The Impact of Preventive Medicine in 2030

The progress of medicine is remarkable. In Japan, a drug for the use of photoimmunotherapy in cancer received conditional authorization in September 2020 after a review by the Pharmaceuticals and Medical Devices Agency (PMDA). The first of its kind, the treatment is poised to be highly effective and place less burden on patients. In June 2021, the world's first drug to treat Alzheimer's disease received conditional approval from the U.S. Food and Drug Administration (FDA). Such progress hints at a future where almost all uncurable diseases have disappeared, with forecasts generally placing this around 2050. Conquering disease is a wish shared across the world, but we cannot celebrate yet.

40% of Japan's public insurance for medical and long-term care is covered by taxes as the premiums collected from subscribers are insufficient in covering all costs. We estimate that the public burden of these costs will increase from 23 trillion yen in 2018 to about 54.6 trillion yen in 2050.

Society faces the challenge of ensuring the sustainability of public finances while accommodating lengthening lifespans. This will require a host of measures including reform of the social security system. Reform is commonly purpoted to be possible through primarily one of two means: either reducing expenditures by reviewing the coverage of insurance or reducing the public burden by increasing the portion of medical and long-term care expenses paid out of pocket.

We propose an additional third option: the introduction of new preventive medicine.

Preventive medicine is comprised of three main forms: primary prevention, or avoiding illness; secondary prevention, or mitigating the progression of illnesses; and tertiary prevention, or functional recovery through rehabilitation. Primary prevention mainly works to improve lifestyle through avenues such as proper diet, sleep, exercise, and even mental health. Secondary prevention can be exemplified by cancer screening as it aims for early detection and treatment.

We have honed in on primary prevention for two reasons. First, primary prevention is poised for future progress in light of new technologies such as AI, IoT, and VR. Second, new medical services for patients have begun to take form that involve a wide range of stakeholders, such as local governments and health insurance associations, instead of just medical institutions.

Preventative medicine can have substantial impacts on diabetes and cancer. When progress is substantial, these two ailments can render patients incapable of recovery; patients are thus forced to face a long period of continually decreasing quality of life. Instead, the chance of contraction itself can be lowered by using new preventive medical technologies and improving lifestyle basics.

Primary prevention is seeing greater use of technologies such as AI, IoT, and VR. This in turn has made possible improvements to the efficiency of monitoring and intervention work by medical professionals. Preventive medical services will reach a larger public in tangent to the spread of these technologies.

However, there are several barriers to continual improvement of one's lifestyle, and this continual improvement will still require considerable effort. For example, many who have been diagnosed with metabolic syndrome have made attempts at ensuring proper diet and daily exercise only to give up in the face of increasing difficulty. Emerging technologies could potentially help in overcoming these difficulties.

We estimated the societal impact of the spread of preventive medical technologies (Figure 1). Specifically, we focused on eight primary prevention domains: diabetes, nicotine dependence, dementia, depression, high blood pressure, physical inactivity, obesity, and fractures due to frailty. We ran a simulation forecasting how the number of people in need of care would decrease if medical technology for primary prevention, which is expected to be commercialized by 2030, were to see commonplace use.

The results show a reduction of about 1.5 trillion yen by 2030 in medical and long-term care costs for the government. Specifically, long-term care will enjoy the greatest savings at about 1.2 trillion yen, and medical care will see savings of about 0.3 trillion yen.

There has been substantial debate about whether preventive care can help control health care costs. One argument points out that although susceptibility to diseases has decreased, problems will still arise throughout the body due to natural aging, and that preventive medicine may simply be delaying the onset of illnesses.

Our simulation pointed to longer healthy life spans as the length of life itself did not increase. In other words, individuals will see a shorter period of illness, and as a result the cost of medical care will be reduced too. Long-term care also saw reduction in expenses. The 75 to 80 age-group demonstrates a tendency to require long-term care, but Improvements to the quality of life for those people reduces both the number of elderly people in need of care and the total costs. The reduction in numbers is integral, and we forecast that a boost in elderly quality of life will result in around 720,000 less people requiring care, enabling them to live their lives independently. Burden will be reduced for families that would otherwise have to provide care.

The potential effects of preventive medicine will remain out of reach if the only measures are to adopt new technologies such as AI, IoT, and VR. The main approach used at present is the high-risk approach, in which those with risk factors such as hypertension and obesity are selected for intensive preventive intervention. However, this approach has limitations.

For example, starting in April 2008, specified medical examinations are being offered to insurance policyholders aged 40 to 74 to identify those who have metabolic syndrome and those who are in need of medical care ─ the goal is to offer them guidance. This is a perfect example of preventive medicine.

Japan’s health insurance is comprised of primarily two types: employer-based health-insurance and mutual-aid associations; and the National Health Insurance Societies run by municipalities and primarily used by those self-employed and the elderly. 80% of those under employer-based insurance undertake their specific medical examinations. However, only 40% to 50% of those under the National Health Insurance Society scheme take part, and subsequent health guidance sees an even lower rate of completion at 20%.

Measures to increase participation in health checkups should not solely rely on individual motivation and effort; behavior across society must be changed. Companies and municipalities should support the efforts of local residents including both the workforce and the elderly. Technologies like AI, IoT, and VR must be incorporated into these efforts moving forward.

The pandemic has accelerated the deterioration of Japan's fiscal situation, which had been poor for years before. This is affecting the sustainability of social security finances. We calculated that the cost of medical and long-term care can be reduced by about 1.5 trillion yen through the widespread use of preventive medicine. However, this amounts to only about 3% of the total costs in 2030 for medical and long-term care.

Preventive medical technology can contribute to better QOL across the nation and control medical-care expenditure. However, it does not address the sustainability of the social security system. This requires continued measures toward reform. A June 2021 revision to the law raises the out-of-pocket burden to 20% for the elderly. As the baby-boomers enter their twilight years, the number of elderly requiring care will continue to grow, and the social security system still requires reform to meet the growing demand.

We have categorized institutional reform into three pillars. Each of these pillars also correlates with preventive medicine and care measures (Figure 2).

The first pillar is the optimization of benefits and burden, such as raising the individual share of expenses for long-term care insurance or medical treatment of the elderly. Preventive medicine will lower the burden of care and raise the number of independent elderly people, and this will in turn foster wider public acceptance of an increase in the out-of-pocket payment rate.

The second pillar is a review of insurance coverage through analysis of cost-effectiveness and testing of potential substitution of prescription drugs with over-the-counter ones. A review of existing medical service and drug coverage could help finance insurance coverage for preventive medicine.

The third pillar is the fortification of the regional medical care providers and improvement of efficiency among providers by utilizating technology and data. The use of AI IoT in preventive medicine, and accompanying support of society, will have substantial effects: increased collaboration between regional medical and long-term care communities, wider sharing of health and medical information in local communities, and greater compatibility with improvements to the efficiency of medical and long-term care providers.

Most importantly, the main purpose of preventive medicine is to achieve self-fulfillment. This requires maintaining good health through later life. The government must continually work to reform the social security system as it is essential to improving the wellbeing of the nation.