2017 Survey on Healthcare in Japan(Updated version)

Health and Global Policy InstituteFebruary 2018

I.

Summary

The Health and Global Policy Institute has been undertaking regular surveys of public opinion on healthcare issues since 2006
in order to gain a better understanding of public perceptions and a better awareness of the health services and health carepolicies that the public desires. Continuing on from previous surveys, the 2017 survey included questions on the level ofsatisfaction that the public feels with the current healthcare system. The survey inquired also about the public’s perceptionof annual upward trends in medical costs, and how they are reacting to this. Moreover, the survey included questions on
issues that have been garnering attention recently, such as measures to prevent passive smoking, the self-medication tax
deduction system, dementia, end-of-life expectations, and degrees of trust in various sources of medical information.
(1) Survey highlights
Respondents were divided on their overall degree of satisfaction with the healthcare system.

In particular, there was low satisfaction with the degree of public participation in shaping the healthcare system, and thefairness of the decision-making processes in the system.

Regarding passive smoking, about half of respondents backed a full ban on smoking in eating and drinking establishments,
irrespective of the establishment’s floor space.



66% of respondents believed that e-cigarettes should be targeted as soon as possible in preventive measures against
passive smoking.



About 90% of respondents were unaware of the self-medication tax deduction system.

Over 50% of respondents approve of remote doctor oversight for death pronouncements.
(2) Healthcare policy based on survey results (future discussion points)



Although efforts have been made to promote participation among the public in medical institution decision making,further measures to encourage more active participation and improved process transparency could be future issues.

Measures against passive smoking affect human life as public health policies. The realization of highly effective passive
smoking countermeasures may also be a future issue.

II.

Overview of survey

An internet-based public opinion survey was administered to 1,000 males and females over 20 years of age throughout Japan,
during November 2017. The breakdown of respondent demographics is shown in Figure 1. The survey was only administered
to those who gave informed consent after having read an explanation of the survey’s objectives. The questionnaires were selfadministered, and a serial number was given to each respondent to ensure anonymity.
The conduction of a survey on the internet introduces a fixed sampling bias in that it selects only for respondents who canuse the internet, and hence have a certain level of education, as internet literacy is generally correlated with education level.1
It is important to take this limitation into account when interpreting the results of this survey.
1) Smith MA, Leigh B. Virtual subjects: using the Internet as an alternative source of subjects and research environment. Behav Res Meth Instrum Comput.
1997;29:496–505.

12017 Survey on Healthcare in Japan – Respondents

Figure 1• Survey period: November 2017
• Survey type: Internet survey• Respondents: 1,000 nationally representative males and females aged 20 and above, selected fromthe monitor panel of the research firm that conducted the survey• Number of valid responses: 1,000• Breakdown of respondent demographics
Area• Hokkaido - Tohoku• Kanto• Chubu• Kinki• Chugoku – Shikoku• Kyushu - Okinawa

Age group

11.7%
33.8%
16.9%
17.6%
8.8%
11.2%

• 20’s• 30’s• 40’s• 50’s• 60’s• 70 and above

Sex

11.4%
14.9%

• Male• Female

17.5%
15.3%
17.6%
23.3%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

2

48.5%
51.5%

III.

Survey results(1) Degree of satisfaction with medical care and the healthcare system
Respondents were divided on “Overall degree of satisfaction with the healthcare system”
Less than half (47.0%) of respondents were either very satisfied or somewhat satisfied overall with the healthcare
system.

Comparatively higher levels of satisfaction (including “somehow satisfied”) were seen related to “accessibility to
medical institutions” (53.7%), the “quality of technology in diagnosis and treatment” (52.9%), and “medical safety”(48.3%) (Figure 2).



The lowest levels of satisfaction were seen for “public participation in shaping the system (whether the voices of
the citizens are accounted for)” (21.0%) and “fairness of the decision-making process (transparency of the systembuilding process)” (21.8%) (Figure 2).
Degree of satisfaction with medical care and the healthcare system ①

Figure 2（November 2017; n=1,000）
Overall degree of satisfaction

4.0%

Quality of technology in diagnosis and treatment

5.9%

Medical safety

4.4%

Availability of information about medical institutions and treatments

3.6%

Incorporation of patient's opinion into courses of treatment

3.5%

Individual out-of-pocket costs

4.5%

Fairness in the healthcare system*1

7.0%
2.9%

Equality of healthcare cost burden sharing among generations
Comprehensibility of information and procedures in the healthcare system
Public participation in shaping the system
Fairness of the decision-making process
Quality of service for patients*2

1.9%
1.9%
2.3%
3.1%

0%

Very satisfied

Somewhat satisfied

47.0%
43.9%
36.6%

35.7%

36.2%

26.3%

28.9%

34.2%
36.5%

19.5%

36.1%

30.9%
30%

8.1%

18.2%

20.3%

11.4%

15.5%

15.0%
16.3%
16.0%
21.8%

19.8%

50%

Very dissastisfied

22.3%
13.4%

23.8%
40%

16.7%

20.7%
37.6%
60%

70%

16.1%

9.1%

20.8%

44.3%
20%

14.5%

17.7%

38.5%

19.1%

10%

13.3%

6.8%
5.8%

33.6%

28.1%

Somewhat dissatisfied*1 Unrelated to economic equality, all citizens of Japan may receive the same medical
treatment*2 Unrelated to the type of services (Health personnel’s conduct, health facility environment,
waiting time etc.)

29.8%
32.8%

22.8%

11.2%

25.8%

37.8%

9.4%

Accessibility to medical institutions

28.5%

43.0％

15.0%

8.7%

13.8%

80%

90%

100%

I don't know

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

CommentaryFree access to healthcare facilities, a characteristic feature of medical treatment in Japan, received the highest levelof satisfaction.

On the other hand, remarkably low levels of satisfaction with the “public participation in shaping the system” andthe “fairness of the decision-making process” suggest that citizen opportunities to participate in the policy decisionmaking process are insufficient, and a substantial number are dissatisfied with the transparency of the system.

Henceforward, it is important to further involve the public in the decision-making process and improvetransparency.

3Highest satisfaction reported for doctors in terms of the “degree of satisfaction with the quality of service for patients”
Respondents who selected either “very satisfied” or “somewhat satisfied” related to “quality of service for patients”
were asked what particular aspects of the services they were pleased with, allowing for multiple answers. 70.9% of
respondents selected “doctor’s conduct,” 56.2% answered “nurse’s conduct,” 45.0% chose “healthcare facilities’equipment and environment,” and 39.1% picked “pharmacist’s conduct.” The numbers thus indicate that medical
personnel rank highest as reasons for some of the respondents’ satisfaction with patient services (Figure 3).
Degree of satisfaction with the quality of service for patients ②

Figure 3

Question: “This question targets respondents who selected ‘very satisfied’ or ‘somewhat satisfied’ for the ‘quality of service for patients’* itemin the previous question. Please choose what particular aspects of the services you were pleased with from the list below (multiple answers
allowed).”*Unrelated to the type of services (Health personnel’s conduct, health facility environment, waiting time, etc.)(November 2017; n=340）
70.9%

Doctor's conduct

56.2%

Nurse's conduct

45.0%

Healthcare facilities' equipment and environment

39.1%

Pharmacist's conduct

32.9%

Waiting time to consultation

22.1%

Consultation time

0.6%

Other

0%

10%

20%

30%

40%

50%

60%

70%

80%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

Commentary

The Family Pharmacist system in Japan started in April 2016 with the purpose of expanding the role of pharmacists.
However, the respondents’ degree of satisfaction with pharmacists was low compared to other medical
professionals.

4(2) Passive smoking
Slightly over 20% do not know the meaning of the term “passive smoking”
When asked if they knew the term “passive smoking,” 10.9% of respondents answered “I don’t know”, and 10.1%
selected “I know the term, but not its exact meaning” (Figure 4).
Passive smoking ①

Figure 4

Question: “Do you know the meaning of the term ‘passive smoking’?”（November 2017; n=1,000）

I don't know
10.9%
I know the term, but notits exact meaning
10.1%
I know both the term
and its meaning
79.0%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

Commentary

A large number of respondents are aware of the term “passive smoking” and understand its meaning. Although it
is a serious health topic, about 20% of respondents either knew the term but not its meaning or were completely
ignorant of it.



The proportion of respondents who knew the term “passive smoking” and understood its meaning was above 70%
across all age groups. Yet the fact that about 30% of respondents in their 20s and 30s either knew the term but
not its meaning or were completely unaware of the term suggests that further awareness-raising efforts arenecessary (Reference Figure 4).

5Lack of awareness about the effects of passive smoking on children
Respondents who knew the term “passive smoking” and understood its actual meaning were asked whether they
were aware of passive smoking’s role in causing lung cancer, ischemic heart disease, cerebral stroke, pediatricasthma, and sudden infant death syndrome. Less than half, 44.4%, were aware of its role in causing sudden infant
death syndrome, compared to 95.6% for lung cancer, 67.9% for ischemic heart disease, 71.4% for cerebral stroke,and 69.0% for pediatric asthma (Figure 5).
Passive smoking ②

Figure 5

Question: “It has been scientifically established that passive smoking has a causative role in the occurrence of each of the diseases listed
below.* Please select, for each disease, how aware you were of passive smoking’s causative role in its occurrence.”* Ministry of health, labor and welfare “Passive smoking and health: Investigative commission report on the health effects of smoking”

1.0%
3.4%

November 2017; n=790）

53.8%

Lung cancer
Ischemic heart disease

29.4%

Cerebral stroke

31.1%

Pediatric asthma

28.1%

38.5%

0%

Very aware

10%

24.4%

40.3%
40.9%

18.1%

Sudden infant death syndrome

41.8%

26.3%
20%

22.0%

6.6%

23.7%

7.3%

37.2%

30%

Somewhat aware

40%

50%

Somewhat unaware

60%

7.7%

18.4%
70%

80%

90%

100%

Not at all aware

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

Commentary

The results reveal that the respondents’ appreciation of passive smoking’s role in provoking diseases detrimental tochild heath, such as pediatric asthma and sudden infant death syndrome, is low. To protect children from the effectsof passive smoking, it is necessary that parents and guardians properly understand its effects. Thorough awarenessraising efforts are needed to bring about understanding on this issue.

6Prevention of passive smoking - 70% believe measures should be strengthenedWhen asked to “please select the option that is closest to your opinion regarding passive smoking,” most (68.6%)
answered “an environment should be created where non-smokers are protected from passive smoking.”
Furthermore, 14.5% answered that “a certain level of passive smoking is unavoidable”, and 3.9% stated that “passive
smoking should be tolerated” (Figure 6).
Passive smoking ③

Figure 6

Question: “Passive smoking is the inhalation by persons, other than the smoker, of smoke given off by a tobacco product or exhaled by thesmoker. The emitted smoke contains nicotine, tar, and many other toxic substances. Please select the option that is closest to your opinion
regarding passive smoking.”

Other
0.7%

（November 2017; n=1,000）

I don't know
12.3%
Passive smoking
should be tolerated
3.9%

An environment shouldbe created where nonsmokers are protectedfrom passive smoking
68.6%

A certain level of passive
smoking is unavoidable
14.5%
Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

About half of current smokers believe that measures should be taken against passive smoking
Breaking down the respondents to the former question by smoking status*, 73.4% of non-smokers and a notable
51.6% of smokers were found to have selected “an environment should be created where non-smokers areprotected from passive smoking” (Figure 7).
Passive smoking ④

Figure 7

Question: “Passive smoking is the inhalation by persons, other than the smoker, of smoke given off by a tobacco product or exhaled by thesmoker. The emitted smoke contains nicotine, tar, and many other toxic substances. Please select the option that is closest to your opinion
regarding passive smoking.”（November 2017; n=1,000）

Breakdown of Respondents by Smoking Status

Smokers

51.6%

26.6%

Former Smokers

70.9%

Non-smokers

73.4%
0%

10%

20%

30%

40%

50%

60%

70%

2.1%
12.0%
3.0%
0.9%
16.5%
8.7%
0.2%
2.9%
9.7%
13.8%
7.8%

80%

90%

100%

An environment should be created where non-smokers are protected from passive smoking
A certain level of passive smoking is unavoidable
Passive smoking should be tolerated
I don't know

Other
Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan*Below are the definitions used for each category of smoking status in this survey.
Current smokers: Daily and occasional smokers, Former smokers: Current non-smokers who smoked in the past, Non-smokers: Respondents who never in their lifetime smoked.

7

Commentary

About 70% of all respondents and about half of the smokers among them expressed the opinion that environments
should be created to protect people from passive smoking. It is necessary that more be done at once to promotemeasures against passive smoking.



About half of respondents support a total ban on smoking in eating and drinking establishments, irrespective of theestablishment’s floor space.
On the question of whether a complete or partial ban on smoking should be introduced for drinking and eating
establishments depending on their floor space, 49.9% of respondents selected the answer, “a total ban should beapplied irrespective of establishment floor space.” 6.3% chose “smoking should be tolerated, irrespective of
establishment floor space,” and 33.5% that “the matter of whether to impose a complete or partial ban on smoking
should be decided based on the establishment’s floor space” (Figure 8).

Passive smoking ⑤

Figure 8

Question: “This is a question regarding preventive measures against passive smoking in eating and drinking establishments.
What do you think of the proposition to impose a complete or partial ban on smoking to drinking and eating establishments
depending on their floor space?”（November 2017; n=1,000）
I don't know
10.3%

A total ban should
be appliedirrespective of
establishment floor
space
49.9%

The matter of whether toimpose a complete orpartial ban on smoking
should be decided based on
the establishment’s floor
space
33.5%

Smoking should be
tolerated irrespective of
establishment floor space
6.3%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

CommentaryCurrently in Japan, there is much debate on using floor space to apply complete or partial bans on smoking in eating
and drinking establishments. However, about half of the respondents of this survey appear to agree with a complete
ban on smoking in such establishments, irrespective of floor space.

8E-cigarettes - 66% believe e-cigarettes should be included in measures against passive smoking as soon as possible

At the time of this survey, e-cigarettes* were not yet included in measures to prevent passive smoking owing to thelack of information on their health effects. Accordingly, respondents were asked to select an answer from a set of
options that was closest to their opinion about that state of affairs.



The majority of respondents (65.7%) answered “E-cigarettes should be included in measures to prevent passive
smoking as soon as possible, even before their effects on health can be well established”. 21.6% answered “It is notnecessary to include e-cigarettes in measures to prevent passive smoking before their effects on health have been
well established”, and 11.5% chose “It would not be necessary to include e-cigarettes in measures against passive
smoking even if their health effects were well established” (Figure 9).
Passive smoking ⑥

Figure 9

Question: “Currently, e-cigarettes are not included in measures to prevent passive smoking, owing to the lack of information on
their health effects. Please select the option that is closest to your opinion regarding this matter.”（November 2017; n=1,000）

Other
1.2%

It would not be necessary
to include
e-cigarettes in measuresagainst passive smoking
even if their healtheffects were wellestablished
11.5%

E-cigarettes should be included inmeasures to prevent passive smoking assoon as possible, even before their effects
on health can be well established
65.7%

It is not necessary toincludee-cigarettes inmeasures to prevent
passive smoking before
their effects on healthhave been wellestablished21.6%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan*Electronic devices that electrically heat tobacco without burning it. The user inhales the vapor generated by this process. Despite containing nicotine, the toxic components emitted
through this process are said to be less harmful than those let out by paper cigarettes. Examples of such products include IQOS and Glo.

Commentary

Almost 66% of respondents are of the opinion that e-cigarettes be included in measures to prevent passive smoking
despite current uncertainties on their potential effects on health. It is therefore urgent that policies that cover ecigarettes be formulated, including laws and regulations.

9(3) Self-medication tax deduction systemAbout 90% were unaware of the self-medication tax deduction system

11.1% of respondents were knowledgeable about the details of the self-medication tax deduction system, while
33.7% were aware of the term but not its exact meaning, and 55.2% were unaware (Figure 10).
Self-medication tax deduction system ①

Figure 10

Question: “Are you aware of the ‘Self-medication tax deduction system’?”（November 2017; n=1,000）

I am knowledgeable about its
details…

I am aware of
the term but notits exact
meaning
33.7%

I am unaware
of it
55.2%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in JapanOver 60% want to make use of the self-medication tax deduction system


62.5% of respondents either “Want to actively make use of it (the system)” or “Want to make use of it to an
extent” (Figure 11).
Self-medication tax deduction system ②

Figure 11

Question: “Do you want to make use of the ‘Self-medication tax deduction system’?”（November 2017; n=1,000）

I do not wantto make use of it at all
12.2%

I want toactively
make use of it
20.0%
I do not reallywant to makeuse of it
25.3%
I want to make use of it toan extent
42.5%
Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

10

Commentary

The self-medication tax deduction system has been in place since January 2017. Yet, the results of this survey
suggest that the number of people who are familiar with the details of it is still small. However, after respondents
were given an explanation of the system and questioned on whether they would make use of it, over 60% said theywould. Incidentally, a similar proportion of over 60% wanted to make use of the system across all age groups. In lightof this, it is necessary that more effort be made to raise awareness about the existence of this system (Reference
Figure 9).

(4)Prescription Refills

About 80% approve of the prescription refill system
When asked whether they approved of the introduction of the prescription refill system, 80.4% of respondents
answered they either “approve” or “somewhat approve.” The remaining 19.6% replied they “disapprove” or“somewhat disapprove”. When calculated for each age group, the approval rate was over 70% in every group, andincreased with age (Figure 12 & Reference Figure 10).
Prescription Refill System

Figure 12

Question: “What do you think of the introduction of the ‘Prescription Refill’ system?”（November 2017; n=1,000）

I disapprove of it
4.2%

I somewhat
disapprove of it
15.4%

I approve of it
32.2%

I somewhat approve of it
48.2%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

Commentary

The government is currently examining the implementation of the prescription refill system. This survey revealed
that about 80% of the public are in favor of this system. Against this backdrop of strong approval, it is likely thesystem can be quickly implemented if issues can be worked out related to safeguards for patients and the role ofthe pharmacists.

11

（5）Health insurance financing
Over 50% were unaware of the state of national healthcare expendituresIn 2015, overall national healthcare expenditures amounted to 42 trillion yen, a rise of 1.5 trillion yen on the previous
year. Respondents were asked whether they were aware of this matter. 46.3% answered either that they “were wellaware” or that they had “heard that before”, while 53.7% answered either they “didn’t know” or that they might“have heard that before” (Figure 13).
State of national healthcare expenditures ①

Figure 13

Question: “Are you aware of the fact that overall national healthcare expenditures amounted to 42 trillion yen in2015 (a rise of 1.5 trillion yen on the previous year)?”（November 2017; n=1,000）

I am well aware of
that
14.1%

I didn’tknow that
24.3%

I may have heardthat before
29.4%

I’ve heard that
before32.2%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

12

Acting on the awareness about high national healthcare expenditures – Many said they would “use generic drugs” or “usethe services of a primary care doctor”


Respondents who were aware of the current state of national healthcare expenditures were asked whether, basedon that knowledge, they intended to take actions which could contribute to reducing medical care costs when
visiting a healthcare facility. Out of the 463 respondents who were aware, 52.7% answered that they would (Figure
14).

Those who said they would act were then asked to write what specific actions they would take. Notable answers
included the use of generic drugs, the use of the services of primary care doctors, and taking health precautions so
as to minimize the chances of having to go to health facilities.
State of national healthcare expenditures ②

Figure 14

Question: “Do you intend to take actions that could help reduce medical care costs the next time you visit ahealthcare facility?”(November 2017; n=463)

I don’t know 11.4%

Yes 52.7%
No 35.9%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

CommentaryOver 50% of respondents were unaware of the current state of healthcare expenditure. However, of those who
were aware of this issue, the majority stated that they did intend to take action to contribute to reducing healthcare
costs.

13

(6) Dementia

About 80% are aware that the early detection of dementia can slow its progressWhen asked if they were aware that the early detection of dementia provides opportunities to slow down its
progress, 77.4% of respondents answered either that they were “well aware” or that they had “heard that before”,
while the remaining 22.6% answered they “didn’t know” or that they might “have heard that before” (Figure 15).
Dementia

Figure 15

Question: “Were you aware that an early dementia diagnosis may provide opportunities to slow down its
progress?”（November 2017; n=1,000）

I didn’t know that 5.1%
I’m wellawareof that
28.9%

I may have heard that
before17.5%

I’ve heard that before
48.5%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

Commentary

About 80% of respondents were aware that the early detection of dementia provides opportunities to slow down
the disease’s progress. Given current trends towards improved access to healthcare to enable early diagnoses andinterventions for outpatients suffering memory impairments, it is anticipated that many patients will receive even
earlier diagnoses and interventions in the future.

14(7) Remote Doctor Oversight for Death Pronouncements
Over 50% approve of “remote doctor oversight for death pronouncements”
Respondents were asked what they thought of a framework by which a doctor could pronounce a person dead froma remote location based on information sent to the doctor by a nurse via a smartphone or other such device, in theevent that the doctor could not promptly attend the deceased. 54.8% of respondents answered that they either“approve” or “somewhat approve” of this framework, and 45.2% answered that they either “disapprove” orsomewhat disapprove” (Figure 16).
Remote Doctor Oversight for Death Pronouncements

Figure 16

Question: “What is your opinion on a framework that would allow doctors to pronounce a person dead from aremote location based on information sent to the doctor from a nurse by way of a smartphone or other suchdevice, in the event that the doctor cannot immediately attend the diseased?”（November 2017; n=1,000）

Disapprove 12.1%

Approve14.1%

Somewhatdisapprove
33.1%

Somewhatapprove
40.7%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

CommentaryOver 50% of respondents approve of remote doctor oversight for death pronouncements. The concrete modalities
for implementing this procedure are currently being deliberated.



It is important to note, however, that this survey was undertaken on the internet, and is therefore likely biased
towards respondents who have high internet literacy. This factor should be kept in mind when interpreting theresults.

15

(8) End-of-life care

About 50% were unsure whether they could receive terminal care in their homes

Respondents were asked to consider whether it would be possible for them to receive terminal care at home, given
the current state of their family and their domiciles. 23.2% answered “yes”, 24.8% answered “no”, and 52.0% replied“I don’t know” (Figure 17).
End-of-life care ①

Figure 17

Question: “Given your present family and home environment, do you think it possible for you to receive terminal
care at home?”（November 2017; n=1,000）

Yes 23.2%
I don’t know
52.0%
No 24.8%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

90% were aware of at least one of the following terms: “euthanasia,” “death with dignity,” and “living will”
Respondents were asked if they were aware of terms such as “euthanasia”, “death with dignity”, and “living will (awritten declaration of intent which states what sort of medical treatment a person wishes to receive in the event
they become unable to provide informed consent).” 49.0% of respondents knew these terms and understood their
meaning, 41.2% knew them but didn’t know the meanings, and 9.8% didn’t know any of the terms (Figure 18).
End-of-life care ②

Figure 18

Question: “Are you aware of the terms ‘Euthanasia,’ ‘Death with dignity,’ or ‘Living will’ (a written declaration of
intent which states what sort of medical treatment a person wishes to receive in the event they become unable toprovide informed consent)?”（November 2017; n=1,000）

I don’t know these
terms
9.8%

I know theseterms and I
understand their
meaning
49.0%

I know of these term but I
don’t know what they mean
41.2%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

16

Commentary

About 50% and more of respondents across all age groups were not sure whether they could receive terminal care
at home when dying (Reference Figure 12). Recently, a trend to shift medical and nursing care away from healthcare
facilities and towards homes has been taking shape. Further research is needed on how the public feels about thistrend.



About 90% of respondents were aware of terms relating to terminal care, which is a large number, although many
did not know the exact meanings of the terms. Moving forward, it is necessary to undertake further awarenessraising activities to help the public understand these concepts.

17(9）Sources of information about healthcare

The most trusted sources of information are doctors, followed by nurses and pharmacists respectively.



Among the media, newspapers and television/radio received high levels of trust.
When asked how much they trusted a pre-set list of sources of information about healthcare, 81.4% answered that
doctors are either “very reliable” or “to some degree reliable.” 77.4% and 75.2% answered the same about nurses
and pharmacists respectively (Figure 19).



About media, 63.1% answered newspapers are either “very reliable” or “to some degree reliable” and 58.8%
answered the same for television and radio (Figure 19).
Sources of information about healthcare ①

Figure 19

Question: “How much do you trust the following sources of information on health issues?”（November 2017; n=1,000）

Very reliable

Nurses

13.8%

Pharmacists

12.5%
3.8%

Healthcare centers & municipalities

6.8%

Medical books for laypeople

5.1%
3.4%

Television & Radio
Magazines (business, economics）
Internet
Friends & Word of mouth
Magazines (weeklies）

Not so reliable

19.4%

Doctors

Newspapers

To some degree reliable

1.3%

Advertisements & Flyers
0%

62.0%

9.1%

7.5%
2.0%
8.3%
1.6%
13.7%
8.4%
2.7%
5.2%
11.4%
12.7%

62.7%

59.3%

20.3%

54.3%

23.2%

55.9%

34.1%

32.7%

8.0%
9.0%

44.9%

20.2%

45.8%

14.0%

48.2%
20%

30%

40%

60%

70%

10.4%
17.1%
13.6%

13.8%

16.7%

15.9%

16.8%

21.1%
50%

13.8%

6.2%

42.8%

23.5%

11.7%

3.4%

24.6%

39.1%

10%

4.0%

21.8%

55.4%

1.9%

0.7%

I don't know

63.6%

1.7%

1.1%

Not at all reliable

16.0%
80%

90%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

18

100%



Reliability of information from the internetOn the topic of how to improve the reliability of health-related information on the internet, 39.8% preferred the“issuing of guidelines by the government and the reinforcement of regulations”, 30.5% preferred the “improvementof health education at schools / improvement of public health literacy”, 16.3% preferred the “issuing of guidelines
and reinforcement of regulations by non-governmental organizations (medical associations, private businesses etc.)”,and 11.9% preferred “education for the media (journalists, editors etc.)” (Figure 20).
Sources of information about healthcare ②

Figure 20

Question: “Which of the following do you think is the most effective way to improve the reliability of healthrelated information on the internet?”（November 2017; n=1,000）

Education for the media(journalists, editors etc.)
11.9%

Other 1.5%

The improvement of healtheducation at schools / Improvementof public health literacy
30.5%

The issuing of guidelines and reinforcement ofregulations by non-governmental organizations(medical associations, private businesses etc.)
16.3%
The issuing of guidelines by
the government and thereinforcement of regulations
39.8%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

CommentaryDoctors enjoy the highest degree of trust amongst the public. There are high hopes that doctors will continue tocommunicate accurate and easier to understand information to the public.

Over 50% of respondents do not trust information coming from the internet. Given that, and the expectation thateven more information on health will be posted on the internet in the future, it is necessary for the government tocreate guidelines and reinforce regulations to ensure a certain standard of information quality.

19

IV.

Appendix

Reference Figure 1

General satisfaction with the healthcare system (Comparison with previous years)
Question: “How satisfied are you with the current healthcare system? Please rate your degree of satisfaction for each of the items below.”(In the graph below, those who answered either “very satisfied” or “somewhat satisfied” have been summed together for this comparison)

Overall degree of satisfaction

70%
Quality of technology in diagnosis and treatment

60%

Medical safety

50%

Availability of information about medical institutions andtreatments
Incorporation of patient's opinion into courses of treatment
Individual out-of-pocket costs

40%

Public participation in shaping the system

30%

Fairness of the decision-making process
Quality of service for patients

20%

Accessibility to medical institutions

10%

Fairness in the healthcare system
Comprehensibility of information and procedures in thehealthcare system

0%2006(n=1,011)

2007(n=1,318)2008(n=1,082)2009(n=1,016)

2010(n=1,024)2013(n=1,013)

2016(n=1,000)

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

Reference Figure 2

Passive smoking (Smoking status)
Question: “Select the option that is closest to your experience with smoking.”（November 2017; n=1,000）

I smokeeveryday16.4%

I have never smoked57.8%

I sometimes smoke
2.8%

I smoked in
the past but I
have since
stopped…

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

20

Reference Figure 3

Passive smoking (Current smokers)(November 2017; n=192）

Current smokers (per age group)
0%

5%

20's

10%

15%

20%

25%

30%

35%

17.5%

30's

16.1%

40's

25.1%

50's

29.4%

60's

19.9%

70 and above

10.3%
Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

Passive smoking ① (Per age group)

Reference Figure 4

Question: “Do you know the meaning of the term ‘passive smoking’?”（November 2017; n=1,000）

20's

71.9%

11.4%

16.7%

30's

70.5%

16.1%

13.4%

40's

76.6%

50's

78.4%

11.4%

12.0%

11.8%

9.8%

60's

85.2%

5.7% 9.1%

70 and
above

85.4%

6.9% 7.7%

0%

10%

20%

30%

I know both the term and its meaning

40%

50%

60%

70%

80%

I know the term, but not its exact meaning

90%

100%

I don't know

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan21

Passive smoking⑤（Per smoking status）

Reference Figure 5

Question: “This is a question regarding preventive measures against passive smoking in eating and drinking establishments.

What do you think of the proposition to impose a complete or partial ban on smoking to drinking and eating establishments depending on
their floor space?”（November 2017; n=1,000）

Smokers

18.2%

11.5%

62.0％

Former smokers

57.0%

7.4%

Non-smokers

57.6%

4.2%

0%

10%

20%

30%

40%

50%

60%

8.3%

26.1%

27.0%
70%

80%

9.6%

11.2%
90%

100%

A total ban should be applied irrespective of establishment floor space
Smoking should be tolerated irrespective of establishment floor space
The matter of whether to impose a complete or partial ban on smoking should be decided based on the establishment’s floor space
Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

I don't know

Passive smoking ⑤ (Per region)

Reference Figure 6

The proportion of respondents per region who answered “A total ban should be applied irrespective of
establishment floor space”(November 2017; n=499）
60%

50%

48.7

51.5

50.3

50.0

Chubu

Kinki

46.6

48.2

Chugoku - Shikoku

Kyushu

40%

30%

20%

10%

0%

Hokkaido - Tohoku

Kanto

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan22

Passive smoking ⑥（Per smoking status）

Reference Figure 7

Question: “Currently, e-cigarettes are not included in measures to prevent passive smoking, owing to the lack of information on
their health effects. Please select the option that is closest to your opinion regarding this matter.”(November 2017; n=1,000）

2.6%

36.5%

Smokers

51.0%

9.9%
1.3%

19.6%

Former smokers

70.0%

9.1%
0.7%

17.5%

Non-smokers

0%

68.9%

10%

20%

30%

40%

13.0%

50%

60%

70%

80%

90%

100%

It is not necessary to include e-cigarettes in measures to prevent passive smoking before their effects on health have been well establishedE-cigarettes should be included in measures to prevent passive smoking as soon as possible, even before their effects on health can be well established
It would not be necessary to include e-cigarettes in measures against passive smoking even if their health effects were well established
Other

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

Passive smoking ⑥ (per region)

Reference Figure 8

Regarding e-cigarettes
Proportion of respondents per region who answered “E-cigarettes should be included in measures to prevent passive smoking assoon as possible, even before their effects on health can be well established”(November 2017; n=657）
80%

75.0
68.6

70%
60%

67.5

62.5

60.7

57.3

50%
40%
30%
20%

10%
0%

Hokkaido - Tohoku

Kanto

Chubu

Kinki

Chugoku - Shikoku

KyushuSource: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan23

Self-medication tax deduction system ② (Per age group)

Reference Figure 9

Question: “Do you want to make use of the ‘Self-medication tax deduction system’?”（November 2017; n=1,000）
20's

17.5%

30's

19.5%

40's

19.4%

41.2%
46.3%

11.4%

24.2%
44.3%

21.0%

70 and above

16.8%

26.9%

45.1%

24.4%

60's

17.5%

17.4%

42.3%

16.3%

50's

23.7%

14.4%
25.0%

37.8%

6.3%

30.9%

I want to actively make use of it

I want to make use of it to an extent

I do not really want to make use of it

I do not want to make use of it at all

10.3%

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

Prescription Refill System (per age group)

Reference Figure 10

Question: “What do you think of the introduction of the ‘Prescription Refill’ system?”（November 2017; n=1,000）
20's

30's

40's

50's

60's

23.7%

51.8%

26.8%

17.5%

49.7%

24.0%

19.5%

49.1%

31.4%

4.0%

21.7%
50.3%

34.7%

7.0%

5.1%

13.1%

49.4%

5.2%
3.4%

12.5%
2.1%

70 and above

44.6%
I approve of it

I somewhat approve of it

42.5%
I somewhat disapprove of it

10.7%
I disapprove of it

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan24

State of national healthcare expenditures ① (per age group)

Reference Figure 11

Question: “Are you aware of the fact that overall national healthcare expenditures amounted to 42 trillion yen in2015 (a rise of 1.5 trillion yen on the previous year)?”10%（November0%2017; n=1,000）

7.0%

20's

20%

30%

15.8%

30's

10.1%

40's

10.9%

50%

60's

17.0%

70%

80%

28.9%

30.1%

29.1%

25.1%

28.1%

26.1%
33.5%

42.9%
I am well aware of that

100%

35.6%

33.5%

19.3%

90%

43.0%

34.9%

15.7%

60%

34.2%
25.5%

50's

70 and above

40%

15.9%
25.3%

I've heard that before

I may have heard that before

12.4%

I didn't know that

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan

End-of-life care ①

Reference Figure 12

The proportion of people who answered that they were unsure whether they could receive end-of-life care at theirhome as it is currently, by age group.
（November 2017; n=520）
70%

60.8
60%

51.8
50%

48.3

50.3

50.0

51.5

60's

70 and above

40%
30%
20%

10%
0%

20's

30's

40's

50's

Source: Specified non-profit corporation Health and Global Policy Institute –2017 Survey on Healthcare in Japan25

Ⅴ．”2017 Survey on Healthcare in Japan” - Survey team
(Titles omitted)
Manami Takamatsu(HGPI Manager)

Yuko Imamura(HGPI Senior Associate)

Nael Aoun(HGPI Program Specialist)

Kazumi Kubota(HGPI Fellow, Yokohama City University School of Medicine, Department of
Biostatistics, Assistant Professor)

The copyright of this report belongs to the Health and Global Policy InstituteSpecified non-profit corporation Health and Global Policy Institute
Grand Cube 3F, Otemachi Financial City, Global Business Hub Tokyo
1-9-2, Otemachi, Chiyoda-ku, Tokyo
100-0004 JAPAN
Tel: +81-3-4243-7156 Fax: +81-3-4243-7378 E-mail:info@hgpi.org

26