Where Does Telemedicine Achieve a Cost Reduction Effect? Cost Minimization Analysis of Teleradiology Services in Japan

Background: Telemedicine as a technology is expected to resolve issues such as doctor shortages and disparities in medical services. However, high costs of system installation and maintenance inhibit its widespread use. Introduction: This study involved a cost minimization analysis for installation of a teleradiology system in the Hokkaido prefecture of Japan. Conditions under which system utilization is cost-efficient and system utilization is effective for cost reduction were analyzed. Materials and Methods: A cost minimization analysis was conducted using three geospatial points of 50, 100, and 200 km from Sapporo city, the prefectural capital of Hokkaido, assuming a central imaging diagnosis center in Sapporo. The analysis was conducted from the standpoint of both patients and requesting hospitals. Results: From the patient's standpoint, a cost reduction effect was observed at all three distances from system installation. In contrast, from the hospital's standpoint, a cost reduction effect was found only when teleradiology examination was conducted from a distance of at least 100 km from Sapporo. Discussion: Results show that the cost reduction effect for patients increased as the travel distance increased. Although the teleradiology service is beneficial for a wide range of patients, the financial burden on requesting hospitals is significant. Conclusions: The following conditions were found necessary to reduce the requesting hospital's financial burden: the hospital should be far from the imaging diagnosis center, an inexpensive system is to be selected, and the system needs to be utilized continuously.

The use of telemedicine for delivering healthcare in Japan: Systematic review of literature published in Japanese and English languages

Background In common with other countries, Japan has an ageing population and geographical impediments to healthcare access. The role of telemedicine within the Japanese health system may be of wide interest, yet it has not been comprehensively explored and documented. Thus, the aim of this study was to systematically review the Japanese and English language literature relating to the clinical use of telemedicine in Japan. Methods For studies published in Japanese, we searched Ichushi and CiNii. For English language publications, we searched Cochrane Library, PubMed, Embase, and Web of Science. All peer-reviewed articles describing the clinical use of telemedicine and published between 2007 and 2016 were included. Data on clinical area, study type, technology used, and type of communication were extracted. Studies were categorised by prevention, screening, diagnosis, surveillance, and treatment. Results The search yielded 1476 records; 26 Japanese language and 15 English language articles were selected for review. A wide range of clinical areas were represented; however, home care and life-style related studies were dominant. More than 50% of studies were related to prevention and early diagnosis. The majority of Japanese studies involved doctor-to-doctor consultation. Smartphones and remote monitoring systems were the main types of technology used. Conclusions Most studies of telemedicine in Japan are published in the Japanese language and are thus relatively inaccessible to the rest of the world; for the first time, this study has provided an overview of the clinical use of telemedicine in Japan. The clinically related papers reflect the Japanese cultural focus on disease prevention.