Report and Proposal Commemorating the110th Anniversary of The Life Insurance
Association of Japan:
Looking 10 Years Ahead and Beyond

April 2019

The Life Insurance
Association of Japan

Greetings from the Chairperson

The Life Insurance Association of Japan celebrated its 110th anniversary on December 7,
2018.
Looking back over the past 10 years, we saw many natural disasters, such as the Great East
Japan Earthquake, typhoons, and heavy rain. I would like to express my heartfelt sympathy tothe victims and hope that everyone will be safe and that the afflicted areas will recover as soon
as possible. These events have made me strongly aware of the life insurance industry’s role tobe there for each and every customer throughout his or her life.
Looking ahead, we see various environmental changes that will impact everyone’s life
approaching. For example, depopulation and demographic aging are accelerating. A longevity
society has arrived with a slogan of the 100-year life span. In addition, as the success of
FinTech shows, technology has achieved a quantum leap. As we predict big changes in oursocial environment and way of life, we have such challenges as to help our customers live theirown lives in a longevity society and build a sustainable society amid population decline.
The Life Insurance Association of Japan has established the three elements required foreverybody to lead a safe and hopeful life as the 3Ps. The 3Ps consist of preparedness for a
deep understanding of the risks in life, protection to ensure security against those risks, andprevention of risks from occurring.
From the perspective of the 3Ps, we have compiled this document to discuss the way social
security should be in the healthcare area where we need to prepare for a longevity society andcontribute to the establishment of a sustainable social security system, as well as the role of life
insurance in Society 5.0 that adopts advanced ICT.
We hope that this document will become the first step toward solving issues for the next 10
years and beyond.
Last but not least, we would like to take this opportunity to extend our sincere gratitude to Mr.
Kentaro Enomoto, Counselor for Social Security, Ministry of Health, Labor and Welfare, Prof.
Hiroaki Miyata at Keio University, Ms. Yukari Iimura, Director of Information Application
Promotion Office, Information, and Communication Bureau, Ministry of Internal Affairs andCommunications, and President Yukiko Furuya, Consumer Conference for Sustainability, for thevaluable suggestions they made in the panel discussions at the 110th Anniversary of The Life
Insurance Association of Japan Celebration held on February 25, 2019.
April 2019
The Life Insurance Association of Japan
Chairperson Seiji InagakiReport and Proposal Commemorating the 110th
Anniversary of The Life Insurance Association ofJapan:
Looking 10 Years Ahead and Beyond
Table of Contents
Greetings from the Chairperson .............................................................................................. - 0 Chapter 1 Report: The Future of the Japanese People and Life Insurance in the Healthcare
Area ........................................................................................................................................... - 3 1. Introduction ........................................................................................................................ - 3 2. The arrival of a super-aging society and changes in the social security system ............... - 4 (1) The arrival of a super-aging society: changes in demographic structure ..................... - 4 (2) Realize a society where everyone can be active in good health for a longer time....... - 7 (3) Extension of healthy life expectancy .......................................................................... - 10 (4) Changes in disease structure and the community-based integrated care system ..... - 12 3. How to react to environmental changes (to improve QOL) ............................................. - 14 (1) Stay healthy naturally while having fun ...................................................................... - 14 (2) Get healthcare services not at a large hospital but at home ...................................... - 15 (3) Self-consideration and self-preparedness: the 3Ps for a safe and hopeful life .......... - 17 4. The role that life insurers should play .............................................................................. - 18 (1) The relationship between social security and private life insurance........................... - 18 (2) The area of “Preparedness”: from financial knowledge to financial and health knowledge- 18 (3) The area of protection: further expansion of security function and the B to B to C
challenge .......................................................................................................................... - 19 (4) The area of prevention: from the perspective of both information technology and humancommunication ................................................................................................................. - 23 (5) Further promotion of public–private partnership ......................................................... - 25 5. Conclusion: play a more active role as a partner in life ................................................... - 26 Chapter 2: Proposal: The Role of Life Insurance in Society 5.0 ............................................. - 27 1. Background ...................................................................................................................... - 28 2. Make insurance contract procedures more convenient and contribute to reducing theburden .................................................................................................................................. - 29 (1) Utilize medical data ..................................................................................................... - 29 A. Concrete details ....................................................................................................... - 29 (a) Status quo ........................................................................................................... - 29 (b) Feasible measures for solving issues ................................................................. - 30 B. Consumer opinion survey ........................................................................................ - 35 (a) More convenient claims procedure ..................................................................... - 35 (b) Opinion survey on health insurance’s claims procedure ..................................... - 35 C. Status of medical data linkage in major Western countries ..................................... - 38 (a) Mechanisms analogous to the PHR .................................................................... - 38 --1-

(b) Mechanisms of data linkage between medical institutions and private insurers . - 39 (2) Utilize administrative data ........................................................................................... - 41 A. Concrete details ....................................................................................................... - 41 (a) Utilization of survival and death data ................................................................... - 41 (b) Utilization of address data ................................................................................... - 41 3. Contribute to extended life expectancy ........................................................................... - 42 (1) Utilization of the healthcare data platform .................................................................. - 42 A. Concrete details ....................................................................................................... - 42 B. Consumer opinion survey ........................................................................................ - 44 C. Status of big data on healthcare in major Western countries .................................. - 45 4. Summary.......................................................................................................................... - 47 Conclusion ............................................................................................................................... - 48 -- The Life Insurance Association of Japan The Life Insurance Association of Japan is an incorporated association to which all life insurers who engage
in the life insurance business in Japan belong. It operates to contribute to the improvement of people’s lives,seeking for the sound development of the life insurance business and the maintenance of its reliability.

-2-Chapter 1

Report: The Future of the Japanese People and Life Insurance
in the Healthcare Area

1. Introduction
Japan sees demographic aging accelerating. As a super-aging society arrives and people talkabout the “era of 100-year life spans,” Japanese social security is responding to this change.
Such a change is expected to affect the life of each one of us greatly.
The life insurance industry has long played a role in complementing social security with themission to ensure security in people’s lives. Going forward, we will make sure to grasp
anticipated environmental changes that give rise to social issues to contribute to solving them.
This way we would like to contribute to the safety of people’s lives, leading to the developmentof a sustainable society.
The healthcare services area in particular is expected to change under the strong influence ofa super-aging society. As it is deeply linked to the life insurance industry, we need to change ourrole accordingly.
This report provides our current answers to the following questions that primarily focus on thehealthcare services area: How is the environment/social security changing? ; How will we
address the question of its impact on our lives? ; How can the life insurance industry contributeand what role can it play? We expect this report to help you have a vision for the future that isrequired for ensuring security in light of environmental changes.

-3-2. The arrival of a super-aging society and changes in the social security
system(1) The arrival of a super-aging society: changes in demographic structure(Reference 1) Changes in the population aged over 65 years and the population aged
between 20 and 64 years and their projection(10 thousand people)
Population aged between
20 and 64 years

ActualForecast

Workforce
population
Number of workers

Population aged
over 65 years(Year)

Sources: Created based on the Ministry of Health, Labor and Welfare’s “Vital Statistics,”
the Ministry of Internal Affairs and Communications’ “Labor Force Survey,” and the National
Institute of Population and Social Research's “Population Projection for Japan.”
After Japan’s total population reached a peak in 2008 with 128.08 million, it began to decline.
It is projected to be about 110 million in 20401. Reference 1 shows this with the population aged
over 65 years separately from the population aged between 20 and 64 years. From this welearn that while the population aged over 65 years rapidly increased in the past, its increase is
projected to slow down; by contrast, the population aged between 20 and 64 years is expected
to decline continuously.

1

The National Institute of Population and Social Research’s “Population Projection for Japan”(Estimate for 2017 with medium-fertility and medium-mortality)-4-

(Reference 2) “Tossing the elderly into air type,” “Cavalry battle type,” and “Ride on the
youth’s shoulder type”

1965

2012

2050

Tossing the elderly
into air type

Cavalry battle type

Ride on the youth’s
shoulder type

Per person
aged over 65
years

1 person1 person1 person

The population aged
between 20 and 64 years

9.1 people

2.4 people

1.2 people

Source: Created based on the Ministry of Finance’s website:
https://www.mof.go.jp/comprehensive_reform/gaiyou/02.htm
Reference 2 presents the population aged over 65 years as the supported (retired layer) andthe population aged between 20 and 64 years as the supporters (active layer) to show the ratioof the supported to the supporters. In the past, Japan was a “tossing the elderly into air type”
society in which many active workers supported the retired layer. It has changed into a “cavalry
battle type” society where roughly two active workers support one retired person. It will becomea “ride on the youth’s shoulder type” society in which one active worker supports one retired
person. It has been generally assumed that in this society social sustainability will be lost.
(Reference 3) Ratio of workers to non-workers (denominator: non-workers; numerator:
workers)(1 million people)

Number of workers per non-worker (right axis)

Non-workers(aged under 15 years)

Non-workers(aged under 15 years)

Workers

Source: Analysis of the Labor Economy 2012.

-5-

(Reference 4) Changes in the employment rate ofHowever, a different figure will
women aged between 15 and 64 years
emerge if we stop looking atand of people aged over 65 years.
ages as numbers. In fact, if we（％）
focus on the workers and the70
67.4
non-workers without recourse to65
a factor of age, we can see that60
as shown by Reference 3, theratio of workers to non-workers
55
51.5
has been stable.
50
This means that as Reference
女性（15-64歳）
45
4 shows, since around 1970, theWomen (aged between 15 and 64 years)
female employment rate has
40
increased. More recently, the35
employment rate of people aged
Aged over 65 years
29.7
65歳以上
30
over 65 years has turned
upward. These have contributed
25
23.0
to maintaining stability. This has
20
made it possible to secure
15
enough workers.
1973
80
90
2000
10 13
17
（年）
It is, therefore, necessary to(Year)
continuously secure enoughSource: Based on the Ministry of Internal Affairs andworkers to build a sustainable
Communications’ “Labor Force Survey”
society in an age of super-aging.
Going forward, it will become especially important to form a society that will enable people who
are technically “old-aged” to continue to be supporters (active layer). Employment will allow
them to continuously get in touch with society and hopefully make their lives more exciting,leading to a virtuous cycle (see Section 3).
(Reference 5) Social security benefits projection
188.2～190.0(In (単位：兆円)
trillions of yen)

9.4
13.1

140.2～140.6

Other
その他

121.3
Children 子ども・子育て
and child care

7.7
10.0
15.3

Nursing介護
care

6.7
7.9
10.7

Healthcare
医療

39.2

47.8
～47.4

Pension
年金

56.7

59.9

25.8

66.7
～68.5

73.2

2018年度Fiscal2018

2025年度Fiscal2025

2040年度Fiscal2040

GDP564.3兆円
564.3
trillion yen

645.6兆円
645.6
trillion yen

790.6兆円
790.6
trillion yen

Ratio of social security
社会保障給付費
benefit expenditures toの対GDP比GDP

21.5%

21.7～21.8％

23.8～24.0％

Source: Created based on the Cabinet Secretariat, the Cabinet Office, the Ministry of
Finance, and the Ministry of Health, Labor and Welfare’s “The Projections for the Future ofSocial Security with a Hard Look at 2040 (Material for Discussion)” (May 21, 2018).
-6-

(2) Realize a society where everyone can be active in good health for a longer time
Reference 5 is the government’s projection of social security benefit expenditures in Japan.
Social security benefit expenditures currently amount to about 120 trillion yen. In 2040 they are
projected to be 190 trillion yen, which is about 1.6 times higher.
One of the factors for the increased social security benefit expenditures is of course theincrease in the elderly population. Healthcare costs significantly increase, notably among the
population aged over 75 years (latter-stage elderly) (Reference 6). Those belonging to the baby
boom generation,2 all of whom will be over 75 years by 2025, are projected to drive up theusage of healthcare services (the so-called “2025 issue”).
(Reference 6) Healthcare costs by age
National
medical expenditures per person (2016)
1人当たり国民医療費（2016年）
0.0

50.0

0-4
5-9

13.7
10.3

15-19

7.8

20-24

8.3

25-29

10.6

30-34

12.5

35-39

14.0

40-44

15.8

45-49

19.5

50-54

24.5

55-59

30.8

65-69
70-74
75-79
80-84
85-

(10 thousand yen)
150.0（万円）

100.0

0.0

100.0

200.0

24.5

10-14

60-64

Nursingcare expenditures per person (2016)
1人当たり介護費（2016年）

40-64

0.4

65-69

3.3

(10 thousand yen)
300.0 （万円）
4 thousand
平均
yen on0.4万円
average

50 thousand

平均
yen onaverage
5.0万円
184
thousand平均
yen on
18.4万円average

70-74

7.0

75-79

15.6

80-84

85-89

39.4
553
thousand平均
yen on55.3万円average

50.0
65.3
80.2

94.4
107.8

90-94

910
thousand平均
yen on91.0万円average95-

36.4
48 thousand

平均
yen on48.0万円average

75.0

131.9

202.0

（歳）
(Age)

(Age)
（歳）

Source: Ministry of Health, Labor and Welfare’s “Structure of National Medical Care
Expenditure” and “Survey of Long-term Care Benefit Expenditures”
Another factor for the increase is the rising unit price of medical care costs due to advanced
medicine. Recently advanced technologies have been used to develop new types of cancer
drugs, which will be made more widely available. In addition to this, iPS cell-based regenerative
medicine, and nanotechnology-based new treatments will be further developed. While suchtreatments make hard-to-treat diseases treatable, they make medical care costs very
expensive3. There is a concern that they may drive up social security benefit expenditures. The
government may consider the way both benefits and burden should be distributed with regards
to medical services that may become very expensive; for example, it may discuss whether
The generation born during the 3 years between 1947 and 1949 (first baby boomers). There
were 6.3 million first baby boomers as of October 2017.
3 For example, chimeric antigen receptor (CAR) T-cell therapy, which is expected to be highly
effective for leukemia and other types of cancer, is very expensive. There was a case in which
one dose was priced as high as over 50 million yen in the US.
2-7-

(Reference 7) Relationship between social security benefits and copayments

Government’s social security expenditures (in relation to GDP)

Relationship between social security expenditures and the national burden
rate in OECD countries (2014)

Top third

Japan offers amedium level ofbenefit payments for
relatively low
copayments.

Finland

Austria
SwedenJapan

UK

Slovakia
PolandMiddle third

France Denmark

Czech Republic

Ireland

Belgium

Netherlands Norway
Germany
Portugal
GreeceSlovenia
Spain
Luxemburg

Italy

Hungary

US Australia
Estonia
Switzerland Latvia

IcelandIsraelBottom third
South Korea

Bottom third

Middle third

Top third

National burden rate (in relation to GDP)
References:(Notes)1.
2.

national burden rates: OECD, “National Accounts,” idem, “Revenue Statics,” Economic and Social Research Institute,Cabinet Office, [National Accounts of Japan], etc.; social security expenditures: OECD, “National Accounts,” Economic
and Social Research Institute, Cabinet Office, [National Accounts of Japan].
Values are on a general government basis (with the central government, local governments, and the Social Security
Funds combined).
Fiscal 2014’s actual values are used for Japan. Other countries are based on the actual values for 2014.

public medical insurance should cover all of these services.
Currently, the relationship between social security benefits and copayments is in the status of
medium welfare with lower copayments in Japan. Benefits exceed copayments and the gap ismade up for by budget deficits. In order to keep the social security system sustainable, it isinevitable to review the relationship between benefits and copayments in the mid-to-long-term(Reference 7). The government’s reconsideration of this matter may lead to an increase in
copayments.
It should be noted that the Japanese economy is expected to grow toward 2040. The ratio ofsocial security benefit expenditures to GDP is forecast to rise from 21.5% annually to 23.8% to24.0% annually in 2040 (Reference 5). Although we cannot be optimistic, a government
document shows that most of the increased benefits will be absorbed by the increase inrevenues as the economy continues to grow. This means that we do not have to be excessively
pessimistic.
As has been mentioned earlier, it will become important to form a society that will enablepeople who are technically “old-aged” to continue to be supporters (active layer). This issignificant in terms of realizing economic growth as well. Focusing on this aspect, thegovernment has set forth a long-term policy for the Japanese social security system toward
2040, seeking to realize a society in which everyone can be active in good health for a longer
time (Reference 8).

-8-The report mentions that efforts will be continued to ensure a sustainable social security
system by reviewing benefits and copayments. In addition to this, it lists the following threepolicy challenges that will respond to the rapid decrease in active workers: Diverse
employment/social engagement, extended healthy life expectancy, and improved productivity(Reference 8) Future policy related to social security
Diversified
多様な就労・
employment and
社会参加
socialengagement

Extension of
健康寿命のhealthy life
延伸
expectancy

an environment for further expansion of employment opportunities for the○Prepare
更なる高齢者雇用機会の拡大に向けた環境整備
elderly○ 就職氷河期世代の就職支援・職業的自立促進の強化
 Support the employment ice age generation’s employment and enhance the promotion○of中途採用の拡大
their occupational independence
mid-career employment○Expand
年金受給開始年齢の柔軟化・被用者保険の適用拡大、私的年金
 Flexible pensionable ages, expanded application of employee insurance, and（iDeCo等）の拡充
expansionof private pension plans (e.g., iDeCo)○Inclusion
地域共生・地域の支え合いand mutual support in the community
A goal of extension of healthy life expectancy by 2040 and flowchart up to 2025
〇2040年の健康寿命延伸に向けた目標と2025年までの工程表
 1. Reinforced approach to those indifferent to health; 2. Resolution of gaps between〇①健康無関心層へのアプローチの強化、②地域・保険者間の格差
regions and between insurers will lead to the promotion of initiatives in the followingの解消により、以下の3分野を中心に、取組を推進
threeareas:• ・次世代を含めたすべての人の健やかな生活習慣形成等
Form healthy lifestyles for all, including the next generation• Prevent illness and aggravation
・疾病予防・重症化予防• Prevent nursing care, frailty, and dementia

・介護予防・フレイル対策、認知症予防Transformation
医療・福祉
of medical andサービス改革welfare services


A goal of improved productivity by 2040 and flowchart up to 2025
〇2040年の生産性向上に向けた目標と2025年までの工程表
 Implement the following four initiatives:〇以下の４つのアプローチにより、取組を推進• Promote practical use of robots, AI, and ICT and reform data health• ・ロボット・AI・ICT等の実用化推進、データヘルス改革
Educate human resources in charge of task-shifting and promote the utilization ofsenior human resources
・タスクシフティングを担う人材の育成、シニア人材の活用推進• Reform organizational management
・組織マネジメント改革• Large-scale management and collaboration

・経営の大規模化・協働化

Source: Created based on “Creating a Society Where All People Can Be Active andComfortable, Looking Ahead to 2040”(https://www.mhlw.go.jp/content/12601000/000370137.pdf)(Column 1) Implementation of care assistants initiatives at nursing homes in Mie Prefecture
Since 2015 Mie Prefecture has implemented a program in which the elderly are hired ascare assistants. The care assistants are engaged in cleaning rooms, putting away trays,
making beds, helping residents with hobby activities such as gardening, and talking toresidents. Since they do such auxiliary and peripheral work, they can help reduce theregular staff’s overtime work and make it easier for them to take paid annual leave. They
have proven to be effective. The elderly who are hired as care assistants feel fulfilled andgain confidence by working. Their employment has led to improved quality of life.
Care assistants’ reflections(Gist of questionnaire results)
1. I never thought I would be working when I was 75 years old. I’ve foundmeaning in life. I enjoy doing something actively.
2. Though I am 70 years old, I am confident that I can still do it. I cameto think that I wanted to become a bit more fit to support society.
3. At the age of 78, I feel fulfilled as I can join society and work again. I findmyself in good shape and I can get energized by coming to work here.

Source: “Report Compiled by Study Group for Future Supply and Demand of Elderly
Nursing Care Systems,” and its attachment“On the Care Assistant Project for Active Seniors” (Japan Association of Geriatric HealthServices Facilities, Chairperson Kentaro Higashi)-9-through reform of healthcare/welfare services. We have already mentioned the need for diverse
employment/social engagement (Reference 8), so we will discuss extended healthy life
expectancy, which is closely related to our lives, in the next section.
(3) Extension of healthy life expectancy
Healthy life expectancy means the period in which one can live without being restricted byhealth issues in everyday life. It thus refers to the survival period where one can live
independently on one’s own. Given the same life span, the longer your healthy life expectancy,
the higher the ratio of active period in your life will be, which will result in a higher quality of life
(QOL).
Reference 9 shows changes in the difference between average longevity and healthy life
expectancy by sex in Japan. As of 2001 healthy life expectancy was 69.40 years for men and
72.65 years for women. In 2016, it was extended to 72.14 and 74.79 years, respectively. The
difference between the average longevity and healthy life expectancy can be taken as theperiod in which one requires support and care. As of 2016 it was 8.84 years for men and 12.35
years for women.
As part of an effort to extend healthy life expectancy, the following is being considered:
medical institutions, insurers4, and private operators (e.g., sports gyms) can work together toprevent life-style diseases from occurring or keep them from getting more severe. This seeks tohelp to extend the period in which people can be more independent and more active than everbefore. Likewise, the government is working together with the private sector to promote thecreation of an environment in which people can stay healthy naturally, including projects that
aim at increasing vegetable intake.
(Reference 9) Changes in the difference between healthy life expectancy and average
longevity by sex (in terms of age)
90.00

90.00

80.00

80.00

9.17

70.00
69.40 69.47

60.00

8.86

9.22

9.02

71.19
70.33 70.42

8.84

72.14

健康寿命
Healthy life
expectancy
(men)
（男性）

50.00

70.00

74.79
73.62 74.21
72.65 72.69 73.36
Healthy life
健康寿命
expectancy（女性）(women)Average longevity

8.67

12.35
12.63 12.77 12.40
12.28 12.90

平
均
寿
命

60.00

50.00
2001 2004年
2004 2007年
2007 2010年
2010 2013年2013 2016年
2016
2001年

2001 2004年
2004 2007年
2007 2010年
2010 2013年2013 2016年
2016
2001年

Sources: Ministry of Health, Labor and Welfare Grants-in-Aid Scientific Research: “Factor
Analysis of Healthy Life Expectancy and Regional Disparities and a Study on the Validationof Effectiveness of Health Promotion Measures” and “Study on Computation and Valuationof National Changes in Healthy Life Expectancy”
4

Health insurance business operators- 10 -

(Column 2) About half of the Japanese population is indifferent to health?
Various questionnaires show that about half of Japanese people do nothing to stay healthy
or improve their health. It is one of the pressing issues to make such people who areindifferent to health take measures to promote health.
Q:あなたは普段から健康に気をつけるよう意識していますか？
Q:
Are you usually health-conscious?
Not
particularly, and I do not do anything.
特に意識しておらず、何も行っていない

気をつけてはいるが、特に何かをやっているわけで
Yes,
but I do not do anything special.

13.5

0%

32.5

20%

36.7

40%

60%

17.2

80%

はない
I生活習慣には気をつけるようにはしている
am careful not to create bad life habits.

100%

I積極的にやっていることや特に注意を払っているこ
am actively living a healthy life or paying
special attention to my health.
とがある

Q:健康的な生活を送るための情報収集・試行をしていますか？
Q:
Are you collecting information to live a healthy life or are you trying to do so?

47.9

19.6

A
lack of exercise and no intention to do exercise
運動不足・実施意思なし

32.5

Alack of exercise but with intention to do exercise
運動不足・実施意思あり

運動充足Alack of exercise

0%

20%

40%

60%

80%

100%

Sources Top:

Ministry of Health, Labor and Welfare, “Public Opinion Survey on
Health” (2014)
Bottom: Population Survey (2000) conducted by the Kuno Project, University ofTsukuba and Tsukuba Wellness Research as commissioned by the
Ministry of Internal Affairs and Communications- 11 -

(4) Changes in disease structure and the community-based integrated care system(Reference 10) Changes in the number of patients with chronic diseases
Thousand people
High-blood pressure
diseaseDiabetes
Hyperlipemia
Malignant neoplasm
Alzheimer’s disease

1996

1999

2002

2005

2008

2011

2014

Source: Ministry of Health, Labor and Welfare, “Summary of 2014 Patient Survey”
Reference 10 shows changes in the number of patients with possible chronic diseases inJapan. As aging progresses, chronic diseases such as hypertensive diseases and diabetes
become more common. As a study suggests that 86% of elderly people aged over 75 years
receive medical treatment and that 64% have two or more diseases5, it is rather common for theelderly to live with some kind of disease. In our life planning, we must think about how we canmaintain QOL while being confronted by diseases.
Recently, diseases that reduce cognitive function such as Alzheimer’s have increased. We
need to do more to prevent dementia and consider how to take care of patients with dementia
whose decision-making capabilities have declined. People who require care will increase as
these diseases increase.
Chronic disease symptoms tend to develop gradually. Development of such symptoms does
not immediately lead to critical conditions. In general, chronic diseases are incurable at the
moment. Therefore, patients have to consult their doctor and control the disease to maintain
QOL over a long period of time (Reference 11).
To respond to changes in disease structure, we need to shift from large hospitals that provide
short-term and intensive medical care to a system of controlling pathological conditions in which
the primary care doctor combines stable and long-term healthcare services in an area familiar to
the elderly patient. In other words, we need to convert from cure to care.

5

Report on Analysis of Medical Expenditures for Latter-stage Elderly Medicine in Tokyo (2015)- 12 -

(Reference 11) Comparison of features of acute illness and chronic diseases
急性疾患
Acute
illness

慢性疾患
Chronic
illness

初期症状
Initialsymptom

急速に進行
Rapidlyadvance

徐々に進行
Graduallyadvance

期間
Period

短期
Short-term

不定
Unstable

治癒
Cure

一般的に治癒する
Generally cured

治癒はまれ
Rarelycured

治療の選択と実施
Chooseand perform a therapy

指導者でありパートナーである
Both instructor and partner

指示に従う
Follow
the instructions

医療従事者のパートナーであり、Medical experts’ partner andresponsiblefor daily care management
日常管理の責任をもつ専門職（医師等）
Role of experts(e.g.,
doctor)
の役割

患者の役割
Role
of patient

Source: Created based on Living a Healthy Life with Chronic Conditions: Self-Managementof Heart Disease, Arthritis, Diabetes, Depression, Asthma, Bronchitis, Emphysema, andOther Physical and Mental Health Conditions (Japan Nursing Association Publishing
Company)
This has prompted the central and local governments to build the community-based
integrated care system, a new way of providing healthcare services.
More specifically, by 2025 when the baby boom generation turns over 75 years, the plan is tobuild a system in which medicine, nursing care, preventive care, housing, and life support work
together to provide seamless and integrated services so that those who are seriously in need ofcare or whose decision-making capabilities are reduced due to dementia can continue to lead
their own lives until the end in areas familiar to them (Reference 12).
Considerable regional disparities are found in the aging progress. For example, thepopulation will not decrease so much in large urban areas. Although the population aged over
75 years will rapidly increase. On the other hand, in town and villages where population aging(Reference 12) Summary of the community-based integrated care system
If I get sick…

Healthcare

Vision of the communitybased integrated care system•

Hospital:
Outpatient care andacute, recovery
hospitalization Day care and admission
phase, and chronic
to a nursing home
Healthcare in Japan:• Primary care doctor• Local hospital
Residence
Community-based integrated• Dentistry and pharmacy•

care center
Care manager

If I need nursing care…

Nursing care

Intensive nursing care prevention services

Provide consultation andcoordinate services• Home• Housing for the elderly with nursing
care services

To live a healthy life forever…

Life support and nursing
care prevention* The community-based integrated caresystem is assumed to cover a daily life
sphere (more specifically, the district of
junior high school) where required services
are provided roughly within 30 minutes.

E.g., Clubs for the elderly, residents’ associations, volunteers, and NPOs

Source: Created based on the Report of the Study Group for the Community-based
Integrated Care System (March 2016)- 13 -

has advanced, the increase in people aged over 75 years will be gradual while the entire
population is expected to decrease. The strength of a local community (mutual aid function) or
the usability of private services also varies according to regions. It is, therefore, important tobuild a system for providing healthcare services in tune with local characteristics based on local
autonomy and independence.

3. How to react to environmental changes (to improve QOL)
Section 2 summarized the environmental changes brought about by a super-aging society
with special reference to the healthcare area. This section will consider how to deal with theimpact of these environmental changes on our lives to improve QOL.

(1) Stay healthy naturally while having fun
Efforts are being made to extend healthy life expectancy, seeking to realize a society in whichpeople can be active in good health for a longer time. Simply put, let’s stay healthy, and gethealthier.
First of all, extended healthy life expectancy will contribute to the improvement of QOL foreach and every one of us as it will expand the period in which we can stay healthy and live an
active life. If you are healthy and full of energy, you can continue to work. If you continue to workand postpone your retirement, you can build more assets that will allow you to lead a fulfilled
retirement life. The fact of working itself is expected to improve QOL (see Column 1).
Some people want to do mountain climbing or travel abroad in their later years. Others will besatisfied if they can live an independent life at home. Different people want different levels of
health. Therefore, if we impose a uniform level to all, we may put off some from improving theirhealth.
Personal preferences have an impact on efforts to improve health as well. For example, somepeople are gourmets and do not want to follow a healthy diet, though they want to do exercise
which they like. Others do not like going to the gym, but they love taking a walk.
If each one of us can find a level of health that we want to achieve as well as a way of
improving health in accordance with our hobbies or tastes, and can thereby stay healthy
naturally while having fun, we can achieve a sustainable society and improved QOL for eachindividual (see Column 3).

- 14 -Walking

Column 3: Can Pokémon GO make you healthier?
The Pokémon GO app has been download by 850 million people across the world. It is
often used as a tool for improving health by making you go out or encouraging
communication with other people.

I’ve found a purpose for walking
I’ve had more opportunities to walklonger
I enjoy walking

LifeI’ve had more opportunities to go out
I’ve had more opportunities to visit
places I have never been before

Mind andbody

I’ve had more topics to discuss andcommunication opportunities with myfamilyI’ve been able to refresh or go out for achangeI enjoy daily life
I live a healthier life

774 men and women who play Pokémon GO more than once a week, aged between 20 and 69 years (multiple choices)

Source: Changes in Action and Awareness Brought About by Pokémon GO
July 2017 (by the Kao Consumer Research Center).

(2) Get healthcare services not at a large hospital but at home
The establishment of the community-based integrated care system will enable the provisionof integrated medical, nursing care, and life support services at or near home for the elderly,
unlike the healthcare system centered around large hospitals. We will have to consider end-oflife at home or a nursing home as much as possible, not at a hospital.
As Reference 13 shows, more than half of the respondents did not want to die at a hospitalbut rather wanted to continue to recuperate or receive medical care at home or a nursing home
and then die, though this depends on pathological conditions. The shift to home or nursing
homes where medical care (nursing care), including end-of-life care services, are provided istherefore consistent with elderly people’s wishes.
It will not be easy to continue recuperation at home. The patient’s family in particular will takea great deal of strain. As Reference 14 shows, the family will be under both physical and mentalpressure as they have to look after the patient, deal with sudden changes in his/her condition,and make decisions on behalf of him/her. However, some of these can be reduced by using
nursing care services or sharing a common prior understanding among the entire family or withthe doctor, nurse, and nursing care operator.

- 15 -

(Reference 13) Elderly awareness of old age and end-of-life medical care (in percent)
Other

I do not know

Welfare facilities, e.g., special nursing
homes
Housing for the elderly withnursing care services
Relative’s house, e.g.,brother or sister
Child’s house

Medical facilities, e.g.,
hospitals

Home

Source: Cabinet Office, 2012 Public Opinion Survey on Elderly Health(Note) The survey targeted men and women aged over 55 years nationwide (with 1,919
valid answers collected). The answer to the question of where you want to die if you suffer
an incurable disease.
(Reference 14) Role of the family in-home care and the reduction of their workloadRoleof family
家族の役割

Examples
具体例

Examplesof reduced burden
負担の軽減例

Meals,
bath, changing diapers
食事・入浴・オムツ換え等

Utilization of home care or home-visit
介護訪問・訪問入浴等の活用
bathing

病状の変化時に対応する役割
symptomRole of responding to change in

緊急時の投薬や医療機関へのMedicationor contacting a medical
institution
連絡等 in case of emergency

医療従事者と家族やヘルパーとEnhancedcooperation among medical
experts,
family, and helpersの連携強化

Role of making decisions on behalf of
本人に代わって判断する役割
the patient

Choosetherapy or hospitalization if
本人が意思表示できない場合
thepatient cannot express his/her willの、治療方針や入院の選択

Share one’s thoughts with family
意思表示能力がある間に、家members while still capable of
族や意思と認識を共有
expressing
one’s will

Role as the family itself
家族そのものとしての役割

精神的な苦痛の緩和や安心でAlleviate
mental pain and maintain asafe
environment
きる環境の維持Carefor the family itself
家族自身に対するケア

Role as caregiver
介護者としての役割

Source: Created by The Life Insurance Association of Japan based on the Tokyo Elderly
Health and Welfare Plan (Fiscal 2012 to 2014).
Generally speaking, patients can spend more time with his/her family or friends at home or anursing home than at a hospital. Home care, therefore, can provide a fulfilling end-of-life forboth the patient and his/her family. Thus, in addition to financial preparation, it is important toshare the patients’ will among the concerned parties as to where and how he/she wants to die
and what services he/she wants to use (see Column 4).

- 16 -

(Column 4) Advanced-care-planning-based prior statement
It has been assumed that about 70% of patients are incapable of making a decision in their
end-of-life period (Silveira MJ, NEJM 2011). In Advanced Care Planning (ACP), the patient
thinks ahead about what medical and nursing care he/she wants to receive in the final
stage of her life and discusses it with a medical and nursing care team to share it withthem. While we need to fully take care of those who do not want to think about it,
discussion will give you more chance to receive the desired therapy and care, should you
get sick.
Source: Created based on the Ministry of Health, Labor and Welfare’s website:
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryou/saisyu_iryou/
index.html(3) Self-consideration and self-preparedness: the 3Ps for a safe and hopeful life
We have briefly looked at how to react to the impact of environmental changes on our lives toimprove QOL. The Life Insurance Association of Japan considers it important to promote the3Ps so that each and every one(Reference 15) 3Ps for a safe and hopeful lifeof us can lead a safe life withhigher QOL as aging progresses,
as both family structure andlifestyle become increasingly
Gain a deep understanding of thediverse (see Reference 15).
risks in life
The first of the 3Ps is
preparedness. First, it isimportant to develop a deep
Ensure security so that risks can beunderstanding of the risks in life.
enduredIn so doing, you need to know
more about the social security
system, finance, and health.
Prevent or avoid the occurrence ofIn the elderly period, differentrisks
people have different life risks
Source: Created by The Life Insurance Association ofaccording to whether they have aJapanpartner or children or whether
they live together. Depending on
where they live, they have different regional community (neighborhood) support, different public
medical and nursing care support, or possibly different private services that supplement the
public ones. Each one of us, therefore, needs to understand the risks associated with ourpersonal situation. Also, we need to think ahead about what kind of risks will arise for ourselves
or our family when our cognitive functions decline. Based on your understanding of risks, yourlifestyle, and values, what risk-preparedness do you focus on, how long do you want to work,
what level of health do you wish to achieve, and how do you want to spend your end-of-life
period? Think about these questions deeply to consider what measures are required for them asmuch as possible when you are young and healthy. It is important to share your desired way of
spending your end-of-life period with your family and relatives.
The second is protection, in which you ensure appropriate security and services. In addition
to asset formation with a view to the age of 100-year life spans, you need to ensure appropriate- 17 -

security in the area of medical and nursing care in light of changes in disease structure andtechnological advancement. For example, you can ensure security against dementia or canconsider purchasing a private insurance policy if or when future social security system reforms
change the coverage of public medical insurance or nursing care insurance. If you want homecare, you may have to make your home wheelchair-friendly or renovate your room.
The third is prevention to improve health and prevent illness. People who want to live an
active life in their own way will find it important to extend their healthy life expectancy. In sodoing, they can continue to work and easily lead a longer, fulfilling life. It is important to achieve
prevention while enjoying yourself by discovering a way that suits your hobbies and taste.
Another effective way is to purchase market services such as products with preventive functions
that naturally support your fitness training.

4. The role that life insurers should play
(1) The relationship between social security and private life insurance
About 20 years ago, life insurance generally meant death protection in case something
happened to the breadwinner. Currently, however, as aging has progressed and dual-income
households have increased, the need to secure the breadwinner’s death protection has
relatively decreased. On the other hand, as the statutory copayment rate increases andmaximum copayments for high medical expenses rise, the copayments paid by customers areon the rise, giving rise to an increased need for medical security preparedness. In light of suchchanges, life insurers have expanded their product lines from death insurance to healthinsurance and annuity, in other words, from insurance in the event of death to insurance during
life (Reference 16). As demographic aging accelerates, which will cause social security andsocial environment to change, how can the life insurance industry contribute and what role canit play? In what follows, we will consider our answers to these questions in relation to the 3Ps
discussed in the previous section.

(Reference 16) Increased copayments and the in force business of private medical
insurance

Publicmedicalinsurance

Privateinsurance

Percentage of copayment
Copayment cap(high-cost medical careexpenses)

Fixedamount30,000 yen

10%

20%

57,000 yen

Health insurance businessin force(ten thousand policies)
Cancer insurance
business in force(ten thousand policies)

63,600 yen

30%

72,300 yen

80,100 yen

918

1,210

1,376

1,740

1,717

1,757

1,762

1,785

Source: Created based on the Summary of Life Insurance Business (2001 onward),
material by the Social Security Council’s Medical Insurance Committee- 18 -

(2) The area of “Preparedness”: from financial knowledge to financial and health knowledge
In proposing a life insurance product to its customer, each life insurer considers thepolicyholder’s family, employment, or what he/she wants to achieve in the future. Based onthese, the life insurer creates and provides a life plan from now to the retirement age. In doing
so, the life insurer explains the future cash flow, possible risks, and the need to prepare forthem.
Working together with the Japan Institute of Life Insurance, The Life Insurance Association ofJapan has built the All-Generation Package6 that provides teaching material and seminars on
finance and life insurance for all generations from children to the elderly.
Thus far we have provided knowledge on finance and insurance, but from now on we will
have to provide knowledge about(Reference 17) Establishment of Self-Help Day
how to improve health andeducational opportunities toenhance knowledge andawareness.
This is why The Life Insurance
Association of Japan establishedthe Self-Help Day this fiscal year toencourage people to think about
what is required to lead a healthy
life in their own way (Reference 17).
Taking this Memorial Day as a cue,the life insurers work together to
Source: Created by The Life Insurance Association
improve both financial and healthyof Japanknowledge. The industry isdetermined to raise awarenessabout the need to improve health, on the basis of which it seeks to contribute to the formation of
more comprehensive life plans.

May 28 is the
Self-HelpDay(3) The area of protection: further expansion of security function and the B to B to C challengeLife insurers have provided a security function in the form of life insurance for the customer
for a long time. Therefore, the protection area constitutes the life insurer’s main business.
Life insurers have mainly designed health insurance products intended for patients with acuteillness, i.e., benefits for hospitalization and surgical operations. As has been mentioned earlier,chronic diseases have increased in the disease structure in Japan. Patients with dementia or
those who need long-term recuperation/nursing care at home or a nursing home are expected
to increase. Apart from aging, therapeutic methods that use advanced technologies can beinnovative yet very expensive. The government will consider the extent to which they can becovered by public insurance. Life insurers must respond to environmental changes adequately,
marking a trend in the social security reform.

6

See The Life Insurance Association of Japan’s website:
https://www.seiho.or.jp/activity/literacy/understand/- 19 -

For dementia, both insurances that pays benefits for dementia and services that prevent it arebecoming more common. Besides providing the protective function for dementia patients, eachlife insurer also increasingly provides products and services with a preventive function toprevent policyholders from getting dementia. As an example, we will present Dai-ichi Life’s
product. This product is not limited to the payment of benefits to dementia patients, but it comeswith many support services for them. It provides an app that can check the cognitive function bytracking eye movements, whereby it combines prevention of dementia with early detection
services. It integrates the preventive functions (Reference 18).
(Reference 18) Dai-ichi Life’s Dementia Insurance

Prevention and early
detection

Ensure that yourpupils are clearlyshown on the screen.

The first of its kindin the life insurance
industry*1

Next

Visiting service

Check your cognitive
function from eye
movements

No need to use security equipment. When amember of the family makes a phone call in caseof emergency, an ALSOK security guard will visit
the house instead of him/her.

Free

InsuredAvailable for thefamily too

Mental workout
Try three typesof gamesYour current capability
and weak areas at a
glance!

Check brain-healthiness by touching
the blinking screen in the order of
instruction

Calculation
PuzzleMemoryTry the games in order of 1.
calculation, 2. puzzle, and 3.
memory. You can enjoy amental workout.

Dementia consultation dial
I thought
I wasbetter.

The results of the games tell
you your mental age, thescope of your capabilities
based on eight capabilities,
and total evaluation.

Dementia prevention program
Provide total support for pedometermeasurement, mental workout, andimproved dietary life and eating
habitsMedical certificate acquisition
serviceDai-ichi Life will acquire a designated medical
certificate on behalf of the customer. All thecustomer has to do is pay the medical certificate
fee paid to the hospital.

Instead of the claimant, a designatedsurrogate such as his/her child or
grandchild can claim insurance money.

Check brain-healthiness

Let’s play with the family!

Insurance money
claims support

Designated surrogate claims
rider

Check your cognitive function by
watching a 5 minute movie on asmartphone

Work out your brain with three
types of games
Mentalworkout

The first of its kindin the life insurance
industry*4

Health First app
to prevent
dementia

Adjust theposition of yourface so that it
fits inside theframe.

Mental care for the
insured and his/herfamilyNurses experienced in dementia nursing
care support your needs to learn about
and get advice on dementia.

SOMPO Care’s nursing
care consultation service
SOMPO Care’s professional staff explain
how to get a certification of long-term careneed and offer information on nursing carefacilities on the phone.

Source: Created by The Life Insurance Association of Japan based on the material posted
on Dai-ichi Life’s website
In connection with the increase in patients who require long-term recuperation or nursing care
at home, life insurers may design products that focus more on physical condition than on events
such as hospitalization and operations. The life insurers will move into the direction where they
consider how much they need to pay when the policyholder recuperates, whether at hospital orat home. In fact, insurance products have already emerged, paying benefits for recuperation at
home. For example, Meiji Yasuda Life Insurance’s product is designed to pay benefits when thepolicyholder requires recuperation at home, being incapable of working. Each life insurer willdevelop products that cover recuperation at home in accordance with customers’ needs(Reference 19).

- 20 -

(Reference 19) Meiji Yasuda Life Insurance’s Wage and Household Budget Supporting
Rider
Hospitalizationor home care
continues for 30
days
Disease or
injuryBenefit times 12 months

Protection
continues

Up to a totalof twoapplications*Requirements for recuperation at home
 The patient must receive the planned treatment, including the doctor’s or nurse’s visits
to his/her house in Japan (including facilities except hospitals and clinics), upon
instruction by the doctor and based on his/her medical care. The patient must
concentrate on the treatment.
 The planned treatment refers to medical care or administrative consultation that can becounted as in-home medical/consultation fees (excluding fees for a doctor’s visits andambulance transportation medical fees), which are categorized as in-home care in the
medical fee schedule.
Source: Created by The Life Insurance Association of Japan based on the material posted
on Meiji Yasuda Life Insurance’s website.
Life insurers will also have to complement the social security system as appropriate in termsof advanced medicine that uses preventive medicine or state-of-the-art technologies, while
keeping an eye on the government’s position on the matter.
What is more, given the fact that aging customers with reduced cognitive functions will
increase, life insurers will of course make sure to pay insurance money and benefits. Besides,
they will also need to play a role in ensuring that customers can effectively use the money whilesafely managing and maintaining it.
For example, when a customer’s cognitive function declines, the life insurer can prevent
him/her from wasting money or from becoming a victim of financial fraud. At the same time, ititself will increasingly have to bridge the customer with market services, becoming a good
judge, so the customer can choose appropriate services that lead to enhanced QOL.
In other words, in addition to the conventional B to C model that is concluded when theinsurer pays insurance money/benefits to the customer, the life insurer is requested to build a B
to B to C business model in which it bridges between the customer and the market (Reference
20).
While many companies in diverse business categories can handle the B to B to C businessmodel in an aging society, life insurers have the advantage of accessing the customer’s life planor its changes as it can build a continuous relationship with him/her because of the long-term
contract. As life insurers have a deep understanding of customers, they can count among thefitting business categories that handle the B to B to C business model, playing the role of agood judge.

- 21 -

(Reference 20) B to C business and B to B to C businessLife insurer

CustomerMarketservice

Life insurer

Employment
supportSupportyourchoiceBenefitInsurancemoney

Nursing watch
Improved life
Nursing carefacility

B to C model

Preventive
medicine
Meal service
Nursing robot
Body care

B to B to C model
Bridge between customers andmarket services

Provide security function for life risks→ Respond to changes in medical
and nursing care needs
Ensure that insurance money/benefits
are paid→ Help you choose services for
improved QOL (a good judge
function)→ Manage assets safely→ Efficient procedure for benefits

Source: Created by The Life Insurance Association of Japan
Some examples are given in relation to these. First, there is a system called life insurance
trust that helps the bereaved to use the death benefit as intended by the deceased customer
while safely managing and maintaining it. If, for example, the spouse is already demented, it
allows the customer to sign a trust agreement with a trust bank for the death benefit so that theamount equivalent to the monthly household budget is automatically transferred. In this way,
assets can be safely managed.
Some overseas life insurers actively raise awareness to prevent those whose judgment isimpaired from selling assets against their will or from falling victim to financial fraud. Such
activities can be said to provide protection for customers in a broad sense.
In Germany, insurance companies often serve as a good judge of services for theirpolicyholders (Reference 21). Working together with organizations that operate in the nursing
care business, insurance companies can provide products that relay services for thepolicyholders as well as paying monetary benefits for nursing care-related services. These(Reference 21) Nuernberger health insurance (a German nursing care insurance plan withassistance)
The policyholders can use the following services provided by the Order of Malta (a Catholiccharity organization that also runs a company for charitable purposes engaged in nursing
care business).
Admission to a nursing
care facility• Secure admission within 24
hours when required

Consultation on phone

Assistance benefits• Provide telephone consultation
for the policyholder and his/herfamily• If necessary, consult thepolicyholder’s doctor by phone,with his/her consent• Dementia-specific consultation• Send documents related to adultguardianship• Installation of equipment for emergency call service• Chaperone service to the hospital/clinic or city hall,transportation service by car• Transportation service by car for a short-term stay at
a nursing home
• Keep pets during short-term stays• Food delivery, shopping, and care
• Cleaning, washing, gardening, and shoveling snow
• Nursing care training for family, moving service(expenses covered up to 2,000 euros)

Source: Created by The Life Insurance Association of Japan- 22 -

cases have a high affinity for Japan where demand for nursing care is increasing and thus canpoint to the direction for services to which life insurers can contribute in the future.
As we have seen above, life insurance’s protective function is expanding its scope. Life
insurers are required to expand or consider expanding their coverage and also provide newservices. The life insurance industry hopes to contribute to improving its customers’ QOL by
actively building a partnership with other industries to provide various services while centering
on insurance products.

(4) The area of prevention: from the perspective of both information technology and humancommunication
As has been mentioned, the area of prevention not only improves QOL but also secures
supporters of society, thereby contributing to the stabilization of the social security system. In
addition, it is good for life insurers that customers stay healthy. As the Omi merchants used tosay, all three parties (seller, purchaser, and society) do well in this relationship. Currently, many
insurance companies are making efforts to support customers’ health through their products andservices.
Typical of such efforts are insurance products that contribute to promoting customers’ health.
Since 2016, many insurance companies have launched new products and services one after
another (Reference 22). Such products not only provide exercise support, advice on health, andinformation on illness but also offer monetary incentives for medical checkups or doing certain
exercise in the form of varying premiums. Various efforts have been made to contribute topromoting customers’ health.
In designing such products, it will be important for life insurers to accumulate data on
customers’ healthy activities and life logs or use anonymized public data to propose healthy(Reference 22) Insurance that contributes to the promotion of customers’ health
Exercise support

Advice on healthMonetary incentives

Provide information ondiseases

Source: Created by The Life Insurance Association of Japan- 23 -

programs that are effective for each one of their customers and suit their tastes. If they can use
advanced information technology that will enable them to provide real-time tailor-madeprograms, they can gain support from more people, including those who are indifferent tohealth.
For example, overseas insurers provide services that enable them to calculate healthy life
expectancy based on diet and sleep information, as well as simulate how healthy life
expectancy varies when exercise or lifestyle is changed. Thus, the visualization of effects ofhealth promotion measures can lead to improving customers’ willingness.
To trigger health promotion or make it a habit, other important elements than information
technology are at work. Reference 23 shows the results of a questionnaire survey conducted byan overseas journal for medical professionals on medical experts, which involved asking them
what is important for triggering health promotion and making it a habit. According to this,different elements are required for triggering health promotion and making it a habit. Direct
human support, however, was the only element required for both. This means that personal
relationships are also important to trigger and maintain disease prevention or health promotion.
In this regard, private life insurers can contribute to a wide range of areas as they havechannels rooted in communities and have established long-term relationships with theircustomers. Thus, taking advantage of strengths of both advanced information technology andhuman communication, we would like to develop the all-three-parties-doing-well relationshipwith more people, including those who are indifferent to health, by helping them stay healthier.

(Reference 23) Elements required to trigger healthy activities and make them a habit
Provide a chance to prevent illness or
promote health

Make it a habit

Enhance access to preventive
services

Direct human support
Virtual support

Direct human support
Knowledge about preventablediseases

Enhance access to preventive
servicesReminderEconomic rewards
Virtual support

Economic rewards
Personal terminal

ReminderWearable terminals and smartphone apps

Personal terminal

Knowledge about preventablediseases

Wearable terminals and smartphone apps

Economic penalties

Economic penalties

Source: “What Creates Behavior Change May Not Sustain It” NEJM Catalyst, May 2018(https://catalyst.nejm.org/survey-sustaining-behavior-change/).

- 24 -

(5) Further promotion of public–private partnership
We have seen the role life insurers can play in the three areas of preparedness, protection,and prevention in the future. Here we will focus on the way public–private partnership should bepromoted in each area.
To begin with preparedness, as has been mentioned earlier, the life insurance industry has
made efforts to improve knowledge on finance and life insurance. What is especially importantis for the younger generation to acquire solid knowledge. We shared this idea with thegovernment. As a result, the curriculum guidelines for junior and high schools have come toadopt the “most optimal combination of self-help, mutual assistance, and public help,” which
consists of the relationship between the social security system and mutual assistance incommunities and the optimal combination of savings and insurance in the private sector. We willcontinue to exchange opinions with those concerned about the content of textbooks, so we cancontribute to helping students acquire knowledge that will form a foundation for leading a safe
and comfortable life.
In working for communities, we cannot just provide financial knowledge, but we will have tounderstand dementia correctly and help people with dementia or their families within our means.
Currently, some life insurers support the Ministry of Health, Labor and Welfare’s initiatives andtrain dementia supporters (see Column 5). We can contribute to furthering public–private
partnership, taking advantage of our strong management resources.
Moving on to protection, it will be much more important to support customers’ self-help
activities and prepare an environment that facilitates the purchase of insurance policies.
Currently, the life insurance premium deduction system is in place as a measure for self-help
support. While many people use it, we believe it is necessary to improve the system in order tohelp customers achieve further stability in life.
(Column 5) Training dementia supporters
Life insurers who regularly keep in touch with their customers can understand thesituations they are in, which enables them to contribute to supporting people withdementia.
The industry is working on raising dementia awareness. In Asahi Life, for example, allemployees (employees and officers as of March 31, 2017, excluding those on temporary
retirement) are dementia supporters. Taking advantage of our strong management
resources, including human channels, we hope to contribute to our customers and enable
them to lead a safe and fulfilling retirement life.
To a society where everyone can live a safe life.

Asahi Life has a project called Dementia Supporter Training.

In light of accelerating aging, Asahi Life has chosen to support
the Dementia Supporter Caravan initiative promoted by the
Ministry of Health, Labour and Welfare and is training its
employees as dementia supporters.
Partner companies As of September 30, 2017, over 15,000 employees andofficers* were certified as dementia supporters.
*Applicable to all employees and officers enrolled as of March 31,
2017, with the exception of employees on temporary retirement.

Asahi Life

Source: Based on Asahi Life’s website (https://anshinkaigo.asahi-life.co.jp/company/).

- 25 -

Finally, as to the area of prevention, some life insurers have signed a partnership agreementwith local governments as part of their community contribution activities, under which joint
efforts are made to improve the checkup rate of cancer screenings, for example, or healthawareness seminars are held.
We hope to promote such efforts to contribute to the creation of a sustainable society.

5. Conclusion: play a more active role as a partner in life
Life insurers create a life plan with customers before they take out a policy. Even after thepolicy begins, the insurers are there for the customers, ensuring that insurance money, or
benefits are paid if or when something happens to them.
Life insurers need to play a more active role if they want to contribute to the creation of asustainable society in an era of a super-aging society. Needless to say, they will continue toprovide products according to changing social security. They will also need to protect theircustomers’ health, act as a good judge on their behalf, and reinforce the relationship with thecommunities where they live. They will have to be more deeply involved in their customers as apartner in their lives to contribute to improve QOL.
People need to create a new life design in order to live a happy life in the era of 100-year lifespans. Forget about the stereotypical idea of retiring at a certain age. Rather, takeenvironmental changes, including social security, positively so that you can concentrate on thevalues that you want to realize, live a vigorous and longer life regardless of age, and improve
QOL on your own. Each one of us needs to paint a firm vision of the future and consider how
the necessary social security and self-help efforts should be achieved. Hopefully, this report can
provide the opportunity to consider these matters.

- 26 -

Chapter 2: Proposal: The Role of Life Insurance in Society 5.0

The life insurance industry proposes that it assumes the following roles in Society
5.07.
 Make insurance contract procedures more convenient and contribute to
reducing burdens(1) Utilize medical data
(2) Utilize administrative data Contribute to extended healthy life expectancy(1) Utilization of the healthcare data platform
This proposal considers the above in detail.
* We propose the utilization of various pieces of data to make insurance procedures moreconvenient and reduce the burden, and to contribute to extended healthy life
expectancy. Whether it is required or how entirely depends on each insurer’s
management decision.

7

For Society 5.0, see the expert opinions on page 36.
- 27 -

1. Background
During the 110 years of its history, The Life Insurance Association of Japan has seencustomers’ expectations toward life insurance change. In the Meiji through Taisho era,customers wanted it to develop assets. During the rapid growth years, they needed it as death
protection. In the Heisei era, they wanted both death protection and preparedness for longevityrisk.
In the coming decade and beyond, Japan will see its population decrease and demographic
aging advance8, and a longevity society of 100-year life spans is expected to emerge.
It is important to create a sustainable society by solving social issues and growing the
economy so that each one of us can lead a safe and hopeful life in an environment
characterized by a declining population and accelerated demographic aging. Society 5.0 is anattempt to solve such social issues and achieve economic growth through the use of ICT
technology.
The era of 100-year life spans will diversify our work and lifestyles in such a way that people
work amid and adapt to various life events, such as education and childcare. It is the health ofeach one of us that supports such diversified work and lifestyles 9.
This is why The Life Insurance Association of Japan has decided to consider how we cancontribute to improved customer convenience/reduced burden as well as extended healthy life
expectancy through the use of ICT and data so that we can be instrumental to creating asustainable and rich society in light of environmental changes such as population decline,
demographic aging, the emergence of a longevity society, and Society 5.0.
Figure 1 Roles of the life insurance industry

8

9Assumed society(Created on the basis of the Basic Policy on Economic and Fiscal Management
and Reform 2018).

Desired roles of thelife insurance
industry

Both life andindustry willchange- Remote and real-time services: create new services by
overcoming geographical and temporal limitations IoT technologies with dramatically advanced image andacoustic quality can enable us to provide services thatgeographical restrictions have so far prevented us fromproviding (e.g., medicine, education, shopping support
services).

Make insurance
contract procedures
more convenient
and reduce theburdenBothadministrationandinfrastructure
will change

Break away from the old-fashioned, analog style ofadministration, and make all services digital (from paper todata) to greatly reduce time, effort, and costs that weighheavily on citizens and companies.

Make insurance
contract procedures
more convenient
and reduce theburdenWhat economic
activities feedon will change

In the data-driven society of the 21st-century, economic
activities most importantly thrive on real data. Collecting,analyzing, and using real data that has been dormant anddispersed across the world in an integrated manner (i.e.,creating big data) will enable us to provide products andservices fine-tuned to individual needs.

Contribute toextended healthy
life expectancy byusing health,
medical, andnursing care data

See Chapter 1: Report: The Future of the Japanese People and Life Insurance in the
Healthcare Area on page 5.
See Chapter 1: Report: The Future of the Japanese People and Life Insurance in the
Healthcare Area on page 11.
- 28 -

2. Make insurance contract procedures more convenient and contribute to
reducing the burden(1) Utilize medical data
A. Concrete details
The Life Insurance Association of Japan proposes improved customer convenience and reduced
burden through the use of medical data (data on medical certificates held by medical institutions andreceipt <statement of medical expenses> data held by health insurance societies).
(a) Status quo
Below is a summary of the status quo of health insurance procedures.
In claiming health insurance benefits for hospitalization, operation, or outpatient care,customers are currently requested in principle to submit medical certificates written by a doctor.
In order to obtain medical certificates, they often have to make a few visits to the medical
institutions to request and receive them. Together with the medical certificates thus obtained,
they also submit claims forms. These are the basic procedures.
We have received opinions about these procedures, such as the following: “Though I haverecovered from illness and returned to work, I have to take a workday off,” “It’s hard to go to thehospital as I don’t feel well after the operation,” and “I have to pay for transport to go to a distant
medical institution just to get the medical certificate 10.” It is one of our challenges to reduce theburden on customers as much as possible.
Moreover, as the population will decrease, demographic aging will accelerate, and a longevity
society will emerge in the future, the number of elderly people who find it difficult to follow theprocedures by going out alone and collecting various documents is expected to increase. As
double income households and single households will increase, the procedures will be required
to be more simplified.
To reduce the burden of getting a medical certificate, a simplified procedure that does not
require the medical certificate to be submitted under certain conditions (hereafter, simplified
procedure)11 may be approved. As it happens, all insurers who handle applicable insurance
products have implemented the simplified procedure.
The number of annual health insurance benefit claims (or payments) in the entire life
insurance industry amount to some 12 million, of which about 65% (or about 78 million cases)
require the submission of medical certificates (the remaining 35% permit the simplified
procedure)12.

Based on the online questionnaire survey conducted by The Life Insurance Association ofJapan in October 2018 on 5,000 men and women aged over 20 years who had recently
submitted a claims form.
11 A simplified procedure refers to a benefit claim whereby a customer submits a return and aphotocopy of the medical expense receipt or the statement of medical expenses instead of a
medical certificate issued by a medical institution.
12 Based on the questionnaire survey conducted by The Life Insurance Association of Japan in
October 2018 on each member (as of fiscal 2017). The number of annual benefit claims (orpayments) (including estimates) is simply summed up. The number of submitted medical
certificates includes cases in which a photocopy of a medical certificate from anothercompany was submitted.
10- 29 -

(b) Feasible measures for solving issues
If the life insurer can accept electronic medical certificates instead of paper ones, it can
improve customer convenience and reduce the burden. This also helps reduce burden on the
doctors who create medical certificates13.
The use of the PHR (Personal Health Record) 14 is one way of doing this. The PHR is asystem to allow the patient and his/her family to grasp his/her health condition and medication
history to improve his/her daily life and promote health. If the PHR includes medical certificate
data, customers can get their medical certificate data from medical institutions and submit themto insurers on a device such as a smartphone.
There are other ways of linking medical certificate data than the PHR via customers; forexample, insurers can directly connect to medical institutions. One way of doing this is by usinga nationwide healthcare information network that enables medical institutions to share individual
patients’ information on checkups, medical care, and medication 15. If life insurers can use sucha nationwide healthcare information network equipped with capabilities to create medical
certificate data with external connection, customers will be able to complete the claims
procedure by simply contacting their life insurers.
Figure2 Image of the PHR

In August 2018 the Ministry of Health, Labor and Welfare hosted the Meeting Group to
Discuss Work-Style Reform for Doctors, where the issues pertaining to document
preparation by doctors (including medical certificates requested by private insurers) was
addressed. Based on this, The Life Insurance Association of Japan revised its Guidelines for
Designing Medical Certificate Forms on March 20, 2019.
For the simplification and standardization of medical certificate forms by private insurers
related to the discussion of doctors’ work-style reform, see the Health Policy Bureau, Ministryof Health, Labor and Welfare’s “Summary of the Discussion at the Study Group for Simplified
Medical Certificates that Private Insurers Request from Medical Institutions” (December 17,2018). https://www.mhlw.go.jp/content/10800000/000458953.pdf
14 In the Future Investment Strategy 2018: Reform Toward Society 5.0 and a Data-Driven
Society (June 15, 2018) (hereafter the Future Investment Strategy 2018), the Next
Generation Healthcare System, which is identified as the flagship project that will givetraction to realize Society 5.0, looks ahead to the era of 100-year life spans and is referred toas a new individual- and patient-first healthcare system that actively implements innovativetechnologies such as data and information communication technology (ICT). The
construction of the PHR is promoted as a concrete measure for creating such a society.
15 Based on the fact that “checkup and medical care information is dispersed and there is no
infrastructure for providing optimal health management, medical and nursing care, putting
the individual/patient-first” (see Material 1 of the Health, Medicine, and Nursing Care
Meeting, the Growth Strategy Council - Investing for the Future and the Council for
Advancing Structural Reform (held on October 27, 2017), the aim is to create a nationwide
healthcare network to provide services that will enable medical experts to share patient
information smoothly. According to the Future Investment Strategy 2018, the network isscheduled to be implemented fully in fiscal 2020.
13- 30 -

Insurers (e.g., Health
Insurance Societies andNational Health Insurance)

Local government

Times of disaster/emergency

Medical institutions to be relocated toMaternal
handbookapp

Schoolcheckups
app

Healthmanagementapp

Nursing carepreventionappPrimary carelink handbook
app

Private insurer

Collect data with thepatient’s consent

Lifestylediseases
handbook app

Utilize data

Distribution

Patients[Get apps consistent
with their life stage]

Highly value-added
health care services

PHR operator

Authenticationand view
Authentication
ID andand view
password

Certified operators
according to the Next
Generation Medical
Infrastructure Act

Secondaryuse of data
Individual
Number Card

*Based on the material created by the Ministry of Internal Affairs and Communications for Part II of the Panel Discussion
at the 110th Anniversary of The Life Insurance Association of Japan Celebration.

If the PHR or the nationwide healthcare information network can accommodate receipt data, it
can advance the simplified procedure, improving customer convenience, and reducing theburden.
Regardless of the medical data linkage method, the customer’s consent is a prerequisite. We
must also address the issue of who bears the costs to establish it as a business model. The
nationwide healthcare information network would require many medical institutions to join it toimprove customer convenience.
Figure 3 Image of information linkage via the nationwide healthcare information network
Services in the healthcare area
Medical ID

Check if theinsured isqualifiedOnline claims

Regional
medicalcorporation

Medical andnursing carelinkage

Electronic
referralElectronicprescription

Private service

Healthinsurance

Nationwide healthcare information network
Regional medical corporation
network

Regional medical corporation
network

Hospital

Hospital

ClinicPharmacy

Nursingcare facility- 31 -

DentistClinicPharmacy

[Reference: the PHR further improves convenience]
Life insurers can further use the PHR in the following areas: they can use it in the undertaking
procedure (when buying an insurance policy, the customer submits his/her checkup results tothe life insurer via the PHR with his/her consent) or to provide services for policyholders(healthcare consultation services on life-style information, such as exercise, diet, and sleep
based on the submitted checkup results).
If life insurers use the PHR for the undertaking procedure, they can electronically process the
medical certificate submission procedure for about 1 million policies that require medical
certificates out of the approximately 14 million life insurance/health insurance applications per
year.

Image

Figure 4 Example of further use of the PHR
Used for undertaking procedure

Policyholder services

In taking up a policy, thecustomer submits checkup
results to the life insurer throughPHR with his/her consent.

Provide health consulting
services on life information, suchas exercise, diet, and sleep
based on checkup results.

Individual

Individual
Healthcertificate

Health certificate,etc.

Insurer

Insurer- 32 -

Expert opinions

Keidanren (Japan Business Federation)
Director, Industrial Technology Bureau,
Mr. Takashi Yoshimura

Society 5.0 is a concept first proposed in the government’s 5th Science andTechnology Basic Plan. It is conceived as the fifth new society, preceded by thehunter-gatherer society, agrarian society, industrial society, and information society.
It is not just about technological innovations but suggests the direction that society
should take. As such, it is identified as the pillar of Japan’s growth strategies and isgaining traction as a social vision to be shared by humanity across the world. The
government, industry, and academia share this concept in Japan, working on
various projects to realize Society 5.0 before the rest of the world.
In “Society 5.0 - Co-creating the future” published in November 2018, Keidanren
defined Society 5.0 as a creative society, created through the integration of digital
innovations and the diverse imagination and creative power of diverse people. The
transformation toward Society 5.0 is driven by AI- and IoT-based digitaltechnologies and data-driven digital innovations. In the age to come, uniquely
human imagination, and creation are strongly required—people must takeadvantage of such technologies to solve diverse social issues and create newvalues.
Society 5.0 is a society in which social issues are solved and new values are
created. Free from conventional values such as size and efficiency, or uniformity,
and concentration, it seeks to be a diverse society in which everyone can safely
take up a challenge, forming a symbiotic relationship with nature and liberated fromvarious restrictions, whenever and wherever he or she wishes. Meanwhile, the way
individual life, companies, industrial structure, and administration should be will also
radically change.

Hunter-gatherer
society

Agrarian society

Industrial society

Informationsociety

Creative society

Digital innovation

People’s(imaginary/creative) power

Solve issues

Create values(Source) Based on the proposal, “Society 5.0 - Co-creating the future”(November 13, 2018).

- 33 -

In the age of Society 5.0, the healthcare-related area will greatly change. One infour Japanese people are already over 65 years. Japan has reached the mostadvanced super-aging society in the world, causing concerns about future shortageof labor and an increase in medical expenditures.
As one of the directions in which to solve such issues, Keidanren drew up a
proposal called Healthcare in Society 5.0 and published it in March 2018. As digitaland bio-technologies advance, it will become increasingly important to prevent
illness. People can receive care that is tailored to their individual needs. Individuals
can manage their own health.
The realization of such new healthcare can extend the period in which individuals
stay healthy and lead to medical cost optimization. If Japan can manage to grow inthe era of a super-aging society, it can expand its healthcare model abroad, thus
improving its industrial competitiveness and contributing to the health of the entire
world.
Healthcare in the age of Society 5.0
Cure illness

Presymptomatic care and prevention
Individualization

Uniform therapy
Medical expert-centric

Individuals’ proactive involvement

Uniform therapy to average group

The scope of healthcare is expanded
Longer healthy life
To individualization(Source) Based on the proposal, Healthcare in Society 5.0 (March 20, 2018).

In the age of Society 5.0, where diverse people can extend their life expectancy
and continue to take on challenges regardless of age and other factors, life
insurance must be there for each individual throughout his/her life, from the healthy
period up to his/her death, which will likely be facilitated by the power of technology.
Keidanren places high hopes on the future of the life insurance industry as anindustry that will support the age of Society 5.0, where diverse people will play anactive role.

- 34 -

B. Consumer opinion survey
In preparing the present proposal, The Life Insurance Association of Japan conducted an
online survey on nearly 5,000 men and women who had claimed insurance money or benefits
for a health insurance policy in October 2018. The survey was conducted to understand general
consumers’ current opinions and realities, as well as to confirm that the general public would
permit the private sector’s utilization of medical data to a certain extent.
(a) More convenient claims procedure
Most people found it most desirable to save the trouble of going to medical institutions to get
medical certificates as a way of making the claims procedure better. Similarly, many requested
to expand the simplified procedure that does not require obtaining a medical certificate.
Figure 5 More convenient claims procedure

Desired approaches to make health insurance claims procedures better(in percentage terms)
Less bother going to medical
institutions
Expand the simplified procedure*
Make required documents
easier to understandReduce required documents
Reduce time required to pay
benefits
Other* The simplified procedure refers to abenefit claim whereby a customer
submits a return and a photocopy ofthe medical expense receipt or thestatement of medical expenses
instead of a medical certificate issued
by a medical institution.

(b) Opinion survey on health insurance’s claims procedure
We confirmed the following requests on the health insurance’s claims procedure:(1) Using a smartphone to submit medical certificate data to the insurer
Over 70% of the respondents hoped for a claims procedure to be developed in which asmartphone is used to submit medical certificate data to the insurer, although some voiced
concern over wrong transmission.

- 35 -

Figure 6 Opinion survey on health insurance’s claims procedure 1

You can submit medical certificate data issued by the medical institution to
the insurer via a smartphone. Do you want this benefit claims procedure to berealized? (In percent)Yes.
If I had to choose, yes.
Not really.
No.
(Customers’ voices)“It would be a great help if I didn’t have to wait for hours in the hospital as I have young children.”“It will be useful as I have difficulty going to the hospital to get the document, suffering as I am
from cancer treatment.”“I don’t have to take a day off; I tend to take too many sick leaves for hospitalization andoutpatient treatment.”“I don’t know much about smartphones/who is going to be held responsible for wrong
transmission?”(2) Method where the insurer receives medical certificate data from medical institutions
Slightly less than 90% of the respondents hoped for a claims procedure for benefits to be
developed in which the insurer receives a medical certificate data via an information linkage
platform with medical institutions with the customer’s consent.
Figure 7 Opinion survey on health insurance’s claims procedure 2

The insurer receives medical certificate data via the information
linkage platform with medical institutions with the customer’s consent.
Do you want this benefit claims procedure to be realized? (In percent)Yes.
If I had to choose, yes.
Not really.
No.
(Customers’ voices)“It will become more convenient as no time and effort is required for the claimant of benefits.”“I don’t know much about medical terms, so it will go smoother if experts handle the case among
themselves.”“The simplified procedure is a good thing, as long as information security management andpersonal information protection are ensured.”“I’m worried about information being exchanged without my knowledge/It will get complicated tocorrect mistakes if they arise.”- 36 -

Expert opinions

PictureConsumer Conference for
Sustainability
President
Ms. Yukiko Furuya

Society 5.0 and Consumers
Society 5.0 was for the first time proposed as a vision of future society that Japan sought toachieve in the 5th Science and Technology Basic Plan (2016 to 2020). This discusses that Japanaims “to achieve a human-centered society (Society 5.0) in which anyone can enjoy a high qualityof life full of vigor. It intends to accomplish this by incorporating advanced technologies in diverse
industries and social activities and fostering innovation to create new value”(note).
While Society 5.0 can bring about dramatic changes in consumers’ lives, viewed fromconsumers’ realities, it can have both positive and negative effects, depending on the way
companies handle it. If Society 5.0 is human-centered in the first place, consumers in it are
expected to both make their own choice to live an enriched life and act proactively to avoid risk.

Consider Consumer Realities
We need to look at the situation consumers find themselves in, to ensure that they can takeaction as the subject. First, we must consider the position of consumers in the market. Consumers
have both aspects: one impacted by the market and the other that impacts the market. In theformer, consumers may fall victim or suffer a loss under the influence of systems or businesses’approaches. Consumer policies have protected them, respecting their rights. In the latter, systems
and businesses have come to recognize that their approaches can be affected by consumer
behavior. Recently, they have expected consumers to play an active role in ethical or sustainableconsumption, and consumer education is thriving.
Second, it is necessary to be aware that there is a gap between consumers and companies.
Since there is a problem of asymmetrical information or power balance between consumers andcompanies, we must be cautious about any approach that does not take the realities into
consideration, be it respecting consumers’ rights or expecting them to play a role, for it can cause a
big issue.

Expectations Toward Companies and the Role of Life Insurance
Companies will produce various products and services while taking advantage of technologicalinnovations and data. In doing so, they need to consider the aforementioned consumers’ realities.
For example, they say that the use of data can enhance consumer convenience in life insurance.
But if companies do not provide user-friendly information that allows consumers to make their own
decisions, this would lead to unexpected dissatisfaction or damage on the part of consumers, which
in turn may impede the use and utilization of data. Since companies have far more information thanconsumers, they will be held responsible for educating consumers to empower them. The
education they provide must be of the sort that supports consumers rather than a conventional typethat simply provides information on life.
Note The Cabinet Office’s website: https://www8.cao.go.jp/cstp/society5_0/index.html- 37 -

C. Status of medical data linkage in major Western countries
We can learn a lot from international cases of medical data linkage when we consider linking
medical data in Japan. The Life Insurance Association of Japan has studied mechanisms forlinking individual data in the healthcare area in the US, the UK, Germany, and France. In doingso, it has divided them into two: those analogous to the PHR and those in which medical
institutions connect to private insurers to transmit data.
(a) Mechanisms analogous to the PHR
The PHR comes in various forms, allowing the patient to manage and use his/her own
healthcare data. Here we have focused on PHRs led by public institutions.
The US has a system called Blue Button run by the Office of the National Coordinator for
Health Information Technology. Blue Button was established in 2010 under the Obamaadministration, aiming at allowing individuals to access their own medical data with ease. It has
been implemented by 500 or more medical institutions across the US, enabling individuals who
receive medical care services in such medical institutions to download their medical data.
In the UK, the Department of Health and Social Care has run a system called the GP online
services since 2015. The system enables patients to obtain their medical data(disease/diagnosis name, examination history, etc.) held by general practitioners (GPs).
France has le Dossier Medical Partage (DMP) that manages individuals’ medical records, inwhich participants of the public healthcare system can join if they wish to do so.
In Germany, an integrated-circuit-embedded health card has been implemented as part ofelectronic administration for public medical insurance. The card has a functionality equivalent to
the PHR. In addition to this electronic health card, Germany is planning to ensure that the publichealthcare insurer provides a PHR functionality that enables the insured to access his/herelectronic medical record by 2021.

- 38 -

Figure 8 Medical data management by the patient in major Western countries

Mechanism
for individuals
to view/
manage their
medical data

US

UK

Germany

FranceThe Office of the
National Coordinatorfor Health Information
Technology runs

The Department of
Health and Social
Care runs
GP online services

The publichealthcare
system’s
electronic healthinsurance card
eGK

The Caisse
nationale del’assurance maladie
runs
DMP

Blue Button(b) Mechanisms of data linkage between medical institutions and private insurers
All four countries have mechanisms in which medical institutions directly transmit theinsured’s hospitalization/release, operational details, receipts, and other types of data toinsurers. While data linkage between medical institutions and insurers is available in eachcountry, we must keep in mind the differences between their healthcare systems and Japan’s.
Commonly, health insurers have a partnership with specified medical institutions in both the
US and the UK. If a patient receives medical services in a member medical institution, theinstitution sends bill data to the insurer, which then makes a direct payment 16. Such a system
has been established.
Germany has a data linkage mechanism that is limited to hospital care that is more expensive
than outpatient care in the short-term. Private health insurance in principle makes a maturity
payment17. Though the customer submits data required for claims to the insurer, direct payment
is made for hospital care. The medical institution (hospital) can directly send hospital-related
data required for claims to the insurer. Since 2013, the law has mandated the use of electronicmeans as a way of linking data. This enables a more simplified procedure than maturity
payment for the customer while helping the medical institution to quickly collect hospital carefees, which is an advantage.
France has established a system in which the payment agency of the public medical security
system directly and automatically sends the customer’s medical care data to the private insurer.
Both public and private security programs in principle make maturity payments, and“complementary health insurance” with higher linkage with public security is the mainstream ofprivate health insurance. These form a background of automated data linkage. In the past, theinsured had to claim against both the payment agency of the public security and the private
insurer, separately. But in 1998, France implemented an electronic medical care information

The direct payment here refers to the one directly made by the insurer to the medical
institution. On July 14, 2010, AIG Edison Life Insurance issued a press release on its Direct
Payment Service. Since then, many more life and non-life insurers have provided direct
payment services for advanced medical benefits in Japan. The services are intended for
proton beam therapy and heavy particle radiotherapy at member medical institutions. The
customer must prepare and submit a claims form to the insurer even for the medical services
provided by a member medical institution. No data linkage is made by the medical institution.
17 The patient must pay the medical fees to the medical institution, and then apply for the
insurer to receive benefits.
16- 39 -

system as well as the public medical security card, enabling automated data linkage between
medical institutions and the payment agency of public security. In 2000, automated linkage fromthe payment agency of public security to private insurers was realized.
In complementary health insurance, direct payments are becoming more widespread. The
insured submits a certificate issued by the insurer to a member medical institution. A direct
payment is then made for medical practice as set forth in the policy.
Figure 9 Medical data linkage in the claim procedure in major Western countries
US

UK

Direct payment

Available

Available

Claimant ofMember medical

Member medical

benefits

institution

institution

Linked data

Germany
Partially available

Partially available(Hospitalization)(Examination, etc.)
Member medical

Medical institution

institution(Via public agency)

Bill includingBill including

Hospitalization/

medical data

medical data

release data

- 40 -

FranceMedical certificate

(2) Utilize administrative data
A. Concrete details
Since 2011, The Life Insurance Association of Japan has requested the construction of apublic–private information-sharing infrastructure that will enable private operators to use
survival, death, and address information held by the government on the premise that theindividual gives prior consent. In June 2011 it published the request, “Utilization and applicationof information communication technology (ICT) through the social security and taxation system
in life insurance business.” In April 2017, it also published the “Recommendation on Utilizationof the Individual Number System in the Private Sector for Promotion of Friendly Life Insurance
Services for the Elderly.”(a) Utilization of survival and death data
If life insurers can access the survival/death data held by the government, they can improve
convenience for customers and reduce their burden, as well as realize prompt and reliableinsurance payments.
A life income policy for example pays annuity as long as the insured is alive. Therefore, it isnecessary to confirm the survival of the insured every year. The life insurer sends required
documents to the customer, who has to go to the city hall to get a certificate, which he/she must
return to the insurer. The life income policy may involve such practice. It imposes a burden
related to transport or postage on the insured, and also causes considerable administrative loadto the local government and the insurer. As the aging society advances, the annuity payments
by private life insurers are likely to increase in the future. If insurers can utilize survival/deathdata, they can get rid of such paper-based practices.
Not only for annuity payment administration, but also for insurance money payment
administration, we expect administrative information to be utilized in terms of thepresence/absence of incidence of events.
The annual number of cases in which life insurers confirmed survival through submission
notices of survival certificates or their equivalents required in the annuity payment procedureamounted to about 3.5 million, and the number of death benefits claims (or payments) was
about 0.6 million18.
(b) Utilization of address data
If life insurers can access address data held by the government, they can improve
convenience for customers and reduce their burden, as well as provide appropriate
maintenance services.
A life insurance contract generally stretches over a long period of time, so it is necessary toprovide appropriate maintenance services. During the policy period, however, customers oftenchange addresses. Many customers do not inform insurers of a change in their address. The
insurers spend a lot of time and effort in locating customers. This can make it difficult for the18

Based on the questionnaire survey conducted by The Life Insurance Association of Japan in
October 2018 on each member (as of fiscal 2017) The number of procedures for changing
addresses (including the number of cases in which addresses were checked due to thenonarrival of notices) was the same as above.
- 41 -

insurers to provide required information and appropriate maintenance services for thecustomers.
If insurers can use address data and identify the customers’ latest addresses, they canprovide appropriate information and maintenance services.
The annual number of change-of-address procedures amounted to about 10 million, including
about 0.7 million cases of address checks due to the nonarrival of notices.

3. Contribute to extended life expectancy(1) Utilization of the healthcare data platform
A. Concrete details
The Life Insurance Association of Japan recommends the utilization of a healthcare data
platform to contribute to providing products and services instrumental to extending healthy life
expectancy.
When life insurers provide PHR- or wearable-terminal-based health consulting services, they
may at times use analytic results of big data to provide optimal health advice consistent withindividual health or life conditions.
The healthcare data platform, which has been considered by the Council of Advisors to the
Health Insurance Bureau, Ministry of Health, Labor and Welfare, is a database that enables
interlinked analyses of both input data (NDB19) and outcome data (long-term care DB20). It isscheduled to go into full operation in 202021.

NDB (National Database) is a database used for studies and analyses for creating,conducting, and evaluating the medical fee optimization plan based on the Act on Assuranceof Medical Care for Elderly People. As such it stores and builds information on receipts(statement of medical expenses), specific health checkups, and specific health guidance.
20 Long-term Care DB (integrated long-term care insurance database) collects electronic
information about the statements of long-term care expenses (long-term care receipts) under
Article 197 (1) of the Long-Term Care Insurance Act. Since fiscal 2013 it has been stored ona server managed by the Ministry of Health, Labor and Welfare to start its operation.
21 In the Future Investment Strategy 2018, the Next Generation Healthcare System (withextension of healthy life expectancy as the KPI), which is identified as the flagship projectthat will give traction to realize Society 5.0, looks ahead to the era of 100-year life spans andis referred to as a new individual- and patient-first healthcare system that actively
implements innovative technologies such as data and information communication technology(ICT). As concrete measures are required to build it, the government presented the
preparation of “a platform which allows government services, insurers, researchers, andprivate sectors to connect and analyze big data on health, medical care, and nursing care as
the history of individuals” as the “promotion of use of base data for health, medical, andnursing services suitable for individuals.”
19- 42 -

Figure 10 Image of the healthcare data platform
Nursing care database
Medicalreceipt

Specialcheckups

Nursing carereceipt

Certificationof long-termcare need

Providelinkedanalytics

Researcher

Localgovernment

Insurer

Insurer*Created based on material from the 5th Data Health Reform Promotion Headquarters Meeting,
Ministry of Health, Labor and Welfare (February 26, 2019) by The Life Insurance Association of JapanIf life insurers utilize the healthcare data platform for studies on the extension of healthy life
expectancy, studies with public interests22, they can provide new services that will contribute toextended healthy life expectancy, such as prevention of aggravation or health promotion
programs based on a new type and range of information thus far unavailable.
Figure 11 Features of the healthcare data platform
Who?
Each one’s healthconditions through aging

What?
Medical and nursing careservices

How healthy?
Changes in ADL, IADL*, orthe level of care needed

You can see how long you have lived a healthy life instead of
how long you have lived.

We help our customers improve their healthconditions to extend their healthy life expectancy.

22

The Report on the Expert Committee on Medical and Nursing Care Data Analytics
Infrastructure (November 16, 2018) mentions that the healthcare data platform is “intended
to be used by a wide range of entities, including those in the private sector, for public
interests.”
https://www.mhlw.go.jp/stf/shingi2/0000148301_00002.html- 43 -

B. Consumer opinion survey
The Life Insurance Association of Japan studied public expectations toward the insurancecompanies in the era of 100-year life spans in the same consumer opinion survey as mentioned
in Chapter 2, 2 (1) B.
Life insurers develop various products to extend each person’s healthy life expectancy23. A
little under 80% of the respondents said they would expect life insurers to contribute to theextension of healthy life expectancy in the age of 100-year life spans.
Figure 12 Expectations toward life insurers

Life insurers are developing various products to extend every person’shealthy life expectancy in the age of 100-year life spans. Do you
expect life insurers to play a social role in the future? (In percent)Yes.
If I had to choose, yes.
Not really.
No.
(Customers’ voices)“My motivation seems to change when approaches to health are quantified. Taking up a policy
is just the beginning, and insurance will become something much more familiar to me.”“Both my life insurer and I need to change the way we think. I’m reassured as my life insurer isthere to support me in the process.”“There are times when it is difficult to leave home in the snowy region.”“It’s okay for healthy people, but it’s all the more difficult for people who are sick.”23

See The Life Insurance Association of Japan’s Report on the Project to Support Initiatives toPromote Health, pp. 41ff.
http://www.seiho.or.jp/activity/health/pdf/report-7.pdf- 44 -

C. Status of big data on healthcare in major Western countries
The Life Insurance Association of Japan studied the use of big data on healthcare in the US,
the UK, France, and Sweden to get some insights.
In the cases of the French, American, British, and Swedish analytics infrastructures, theprivate operators are allowed to access them. They apply to the authorities mainly for research
purposes, and they can use them upon approval.
In 2015, the target American analytics infrastructure permitted access for business-related
innovative research, and some insurers have actually used it.
The target French analytics infrastructure allows free access to all applicants, though theinsurers, and pharmaceutical manufacturers are legally forbidden to use the information forcertain purposes. Insurers who provide health insurance are prohibited to use it for freedom
from protection and change in premium.
For other findings, see Figure 13. A Japanese attempt to perform linked analytics on medical
checkups, medical receipts, and nursing care information under the universal healthcare systemis epoch-making and is expected to be used effectively.

- 45 -

Figure 13 Each country’s healthcare database and private accessFranceOperator/holder Caisse nationale del’assurance maladie(CNAM)

Databaseoverview

 French
Administrative HealthCare Database(SNDS)• Integrates existing
health and nursing
care databases:
1. System nationald’information interregimes del’Aassurance maladie
2. Medical information
system program
3. Medical causes ofdeath database
4. Medical and social
database
5. Complementary
health insurance
specimen database

Private access • Accessible if
application isapproved by theauthorities• Though anybody canapply, insurers thatprovide healthinsurance andpharmaceuticalmanufacturers are
forbidden to use theinformation forcertain purposes(e.g., change inpremium).
• The insurers and thepharmaceuticalmanufacturers
mentioned above canapply in one of thefollowing ways:
1. Apply with acertificate for the
non-use of data for
the forbidden
purposes.
2. Work together with aresearch institution
which handles dataprocessing for
application.

US

UK

SwedenThe Centers for
Public Health England
Medicare and Medicaid (PHE)
Services (CMS), UnitedStates Department of
Health and Human
Services

National Board of
Health and Welfare(NBHW)

 Medicare claims data 1. Medical databaseis held in the
2. Cancer database,following three dataetc.
files:• Multiple databases
1. Data that allows
can be linked
individuals to be
identified (IDFs andRIFs)
2. Data that excludes
direct identifiers(LDS)
3. Public file (PUFs)• RIFs can linkindividual identifier
information with otherdatabases outside
the CMS.

 Healthcare data
Registry• Composed of a totalof seven registries oncancer, childbirth,patient, prescription,
dentistry, cause ofdeath, and welfare.

• For (1) IDFs andRIFs, and (2) LDS,
accessible if
application isapproved by theauthorities• Applicants arebasically
researchers.
• Though access for
product/service
development was not
permitted, it has
been allowed since2015.
• Part of the thenadministration’s
approach to datautilization leading to
medical systemtransformation• Insurers haveaccessed it.

- 46 -• Individual numbers
can be used to linkregistries.

• Accessible if• Accessible if
application isapplication isapproved by theapproved by theauthorities
authorities• There is no indication • There is no indicationof restrictions onof restrictions on
applicants, whether
applicantspublic, or private or(researchers),
industry.
whether public, or• On condition thatprivate or industry.
access is forhealthcare-related
purposes• The PHE allows the
Association of the
BritishPharmaceuticalIndustry (ABPI) to
access it, among
other accessibleorganizations.

4. Summary
We have thus far proposed the use of medical and administrative data to improve customer
convenience and contribute to reduce the burden, as well as the utilization of the healthcare
data platform to contribute to the extension of healthy life expectancy.
Our efforts to reduce the burden related to policy procedures will help you to plan yourretirement life and enjoy hobbies without having to go through bothersome procedures forreceiving annuity every year after your retirement. In case you are hospitalized or requirenursing care, you can quickly finish the procedure for receiving benefits so that you canconcentrate on early recovery or rehabilitation to prevent aggravation. Your fulfillment in life may
depend on how you overcome retirement, hospitalization, nursing care, and other major eventsin life. If you proactively engage in a role that only you can play, you can consequently create afulfilling and meaningful life. The extension of healthy life expectancy can be said to be the basisof everything.
The Life Insurance Association of Japan hosted a panel discussion entitled “The Role of Life
Insurance in Society 5.0” at the 110th Anniversary Ceremony on February 25, 2019. There we
deepened our understanding of the following issues: the utilization of data can be advanced on
the premise that personal information is protected; it is important for companies to provide
information so that individuals can control their own information; the question of digitalization in
undigitalized areas arises in actual operation; and it is necessary to solve technical and costrelated issues.
On the basis of the insights gained from the panel discussion, we at the Life Insurance
Association of Japan would like to gain customers’ understanding, solve each issue with ourpartners, and play a new role in contributing to the creation of a sustainable society and theextension of healthy life expectancy.
Figure 14 Create a fulfilling and meaningful life

Extension of healthy life expectancy
Age of 100-year life
spans

Open up a safe and hopeful future

End of text

- 47 -

Conclusion
As we head from Heisei to the next era, we have various social issues as big environmental
changes take place: e.g., demographic aging, the declining population, the arrival of an era of
longevity and 100-year life spans, and technological advancement. Against such a backdrop,
last year, The Life Insurance Association of Japan announced a slogan, “Create a Brighter
Future” so that each one of us can firmly look ahead, paint a vision of the future, and live a safeand hopeful life.
Chapter 1 presented our current position as to how to respond to changes in environment andsocial security in order to make our social security system, which embodies the provision ofsafety to society, sustainable. It covered the 3Ps, elements required for each one of us to live asafe and hopeful life, and summarized what role the life insurance industry must play in it.
Chapter 2 proposed the use of medical and administrative data to improve customer
convenience and reduce the burden in insurance contract procedures, as well as the utilizationof the healthcare data platform to extend healthy life expectancy. Building the extension ofhealthy life expectancy, improved procedural convenience, and reduced burden can hopefully
help create a sustainable society in Japan, which is currently in an era of population decline anddemographic aging.
The life insurance industry is an industry to complement the social security system. Its main
duty is to provide products and services that will be there for each one of its customers
throughout their lives for a long period of time. The Life Insurance Association of Japan will open
up a future full of safety and hope, looking 10 years ahead, and beyond, making sure that what
has been considered in this report and proposal can lead to a situation where society, people,
and businesses can all do well and to solving the social issues facing Japan.
The Life Insurance Association of Japan- 48 -