Mini-Review

Global Health & Medicine. 2022; 4(1):9-13.
DOI: 10.35772/ghm.2021.01109

Ningen Dock: Japan's unique comprehensive health checkup systemfor early detection of disease
Jun Lu*Medical Examination Center, National Center for Global Health and Medicine, Tokyo, Japan.

Abstract: Japan's comprehensive health checkup – Ningen Dock – is a unique system for early detection of disease
that has developed over the years along with the country's universal health insurance system. Ningen Dock iscurrently offered at 1,727 facilities nationwide, involving about 3.7 million people annually. The development of thecomprehensive health checkup system may be one reason for Japan's long life expectancy. The major purpose of thecomprehensive health checkup system is to maintain health in three main ways: early detection of cancer, detectionof lifestyle-related diseases, and confirmation of health status. Here, the history and current status of Ningen Dockin Japan, tests and examinations included in the comprehensive health checkup system, the effectiveness of thosecheckups, and their advantages and disadvantages are described.
Keywords: Ningen Dock, comprehensive health checkups, Japan

Introduction

Ningen Dock in Japan, tests and examinations includedin the comprehensive health checkup system, theeffectiveness of those checkups, and their advantages
and disadvantages are described.

Japan's comprehensive health checkup – Ningen Dock
– is a unique system for early detection of disease
that has developed over the years along with thecountry's universal health insurance system. "Ningen"means human in Japanese, "Dock" is derived from the
dockyard for inspecting and repairing ships. "NingenDock" is similar to the medical checkup system inwhich people visit a facility for a medical checkup. Asa comprehensive health checkup system, Ningen Dock
have advanced in Japan and are currently offered at
1,727 facilities nationwide, involving about 3.7 million
people annually (1).
The development of the comprehensive healthcheckup system may be one reason for Japan's long life
expectancy (2). The major purpose of the comprehensive
health checkup system is to maintain health in threemain ways: early detection of cancer, detection oflifestyle-related diseases, and confirmation of healthstatus. Although the cost of such an examination isborne by the examinee, this system will help to reducethe country's overall health care expenditures throughearly detection and early treatment.
Symptom-based medical care is being major
developed around the world, so there is limited publicawareness of the comprehensive health checkup system.
Facilities perform comprehensive health checkups incountries such as China (3), Thailand (4), Singapore (5),and Vietnam (6). Here, the history and current status ofHistory of Ningen Dock
In Japan, July 12 is "Ningen Dock Day". The firstsystematic Ningen Dock was created at the NationalTokyo Daiichi Hospital – now the National Center
for Global Health and Medicine (NCGM) – on July12, 1954. At the time, the examination was called "adetailed physical examination involving short-term
hospitalization", and a full-scale medical examination
was conducted over 6 days. This is the origin ofcomprehensive medical examinations in Japan (7).
In 1955, an outpatient health checkup over fivedays, mainly involving internal medicine, was instituted
at the Aichi Prefectural Central Health CounselingCenter. On 1958, a health checkup involving short-term
hospitalization for one night and two days was devisedat St. Luke's Hospital, and it widely served as the basic
format for a health checkup (8). This multi-day healthcheckup was undergone by about 300,000 people
annually in 1994. Checkups have taken less and lesstime, and one-day health checkups are now possible.
Today, one-day health checkups are the mainstream,
and one-day and multi-day health checkups areundergone by more than 3.7 million people annually(Figure 1).

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Current status of Ningen Dock

Basic tests and examinations

Currently, Japanese medical examinations are roughly
divided into legally mandated medical examinationsand voluntary medical examinations (Table 1). Legally
mandated medical examinations include medical
examinations of local residents conducted by local
governments, regular medical examinations conductedby companies and employee organizations, tuberculosis
and lung cancer examinations, and health examinations
based on the Maternal and Child Health Act and theSchool Health Act. Health checkups for the elderly
have been conducted since 2008 for all participants inpublic medical insurance ages 40 to 74 (9).
In addition, voluntary medical examinations such as
Ningen Dock are also conducted. Within the voluntary
medical examination market in FY2016, "general healthcheckups" represented a market of 420 billion yen while"specialized health checkups" such as breast cancer
screening and brain examinations represented a marketof 45 billion yen. Over the past few years, the market for
general health checkups has changed little, amounting to
484 billion yen in 2013, 464 billion yen in 2014, and 464
billion yen in 2015 (average 471 billion yen) (10,11).

Basic tests and examinations include an uppergastrointestinal tract test, physical measurements,
medical examination, physiological function test, urine
test, stool test, X-ray examination, abdominal ultrasound,blood test (general blood test, liver function test, renal
function test, lipid metabolism test, pancreatic function
test, sugar metabolism, test for gout, serology, thyroid
test, test for tumor markers, and an immunological test),
gynecological examination, etc. (12) (Table 2).

Te s t s a n d e x a m i n a t i o n s t h a t a re p a r t o f acomprehensive health checkup

To provide tailored comprehensive health checkupssuitable for everyone, the NCGM is striving to offer
options to examinees beyond the basic tests andexaminations (Figure 2).
Since 2010, encouraging medical tourism has
been a key policy of the Japanese Government. The
number of facilities catering to medical tourism hasincreased. Given that context, the current authors'facility – Ningen Dock at the NCGM – has endeavored
to become an international medical facility since2016. Various efforts have been made to enhance
the facility's ability to cater to foreign examinees bytranslating explanations, test and examination guides,
and consent forms, by providing guidance before tests
and examinations and on-site interpretation for tests
and examinations, and by publishing reports on thenumber of examinees and their country of origin. As
a result of these efforts, the total number of foreign
examinees as of March 2017 had increased about
10-fold compared to the previous year. The number

Optional tests and examinations
Various examinations and tests are conducted byeach facility, including a lower gastrointestinal tract
examination, breast examination, test for arteriosclerosis,
brain examination, heart examination, pancreas
examination, liver examination, bone examination, test
for lifestyle-related diseases, test for Helicobacter pylori
infection, test for human papillomavirus infection, PETCT scan, etc..
Ningen Dock at the NCGM

Each facility has some basic tests and examinations
and optional tests and examinations, although there aresome differences.

Figure 1. Average number of people who undergo Ningen
Dock health checkup in Japan. (Apr. 2017-Mar. 2019).
Source: Reference (1) 2017/2018 Report on a survey ofmember facilities (2021/3/31), with modifications.

Table 1. Comparison of legally mandated and voluntary medical examinations conducted annually in JapanLegally mandated medical examinations
PurposeContents

Number of examinees
Market size

Maintain public health
Anthropometry, eyesight, hearing, blood pressure, chest X-ray, bloodtest (hemoglobin, red blood cell count, ALT, AST, γ-GTP, triglycerides,HDL-C, LDL-C, fasting blood glucose, HbA1c), urinalysis (protein,sugar), electrocardiogram, doctor's consultation, etc.
About 28,000,000
About 445 billion yen(10)

Voluntary medical examination(Comprehensive health checkup)
Maintain personal health
Includes the same tests/examinations
as the legally mandated medicalexamination
About 3,700,000
About 471 billion yen

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Table 2. Tests and examinations that are part of Ningen Dock health checkups
Details

Test/examination
Upper Gastrointestinal exam
Physical measurements
General consultation
Physiological function test
Bloodwork
GeneralLiver function
Kidney function
Lipid metabolism
Pancreatic function
Glycometabolism
Gout
Serological tests
Thyroid gland
Tumor marker
Rheumatoid
Urine analysis
Stool analysis
X-ray examination
Abdominal ultrasonography
Gynecology (female only)

Gastric camera (gastroscopy) or barium meal (stomach X-ray)
Height, weight, obesity index (BMI), body fat percentage, abdominal circumference
History taking, auscultation and percussion of the heart and lungs, palpation
Blood pressure, electrocardiogram (at rest), hearing test (simple), visual acuity, intraocular pressure, ocular
fundus, lung function test (FVC, FVC%, FEV₁%)
White blood cell count (differential count of leucocyte), red blood cell count, hemoglobin level, hematocrit,platelet count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscularhemoglobin concentration (MCHC)
Total protein, albumin, total bilirubin, AST, ALT, γ-GTP, ALP
Urea nitrogen, creatinine, electrolytes (Na, K, Cl, Ca, P, Mg)
Total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides
AmylaseFasting blood glucose, glycohemoglobin (HbA1c)
Uric acid
Hs-CRP, syphilis reaction, hepatitis virus test (HBs antigen and antibody, HCV antibody), blood type (ABO,Rh type)
TSH, FT4
PSA (male only), CA125 (female only), CEA
RF (Rheumatoid factor)
Urine specific gravity, pH, protein, glucose, occult blood, sediment, urine microalbumin
Occult blood reaction (samples to be collected on 2 separate times)
Chest X-ray (2 directions)Liver, gallbladder, pancreas, kidneys, spleen, and other organs
Pelvic exam, speculum exam, transvaginal ultrasonography, Pap smear (cervical screening)

Figure 2. Ningen Dock: Rubric for selecting optional tests and examinations to undergo as part of a personalized medicalexamination. As an example, the general condition and risk of a 45-year-old smoker could be evaluated by adding a colonoscopy,
brain examination, heart examination, lung examination, and test for arteriosclerosis. The idea is to be able to perform a tailoredexamination that is better suited to the individual.

Effectiveness, advantages, and disadvantages ofNingen Dockof Vietnamese examines increased rapidly after
September 2017. Prior to 2019, the number of foreign
examinees totaled 3,385, accounting for 28% of all
examinees, and foreign examinees accounted for morethan 50% of the facility's total revenue (Figure 3).

Two year of data from the latest survey on the five
major cancers by the Japan Society of Ningen Dock(11)Global Health & Medicine. 2022; 4(1):9-13.

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Figure 3. Changes in the number of foreigners visiting the Ningen Dock at the NCGM.

Table 3. Number of cancers found in individuals undergoing Ningen Dock health checkups (Apr. 2016 ~Mar. 2018)
Examination
Lung cancer
Gastric cancer
Colorectal cancer
Breast cancer
Cervical cancer

Number of examinees

Number of cancers found (including suspected)

Cancer confirmed

6,395,860
5,681,805
6,107,352
2,055,693
1,772,270

26,36739,82883,58727,490
9,746

1,754
4,526
4,239
4,463772

Data source: Reference (1) 2017/2018 Report on a survey of member facilities (2021/3/31), with modifications.

Conclusionindicated that the rate of cancer detection, including
suspected lung cancer, in comprehensive healthcheckups was approximately 0.41%. In 6.65% ofexamines, lung cancer was definitively diagnosed. The
rate of detection of gastric cancer was 0.7%, and gastriccancer was confirmed in 11.36% of examines. The rateof detection of breast cancer is the highest, with a rateof detection of 1.34%, and cancer was confirmed in16.23% of examinees (Table 3).
The biggest advantage of comprehensive healthcheckups is preserving life through early detection andearly treatment. Since there is a high possibility that thepatient can be cured at an early stage and the treatment
is often less burdensome, the patient generally has lessof a physical, financial, or temporal burden. Regular
medical examinations are required so that disease canbe found at an early stage.
A disadvantage of comprehensive health checkups
is that the determination/results of the medical
examination are not 100% correct. Although testingand examination accuracy and technology have maderemarkable progress, there are still some situations inwhich disease may be overlooked. A comprehensive
health checkup can also result in a "false positive"(13) and, as a result, "overdiagnosis" leading to
unnecessary testing and treatment. Unnecessary tests
and examinations may strain the body physically (pain,radiation exposure, etc.) and psychologically. One
should undergo a comprehensive health checkup after
considering its advantages and disadvantages.

There are still various aspects of the global problemof aging that still need to be addressed, such as early
detection and treatment of disease and tests andexaminations suited to the individual, but Japan'sunique comprehensive health checkup system – Ningen
Dock – should help in that regard. Even though the costof such tests and examinations is born by individual
examines themselves, this approach should help toreduce national health care costs through early detectionand treatment.
Funding: None.
Conflict of Interest: The author has no conflicts ofinterest to disclose.
References
1.

2.

3.

(12)

Committee to Survey Facilities PerformingComprehensive Health Checkups. 2017/2018 Report ona survey of member facilities (2021/3/31). https://www.
ningen-dock.jp/wp/wp-content/uploads/2013/09/d36e0ceb105a39e3b9a9b519b10affd1-4.pdf (accessed August 5,2021). (in Japanese)
Ministry of Health, Labor, and Welfare, Overview of the2020 simplified life table https://www.mhlw.go.jp/toukei/
saikin/hw/life/life20/dl/life18-15.pdf (accessed August 5,2021). (in Japanese)
Shanghai Senmao Clinic. https://senmaoclinic.co.jp/

Global Health & Medicine. 2022; 4(1):9-13.

www.globalhealthmedicine.com(accessed October 15, 2021). (in Japanese)
Samitive Hospital. https://www.samitivejhospitals.com/(accessed October 15, 2021)
5. Raffle Japanese Clinic. https://rafflesj-clinic.com/(accessed October 15, 2021). (in Japanese)
6. Cho Ray Hospital. https://bvcrheci.vn/en/ (accessedOctober 15, 2021)
7. Japan Society of Ningen Dock. July 12th is Ningen DockDay. https://www.ningen-dock.jp/0712dock (accessedAugust 5, 2021). (in Japanese)
8. Iwatsuka T. History and current status of comprehensive
medical examinations in Japan. Jpns. J Multiphasic HealthTesting and Service. 1994; 21:370-376. (in Japanese)
9. E-Healthnet. Health information site for prevention oflifestyle-related diseases. https://www.e-healthnet.mhlw.
go.jp/information/others/metabolic.html (accessed August5, 2021). (in Japanese)
10. Yano Research Institute. Conduct of a survey on the
medical checkup and Ningen Dock market (2019).
https://www.yano.co.jp/press-release/show/press_id/2300(accessed August 5, 2021). (in Japanese)
11. Yano Research Institute. Conduct of a survey on the

medical checkup and Ningen Dock market (2016).
https://www.yano.co.jp/press-release/show/press_id/1542(accessed August 5, 2021). (in Japanese)
12. National Center for Global Health and Medicine, Medical
Examination Center. http://www.hosp.ncgm.go.jp/cmc/040/menu.html (accessed August 5, 2021) (in Japanese)
13. Japan Cancer Society. Promotion of cancer prevention andcancer screening. https://www.jcancer.jp/about_cancer_
and_checkup (accessed August 5, 2021). (in Japanese)

4.

---Received October 18, 2021; Revised February 4, 2022;
Accepted February 16, 2022.
Released online in J-STAGE as advance publication February
24, 2022.
*Address correspondence to:
Jun Lu, Medical Examination Center, National Center for
Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku,
Tokyo 162-8655, Japan.
E-mail: j-lu@hosp.ncgm.go.jp(13)