Japan's national metabolic syndrome examination and health guidance mandate – What can we learn from their experience?

Japan introduced the so-called Metabolic Syndrome Mandate in 2008. Under this legislation, all health care insurers (local administrators of the national health insurance systems) are required to provide annual, systematic health examination to all enrollees and their dependents aged 40 to 74 years. The health examination features laboratory tests and physical examination to evaluate metabolic risk factors including waist circumference, BMI, blood pressure, lipids, blood glucose, and smoking. The Mandate also requires all health care insurers to provide annual health guidance (HG) to individuals who are deemed to require health improvement. Two types of 6-month HG programs are offered: intensive HG (personalized lifestyle modification coaching, for those who with high risks) and enhanced HG (initial counseling and self-lifestyle modification, for those with moderate risks). Adults with low metabolic risks receive informational resources only. The preliminary study of the national electronic medical records found that for 2008-2011, 20.2 to 23.5 million eligible adults participated in the health examination annually (39 to 45% participation rate), and 4.0 to 4.3 million adults became eligible for HG due to elevated metabolic risks. Of those, 309,000 to 643,000 adults completed HG programs (7.7 to 15.5 % completion rate). Although the rates of participation and completion were still low, significant impacts were already seen in both clinical and economic indicators after 12 months from baseline. Overall and for each gender and age sub-groups, those who completed the intensive HG program achieved greater reductions in waist circumference (2.2 to 3.2cm), BMI (0.6 to 0.9 kg/m2), and body weight (1.9 to 2.2 kg), and also had greater improvements in fasting blood glucose (1.7 to 3.1 mg/dl), blood pressure (systolic 2.0 to 3.4 mmHg), and lipids (triglycerides 26.4 to 27.2 mg/dl) compared to thier controls (non-intensieve HG participants) as well as those completed enhanced HG. Furthermore, the intensive HG groups also achieved the largest reduction in health care costs for hypertension, hyperlipidemia, and diabetes in the same time period. This presentation will discuss implications of the Mandate in public health and medical care communities in Japan, and what the U.S. can learn from Japan’s experience.