Special Aspects of IBD management in Japan, monitoring strategies and medical treatment in IBD patients

So in Japan, one of the most important characteristics of our healthcare system is the insurance is completely public.

That means everybody has 100% of us have the same insurance, which actually covers 70% of the medical expense.

But the medical expense, all the prices are determined by the government.

they're completely flat everywhere and it's very cheap already but again the public insurance covers 70 percent of it so that the patient only have to pay like 30 30 percent of the cheaper like the price for medicine or procedure for hospitalization like any the health care there and what's also unique to IBD patients is that there is a medical extra medical subsidy for IBD patients once they are qualified for the refractory diseases that there's a refractory disease specific medical subsidy which actually covers more than that 70 percent so the most of the patients only have to pay around like 50 to 100 euros maximum per month based on their income.

So the vast majority of the medical expense is covered publicly.

This brings me to one question because not everything is invented in Japan and something is coming from overseas.

So how can your government convince companies to to have a certain price and to accept this certain price because you said it's the same price all over the country and it's fixed by the government so if there's something a new innovation at least in in germany i know the prices are always very high and after 10 years or 15 years when it goes out of patent it becomes cheaper

yeah so the price of prices of the drugs actually gets gradually cheaper over time, but the initial price is actually determined by the previously existing drugs in the similar class.

So the second anti-TNF, the price was set, determined, completely matched with the first anti-TNF, for example.

And how is GI done? So how are the offices based? Is it all based at hospitals and outpatients and inpatients at hospitals? Or do you have private practices, private offices for, especially you mentioned complex IBD and there is also a different payment.

How is this set up?

So, of course, we have private clinics and the usual hospital-based clinics and hospital wards as well.

But regardless of which hospital or which clinic the patients are seen, the medical price is completely the same, regardless.

Okay.

Another important issue is probably how do you collaborate with colleagues? So we always talk about the MDT groups, so multidisciplinary teams.

Are they based at the hospitals? And another question also going along with this, how is the access for the IBD patients? So Tokyo, I assume there are...

hundred hospitals and the patient has it easy to do it but in the more remote areas in Japan do they have to come to Tokyo to Sapporo or other big cities or do they have local facilities?

Yeah so it really depends but Japan isn't that huge country and there are like multiple several like big cities so the There is a trend for the IBD patients, especially because these are the refractory diseases.

So most of the patients want to be seen by the experts and specialists, mainly in the urban areas.

But again, anyway, the prices are exactly the same regardless.

So that's also the reason why the patients always want to be seen by the experts.

OK.

And coming back to the MDT team, so are you organized in a similar way like the echo recommendations where we say you should have a surgeon, you should have a pediatrician, nutrition, psychologist, and so on? Or how is it the setup? Yeah, so

our center has our own MDT team designated for IBD, but it's typically quite difficult in Japan because all the nurses and the pharmacists and dieticians actually have to rotate among the department.

So even if we educate and train our nurses, then those nurses may actually leave GI for like dermatology or OR, ER.