5.5. Country case study: Japan
Shigeo Yamamura, PhD, email@example.com, and Rieko Takehira, PhD, Faculty of Pharmaceutical Sciences, Josai International University; Sentaro Oide, BSc and Nobuo Yamamoto, BSc, Japan Pharmaceutical Association; Naoko Arakawa, FIP Collaborating Centre, London.
After the massive 9.0 magnitude earthquake and nuclear reactor problem in the Fukushima prefecture in March 2011, the Japanese economy remains in a recovery phase. The fiscal budget (April 2012) was enacted at a total of 90.33 trillion yen (USD 1.11 trillion). Of this, expenditure for social security, including medical expenses accounts, was 26.39 trillion yen (USD 320 million).
Japan is well on the way to becoming a super-aged society. The health care system needs to be reformed in order to address the challenges of a low birth rate and an aging population.
There are presently two pharmacy education programmes: 1) a six-year programme that aims to educate pharmacists and 2) a four-year programme that aims to educate pharmaceutical scientists. In April 2012, 8,182 pharmacists graduated from the 6-year programme to enter the workforce.
In a revision of the sales system for over-the-counter (OTC) drugs, an examination system regarding registered assistants to sell OTC medicines was implemented.
The development of the community health care programme is scheduled for 2013. In this proposed government policy, pharmacies and pharmacists are expected to play an important role in enhancing the home health care programme.
Pharmacists will be a key professional to seek balance between cost and effectiveness through rational use of medicines.
After the massive 9.0 magnitude earthquake and nuclear reactor problem in the Fukushima prefecture in March 2011, the Japanese economy remains in a recovery phase. The fiscal budget (April 2012) was enacted at a total of 90.33 trillion yen ($1.11 trillion). Of this, expenditure for social security, including medical expenses accounts, was 26.39 trillion yen ($320 million) [1, 2]. In Japan, the numbers of pharmacists and pharmacies as of December 2008 are 267,751 and 53,304, respectively, as summarized in Table 5.5.1. The number of pharmacists is 209.7 for every 100,000 people. As compared with 2006, the number of pharmacists and pharmacies increased 15,218 and 1,352, respectively.
Table 5.5.1. Number of pharmacists and pharmacies
Source: Data from Ministry of Health, Labour and Welfare [3, 4]
The total number of registered pharmacists has increased by 15,218 from 2006 to 2008 (a rise of 6%). The number of pharmacists working in community pharmacy has increased, while those working in hospitals have remained constant. Pharmacists have many responsibilities in health care, research and education. In the health care system, community pharmacists contribute by dispensing, providing OTC drugs, and other activities. Hospital pharmacists work with medical team members to provide in-patient care. According to the School Health and Safety Act , all schools (excluding universities) need a designated pharmacist (school pharmacist) to monitor appropriate environmental conditions (classroom illumination, air ventilation, examination of tap water etc.). Other pharmacists work in the pharmaceutical industry to develop new drugs and formulation and provide drug information to health care professionals. Other important roles of pharmacists are to educate pharmacists and lead continuous professional development programmes in pharmacy schools and other related organizations.
Community pharmacies can be classified into two groups. Some pharmacies focus on dispensing and patient counselling. Others deal with drug supply and also cosmetic goods, usually involving a chain drug store group. Pharmacy education has changed from a four-year to a six-year programme in 2006. Therefore, in the intervening two years, fewer pharmacists en- tered the workforce. Many pharmacies, especially chain drug stores, are now offering job opportunities to enhance or expand their business.
In hospital settings, tenured pharmacists can get preferential remuneration for pharmaceutical services. Furthermore, there is no pharmacy technician cadre in Japan. This situation provides pharmacy students and pharmacists with opportunities for this career direction. However, it has been pointed out that this may lead to unequal workforce distribution.
NUMBER % NUMBER %
Total Pharmacists 252,533 100.0 267,751 100.0
Community Pharmacist 125,254 49.6 135,716 50.7
Hospital Pharmacist 48,964 19.4 50,336 18.8
Academia/Graduate student 8,845 3.5 9,276 3.5
Pharmaceutical Industry 45,415 18.0 37,643 14.1
Government 5,951 2.4 6,280 2.3
Others 18,086 7.2 18,476 6.9
Total Community Pharmacies 51,952 -- 53,304 --
5.5.2. Key workforce issues
Training programme for pharmacy students and pharmacists
In 2006, the Ministry of Education, Culture, Sports, Science & Technology in Japan introduced a new six-year programme to educate pharmacists. There are presently two pharmacy education programmes: 1) a six-year programme that aims to educate pharmacists and 2) a four-year programme that aims to educate pharmaceutical scientists. In April 2012, 8,182 pharmacist graduates from the six-year programme entered the workforce (Table 5.5.2). In doing so, they passed the Pharmaceutical Common Achievement Test consisting of Computer-Based Testing (CBT) and Objective Structured Clinical Examination (OSCE) in their fourth year. The fifth year comprises pharmacy practice training over 22 weeks: 11 weeks in hospital and 11 weeks in community settings. This specialized clinical training represents the largest difference compared with the previous programmes. However, evaluating improved clinical skills remains a challenge.
Table 5.5.2. Results of national examination of pharmacists carried out March 2012 
An increase in the number of pharmacy schools (from 46 in 2002 to 74 in 2012) could have the effect of decreasing the quality of school entrants. Also, the extended educational period of the pharmacy programme could adversely affect the number of pharmacy students due to total higher tuition fees. From this, a concern remains about whether all pharmacists graduate from the six-year programmes have appropriate clinical competencies to become effective pharmacists in the future.
Reform of the pharmaceutical supply system
Before 2006, medicines were classified into two groups: prescription and non-prescription medicines. In 2006, to provide easier access to self-medication, OTC medicines were further classified into three categories according to potential risk of medicines (first, second, and third-class OTC), and an OTC supply system with a registered salesperson was implemented (Table 5.5.3) . An examination system to qualify the registered salespersons is carried out by the governor of each prefecture. The number of registered salespersons is 95,696 as of March 2011 .
Table 5.5.3. Classification of OTC drugs 
Information for rational use of medicines should be provided by specialists in accordance with the degree of potential risk. First-class OTC medicines should be supplied only by a pharmacist who provides additional written information. However, a survey on supply compliance for first-class OTC drugs in 2010 indicated that the rate of compliance in pharmacies was only 31.5% .
Home health care programme for elderly people in the community
Japan is well on the way to becoming a super-aged society resulting from a low birth rate and an aging population. The number of elderly people over 65 years old is expected to reach a maximum in 2025. Enhancement of the home health care programme is a key issue. The development of community health care programmes is scheduled in 2013, and the published policies from the government have stated that each prefecture is responsible for the planning of community health care programmes to meet local needs. In the programme, pharmacies and pharmacists are expected to play an important role as part of a multidisciplinary health care team involving doctors, nurses and other health care professionals. The role of pharmacists is to contribute to the rational use of medicines and medicines management, and pharmacists will need to expand and improve their capabilities in order to become actively involved in these community health care programmes.
Successful candidates 8,641
Pass rate (%) 88.31
Graduates of 6 year programme
Successful candidates 8,182
Pass rate (%) 95.33
Successful candidates 459
Pass rate (%) 38.19
Risk category of OTC drugs
First-class Pharmacists Necessary information for proper us should be provid in writing
Pharmacists or registered sales persons
Effort should be made to provide necessary information for proper use
Specialists in charge
Response when consulted by purchasers
Active information supply even without question from purchasers