Comparison of the Nature and Cost of Diabetes Treatment at Two Clinics in Japan and the United States

Abstract

In order to compare the cost-effectiveness of diabetes treatment in Japan and the USA, we examined medical expenses per diabetes outpatient (annual and per visit) at two specialist centers, Joslin Diabetes Center (USA) and Yokogawa Clinic (Japan). At Joslin, which implements advanced, short-term, intensive education of patients about self-management, the annual medical expenses incurred per outpatient and medical expenses incurred per outpatient visit were $418 ± 272 and $204 ± 100 (mean ± SD), respectively, but costs recovered were significantly below actual costs, and this is a source of serious financial pressure. On the other hand, diabetes patients tend to attend clinics regularly throughout the year in Japan, and the corresponding expenses per outpatient at Yokogawa Clinic were $1142 ± 631 annually and $114 ± 44 per visit; in this clinic, the actual costs were almost fully recovered, due to the comprehensive national insurance system in Japan. It is noteworthy that, despite the lower cost per visit, the annual cost per patient is substantially larger in Japan, due to the habit of frequent checkups. The marked increase in the number of patients with type 2 diabetes is relatively recent in Japan, where it may be related to an increasingly westernized diet, and currently there are few facilities for education of patients. Our findings suggest that the annual cost per patient in Japan could be greatly reduced if more time were allocated for advanced education of patients about self-management of their condition, since this should reduce the need for frequent checkups, depending upon patients’ ability to take responsibility for their condition. In addition, efforts should be made to clarify the roles of doctors, staff and management so as to generate an environment in which specialists can work more effectively.