Return on Investment of National Standardized Health Training in Japan: A Cohort Study Using “Wellness-Star☆” Health Insurance Claims Database

OBJECTIVES: Since 2008, Standardized Health Training (SHT) has been offered to members of Japan's national health insurance system along with Standardized Health Check-ups (SHC). SHT helps people at risk for metabolic syndrome prevent lifestyle-related diseases through behavioral changes. The content of SHT is either motivational support (MS) or proactive support (PS), depending on the risk level. MS is designed to help people reflect on their lifestyle and set goals. In addition to MS, PS is provided by public health nurses continuously. SHT is paid by health insurers. In this study, we estimated ROI of SHT using the “Wellness-Star☆” database, which includes information on SHT, SHC, and medical costs, provided by Nippon Life Insurance Co.

METHODS: Among people with a one-year baseline period before the index date, the date of SHC, and a four-years observation period, the intervention group was defined as those having SHT associated with the index date, and the comparison group was as those not having SHT and matched to a person in the intervention group in index date, observation period, age, sex, metabolic risk, and baseline medical expenses. Returns were defined as the difference in medical cost between intervention and control groups over the four-year period. The return divided by the investment, the SHT costs, was ROI.

RESULTS: “Wellness-Star☆” database includes 3.6 million insureds. The number of insureds in the intervention and comparison groups were 4,066 and 17,323, respectively. Healthcare cost per member Per month over the four-year period for the intervention and comparison groups were 10,348 and 11,802 JPY for PS, and 9,180 and 11,035 JPY for MS. The intervention costs of PS and MS were 39,941 and 13,891 JPY. The ROI of PS and MS were 1.75 and 6.41, respectively.

CONCLUSIONS: ROI of SHT was estimated more than 1.