Extremely excepted (1)
In Japan, national health insurance is well established. Almost all Japanese can use health insurance without trouble to visit any hospital he wants to a low cost. However, the examination of health insurance for a new drug is rather strict. Therefore, it takes a long term to add a certain drug into health insurance application. Some drug companies tend to abandon adding a new application for an older drug, not expecting more interests.
So, what should the physicians want to use a certain drug for a patient who has no disease applicable to the drug?
It is very frequent that a false name of a disease is registered for the patient.
For example, I have experienced a case that a politician investigated the situation about public health in a village.
An official receipt data in the village showed that schizophrenia was the third most expensive disease of the village.
It is sure that schizophrenia is a difficult disease. But its prevalence rate is only 1%. Why is treating schizophrenia so expensive?
The answer is false name problem.
Risperidone is one of antipsychotic drugs, used to treat schizophrenia. Its application is limited to schizophrenia in the national health insurance. But this drug has good effect for abnormal behavior in delirium, dementia, or bipolar disorders.
So physicians described their patients as schizophrenic and gave them Risperidone. This usage is quite appropriate, as reliable evidence shows its benefits. But in the health insurance context, it was disguising.
In Japan, false name of the disease is so common that official receipt data are no use for the analysis of public health.
It is more fearful that some scholars not familiar with the clinical situation analyze the data with wrong method. If so, the result obtained can be far from the real world. To avoid this mistake, the analyst should ask for help to a clinician in advance.
Every system is getting older. The more time passes, the more exception occurs. At a certain point the exception will overcome the system itself, when we have to scrap and rebuild the system. I think Japan has a lot of similar problems.