elderly people

Treatment after illness

Disease prevention and individualized medical care

e.g.) Genome diagnosis

Centered on medical science, medicine with the support of various academic disciplines and medical industry segments in the spirit of “Patient-Centered” Rational Medicine

Medicine

Medical Science Engineering

Pharmaceutical Science

Chemistry Agriculture

Economics Law

Ethics

Mathematics

16

Asia Health and Wellbeing Initiative Africa Health and Wellbeing Initiative

The technology of medical instruments, such as diagnostic imaging and ion beams, is constantly advancing. Moreover, it is also necessary to improve doctors’ skills continually as they utilize these kinds of cutting-edge equipment.

Our Commitment(Prime Minister’s Speech on May 14, 2015 at the 21st International Conference on the Future of Asia)

And therefore, I say, “Be innovative.” Why not do so together with Japan?

Japan has now established state-of-the-art gastrointestinal endoscopy centers in Hanoi and Jakarta and is assisting in the training of young doctors. And in Mandalay, we have built a breast cancer screening center to help women.

Japan intends to make its greatest possible efforts to raise Asia’s healthcare standards into the future as well, using our experiences until now together with our technologies.

17

Source ：The Cabinet Office of Japan, Comprehensive Reform of Tax and Social Security, ADB

17 30 51 87

152

45 60

81

108

140

0

50

100

150

200

250

300

350

2010 2020 2030 2040 2050

アジア アジア以外

Through Japan's excellent medical technologies and services overseas expansion, we aim to:1- contribute to solving social issues faced by countries; and 2- capture expanding healthcare demands and markets.

Therefore, we provide Japanese excellent medical devices and services abroad according to the needs of each country (Outbound), and promote visit of foreign patients who desire to consult in Japan (Inbound) based on Japan Revitalization Strategy.

Japan

Guiding principles of overseas development of Japanese medical care

T USD

T JPY

Notes： Figures for 2015 onwards are forecasted mediansSource：World Population Prospects: The 2015 Revision, UN

Capturehealthcare market

18

JapanChinaIndiaUSIndonesiaThailandSouth KoreaFranceGermanyItalyUK

Asia Outside Asia

Economic Revitalization scenarioBase line scenario

Trend in Global GDPAging population ratio

by country

Overseas(Emerging countries especially in Asia)

Improvemedical care levels

Japan real GDP growth rate (Estimation)

Trend in healthcare expenditure

0.0

20.0

40.0

60.0

19901995200020052010201520202025

(Trend of over 65 years old population to total population)

19

Government Players

Contribution through

Sustainable Commercial Promotion

Contribution toward UHC (Universal Health Coverage)

Ministry of Health,

Labour and Welfare

Ministry of Foreign Affairs

Intragovernmental Taskforce

Ministry of Economy, Trade and Industry (Dissemination of Japanese healthcare)

Ministry of Health, Labour and Welfare(Support to improve healthcare system)

Ministry of Education, Culture, Sports, Science and Technology(Education, Human networking)

Ministry of Foreign Affairs(Marketing, Collaboration support)

Ministry of Internal Affairs and Communications(ICT infrastructure for healthcare)

Cabinet Secretariat(Strategic planning & facilitation)

Medical Excellence JAPAN

(Outbound & inbound promotion)

Foreign Countries

Governments andMedical Institutes

●Medical devices●Medical consulting●Medical assistance

●Hospital Networks●Highly advanced

medical services

Intragovernmental Task Force For promoting Japanese Healthcare

20

Pilot Projects

Project Making

Market Research Materialize

Research through medical device demonstration

Business scheme making Drafting business plan Building partnership with

local players

Fund raising Preparation of

operation Starting a business Local human resource

development

・Profit making

・Cash return frominvestment

・Expansion to other countries

◆ METI has funded Pilot Projects conducted by Japanese Consortiums(Companies or Hospitals).

METI’s focus

Feasibility Study

21

22

History of Public-Private Joint Mission

41

1

1

1

RUSSIA2013 Cancer Treatment2014 Cancer/NCDs Treatment

MEXICO, SOUTH AFRICA, TANZANIA, and KENYA2019 Building Rapport and

Japanese Medical

SAUDI ARABIA2016-2017 Building Rapport and Japan-style Medical Service

INDIA2013 Japanese Medical 2015 Advanced Cancer Treatment

INDONESIA2012 Cancer/Liver Disease Treatment2013 Endoscopy/Radiotherapy2014 Diabetes/Medical ICT2018 Diabetes/Cardiovascular Diseases

THAILAND2017 Endoscopy/Diabetes2019 Dentistry

PHILIPPINES2015 Ningen Dock*2016 Cancer/NCDs Treatment

MYAMMAR2014 ER/Endoscopy/Breast Cancer2015 Japan-Style Medical Service2016 ER/NCDs/Cancer/ME

BANGLADESH2013 Radiotherapy2015 Ningen Dock*

VIETNAM2013 Endoscopy/Pediatric care2014 Cancer/NCDs Treatment2015 Medical ICT2019 Cancer Treatment/Particle therapy

2

2

2 2

2

3

*Ningen Dock = Optimal preventive healthcare system in Japan

4

2

Medical Seminar (Myanmar, Yangon)Meetings with

the Government Officials (Philippine, Manila)

Symposium and Exhibition of Medical Devices and Services (Japan, Tokyo)

Public-Private joint Mission Activities

23

Roundtable with

the Government Officials (Jakarta, Indonesia)

24

Meeting with Key Opinion Leaders(KOLs) Government-

affiliated KOLsMedical Experts and

KOLsCountry

THAILAND

VIETNAM

PHILIPPINES

MYANMAR

INDONESIA

Others

15 21

5 12

6 13

8 15

18 15

90 140

Secretary of Department of Health(DoH), Senior Health Program Officer at DoH, University of Philippines Faculty at Dept., of Surgery, Philippine General Hospital, Jose R. Reyes Memorial Medical Center, etc.

Ministry of Public Health, Medical Device Control Division at Food and Drug Administration(FDA), BumrungradInternational Hospital, President of the Private Hospital Association, Chulalongkorn University etc.

Union Minister of Ministry of Health and Sport, Chief Minister of Yangon Regional Government, Chairman of Myanmar Urology Society, Rector of University of Medicine 2 Yangon, Parami General Hospital etc.

Vice Minister of Ministry of Health(MoH), Director General of Administration of Health Information Technology at MOH, Director of Bach Mai Hospital, Director of K Hospital, etc.

Secretary General of Ministry of Health(MoH), Director of Bureau of Planning and Budgeting, Deputy Director for Health Economy and Financial Evaluation, President of the Private Hospital Association, Director of CiptoMangunkusumo Hospital , etc.

AND MORE AND MORE

Minister of Ministry of Health(MoH), Director Generals at MoHs, Director of National Hospitals, President of the Private Hospital Associations, President of Medical Associations, Professor of Faculty of Medicine at the National Universities, etc.

4

24

2

3

Throughout the activities of PPM, we are building and maintaining Successful Relationships with KOLs for contributing UHC in each partner country.

Projects for Establishing Japan-Style Medical Services

METI/MEJ have supported over 130 pilot projects since FY2012.

New business models have been created and some projects have been materialized.

(1) “Whole Hospital Export” model

Construction of hospitals and provide sustainable medical service.

(2) Market cultivation through medical human resource development

Establishment of training centers in teaching hospitals and other locations

Brazil Colon Cancer Diagnosis Training Center(Fugast Hospital, Hospital de Base)Established in January 2015

Indonesia Endoscopy

Training Center(Dr.Cipto Mangunkusumo Hospital)

Established in September 2014

Vietnam Endoscopy

Training Center(Bach Mai Hospital)Established in July 2014

Vladivostok Imaging

Diagnostic Center(Green Field Project)Established in May 2013

Cambodia Emergency

Medical Treatment Center(Green Field Project)Opened in October 2016

China Rehabilitation Center(Beijing Puhua

International Hospital)Opened in March 2015

Myanmar Breast Cancer

Diagnosis Center(Central Women Hospital,

Mandalay)Established in February 2015

T-TEC Thai-Training

& Education CenterEstablished in May 2016

Bangladesh

Japanese-Style Hospital (Aichi Hospital)On going (will open in 2018)

Cardiac Imaging

Training Center

(Moscow)Established in 2015

Exporting a whole hospital

Developing medical human resources

Human Resource Development at Training Center opened（ Japanese style Endo-Surgery training center ）

Olympus opened Japanese style surgical training center (T-TEC; Thai-Training & Education Center) in Thailand bycooperation of Societies for Endoscopic Surgery both in Japan and Thailand in May 2016.

As a result of Olympus activity subsidized by METI, MESDA(Mekong Endo-Surgery Development Academy) hasbeen established in 2016 to promote educational projects for minimally invasive surgery in Mekong region.

More than200 doctors are trained through MESDA program. This project will contribute to the increase the number of endoscopy specialist and to improvement of health

standard in Mekong region.

26

T-TEC Thai-Training & Education Center MESDA Operation Model

Overview of “Healthcare Innovation Hub”

“Healthcare Innovation Hub” accepts consulting requests from a wide variety of organizations such as healthcare startups.

“Healthcare Innovation Hub” provides networking opportunities with its “Supporters” and “Supporting Organizations”.

StartupsBig

businessesInvestors Academia

Healthcare Innovation Hub• Counseling about business development in Japan• Providing networking opportunities with “Supporters” and “Supporting Organizations”

AdvisorsMentoring the consulters

Hospital

Nursinghome

University

Internationalorganization

Networkingopportunities

Su

pp

ort

Su

pp

ort

Consulting

: Networks consisted of a wide variety of organizations performing healthcare industries such as big businesses, venture capitals/investors, academia, and local governments.

Manufacturing

Pharma

IT

Banking

Developer Trade firm

Government/Local government

Investor

SupportingOrganization

Consulting requests

collaboration

Medicaldevice

collaborationcollaboration

28

InnoHub Supporting Organizations

「2nd Well Aging Society Summit Asia-Japan」Event Overview Experts, companies, start-ups, VC, and government agencies etc. from all over the world gathered

together to discuss on the effort and solution about super aged society. Disseminating the qualities of Japan’s services and R&D which contribute to super-aging societies. Creating matching opportunities between great innovation (seeds) all over the world and field in

Japan (needs)

• The number of visitors：650(people)(22 countries)

• Speakers：80

• Start-ups：16start-ups

• Support organization：60 organizations

• Co-Event：18 Events

Organizer: Ministry of Economy, Trade and IndustryCo-organizers:Office of Healthcare Policy, Cabinet Secretariat, JapanMinistry of Health, Labour and Welfare, JapanJapan Agency for Medical Research and Development (AMED)Cooperation in Planning：Aging Japan, Life Science Innovation Network Japan (LINK-J)Alliance Forum Foundation(AFF)Venues：Muromachi Mitsui Hall & Conference

3030

Cooperation with other countries in the 2nd Well Aging Society Summit Asia-Japan

Sweden：Dementia, Digital health

WEF (World Economic Forum)：Aging society

HIMSS(Healthcare Information and Management Systems Society):Digital health

China：Aging society, Elderly care

AARP：Aging society

Singapore：Digital health, Bio

WEF C4IR (Center for the Fourth Industrial Revolution) Tokyo Centre

Finland：Dementia, Digital health

India：Digital health

Hong Kong：Aging society, Elderly care

Taiwan：Aging society, Elderly care

Israel：Digital health, Aging society, Bio

Japan invited startups, healthcare companies, investors, and governments in the world to the 2nd Well Aging Society Summit Asia-Japan

We built a collaborative relationship on issues of aging society

UK：Dementia, Bio

Japan：Aging society, Digital health, Bio technology

Host of the 1st Well Aging Society Summit Asia-Japan

NAM(National Academy of Medicine)：Healthy Longevity

Canada：Digital Health

Denmark：Aging society

Netherlands：Dementia, Bio