Chronic diseases, also known as non-communicable diseases, are responsible for approximately 70% of all deaths globally, according to the World Health Organization. The four main categories of chronic diseases are cardiovascular disease, cancer, respiratory diseases and diabetes. When these chronic diseases become severe, they are expensive to treat and negatively impact a patient’s quality of life.
Disease management is defined as a system of coordinated healthcare comprised of healthcare professionals, health insurance, data analytics on the disease, and self-care designed to improve long-term health. Its primary goals are to monitor the chronic disease and intervene early to prevent further complications. The disease management industry in the United States is comprised of very large companies such as Eli Lilly, Merck-Medco Managed Care, American Healthways and Aetna Health Management. In Asia, however, the disease management industry is smaller and generally unstructured except in a few countries discussed in this article.
The chronic disease management system in Singapore is very strong. Early in 2006, the Ministry of Health launched the Chronic Disease Management Programme (CDMP). This program created an infrastructure for chronic disease treatments to be paid for by the Medisave insurance program, a national medical savings scheme required for Singaporeans to help pay for subsidized healthcare. In the beginning, the CDMP was only implemented for diabetes mellitus, but as of 2017, there were 19 chronic diseases under the program. These chronic diseases are diabetes mellitus, hypertension, lipid disorders, asthma, chronic obstructive pulmonary disease (COPD), nephritis/nephrosis, schizophrenia, major depression, bipolar disorder, anxiety, stroke, dementia, osteoarthritis, Parkinson’s disease, benign prostatic hyperplasia (BPH), epilepsy, osteoporosis, psoriasis, and rheumatoid arthritis (RA).
As Singapore has a rapidly ageing society, the public’s demand for better healthcare and disease management is expected to rise. Singapore is turning to technology and has already created an electronic database for all hospital records called the National Electronic Health Record. In addition, the government has recently initiated the Smart Health-Assist program, which aims to use wearables and sensors to monitor chronic disease patients remotely and provide medical attention if needed.
Private Singaporean companies such as Healint and myHealth Sentinel are also contributing to this increase of technology in chronic disease management. Healint’s app called Migraine Buddy was listed as the number one migraine tracking app in 2015 and has more than 100,000 global users. Chronic migraine is a condition itself, and migraines can also signal other chronic conditions. Healint is looking to expand its product line to track asthma and other chronic diseases. MyHealth Sentinel focuses on providing network-based solutions that collect and integrate medical data. In 2014, Jurong Health selected myHealth Sentinel to implement a medical device integration solution for two of its hospitals.
In Japan, the chronic disease management system is developing quickly, but it is not as robust as Singapore’s. In 2006, the Japan Chronic Disease Self-Management Association (J-CDSMA) was approved by the Japanese government as a non-profit organization. This organization was formed for the purpose of incorporating the principles of the Chronic Disease Self-Management Program (CDSMP), developed at Stanford University, into the Japanese healthcare system. Although disease management programs faced opposition by the Japan Medical Association because of concerns with quality issues early on, chronic disease management has, to a certain extent, been integrated into the Japanese healthcare system. In 2008, the Japanese government created the Tokugeti-Kenshin system, a program to prevent lifestyle diseases by allowing citizens between the ages of 40 to 74 to receive a free annual health checkup. In the private sector, DPP Health Partners (Hiroshima, Japan) was established in 2010 as the first disease management company in Japan, and a number of other disease management programs have followed.
Organizations such as the J-CDSMA do not provide disease management services, but they create a support network for chronic disease management in Japan. The J-CDSMA offers workshops that assists chronically ill patients on communicating with others, creating individualized “action plans,” and empathizing with each other. Other organizations that comprise this support network include the Disease Management Association of Japan and the Japan Society for Health Support Sciences. With their contribution, the awareness of major chronic diseases is approximately 70% in Japan, but other chronic conditions such as chronic obstructive pulmonary disease (COPD) still have low awareness.
Korea’s chronic disease management system is not very strong. The Korea Centers for Disease Control & Prevention (KCDC) provides community-based programs for hypertension and diabetes to improve patients’ self-management skills, but these are the only two chronic conditions that they cover. The KCDC partners with local governments and private institutions every year for campaigns to spread awareness of hypertension and diabetes. In addition, the KCDC subsidizes approximately $4 per month for patients aged 65 or older for hypertension and/or diabetes. They also provide a reminder service used to remind patients to attend appointments and an education and counseling service, but adherence to treatment programs is not very high.
The KCDC also oversees research and development in chronic disease management for COPD, respiratory allergic diseases, dementia, and obesity. Clinical studies investigating the efficacy of chronic disease management are ongoing, and the studies are reporting the benefits of chronic disease management programs. Findings show that the programs promote adherence to treatment timelines, better medical outcomes and create happier patients. One 2015 study proposes the implementation of “ubiquitous healthcare” (U-healthcare) that utilizes mobile networking and medical devices to ensure access to healthcare anytime and anywhere. Considering Korea’s excellent IT infrastructure, the proposal to utilize technology to facilitate chronic disease management in Korea is very reasonable.
While Singapore, Japan, and to a certain extent, Korea, have implemented disease management systems, other advanced countries in Asia including Hong Kong and Taiwan have not. As the populations in the less wealthy Asian countries age, chronic diseases will become a growing public health concern. However, at this point in time, most Asian countries with resource-constrained health systems cannot implement disease management adequately. Chronic disease management in Asia is still developing, and Asian countries should look to Singapore and the United States as a guide.