The Relationship Between Innovation and Corporate Performance in Japanese SMEs by Two-Stage Panel Data Analysis: Focusing on the Joint Effect of ICT and R&D.

The final aim of innovation is not innovation itself but enhancing profits or sales. To complete the theory of innovation, it is required to show whether innovation contributed to improvements in business performance. A further focus of this paper is on the role of ICT and R&D in the innovation process. ICT plays a vital role in absorbing information from outside the firm, while R&D is essential for assimilating obtained information with existing resources to create something novel. The focus of this paper is on the joint effect of these two factors. The estimation is based on a two-stage probit instrumental variable (IV) panel model and the authors' own survey data of 2012 and 2018. The dependent variables are innovation in the first equation and sales in the second. The results obtained show that (i) innovation enhances sales; (ii) R&D is significant for innovation; (iii) ICT is not significant for either of the equations; and (iv) the cross term of R&D and ICT is significant for innovation, implying that ICT is an enabler of innovation. These are novel results.

A novel semantic representation for eligibility criteria in clinical trials.

Eligibility Criteria (EC) comprise an important part of a clinical study, being determinant of its cost, duration and overall success. Their formal, computer-processable description can significantly improve clinical trial design and conduction by enabling their intelligent processing, replicability and linkability with other data. For EC representation purposes, related standards were investigated, along with published literature. Moreover, a considerable number of clinicaltrials.gov studies was analyzed in collaboration with clinical experts for the determination and classification of parameters of clinical research importance. The outcome of this process was the EC Representation; a CDISC-compliant schema for organizing criteria along with a patient-centric model for their formal expression, properly linked with international classifications and codifications. Its evaluation against 200 randomly selected EC indicated that it can adequately serve its purpose, while it can be also combined with existing tools and components developed for both EC specification and especially application to Electronic Health Records.

Can eHealth Reduce Medical Expenditures of Chronic Diseases?

The objective of this research is to evaluate empirically the effectiveness of eHealth in Nishi-aizu Town, Fukushima Prefecture, based on a mail survey to the residents and their receipt data of National Health Insurance from November 2006 to February 2007. The residents were divided into two groups, users and non-users, and sent questionnaires to ask their characteristics or usage of the system. Their medical expenditures paid by National Health Insurance for five years from 2002 to 2006 are examined. The effects were analyzed by comparison of medical expenditures between users and non-users. The interests are focused on four chronic diseases namely heart diseases, high blood pressure, diabetes, and strokes. A regression analysis is employed to estimate the effect of eHealth to users who have these diseases and then calculate the monetary effect of eHealth on reduction of medical expenditures. The results are expected to be valid for establishment of evidence-based policy such as reimbursement from medical insurance to eHealth.

Prospective multicenter case-control study of telemedicine for home medical care.

We evaluated the safety and efficacy of the combined use of remote medical services for patients with stroke, cancer, neuromuscular diseases, and other conditions, who are being cared for at home. This study was conducted as a part of a multicenter joint trial supported by the Health and Labour Sciences Research Grant for the 'Comparative Study of the home telemedicine in Japan'.

Empirical analysis of the long-term effects of telecare use in Nishi-aizu Town, Fukushima Prefecture, Japan.

This paper examined the long-term effects of the use of telecare (e-Health) on the residents of Nishi-aizu Town, Fukushima, Japan, between 2002 and 2010. We compared medical expenditure and days of treatment between telecare users (treatment group) and non-users (control group) based on receipt data obtained from the National Health Insurance, which is operated by the government. In previous studies, we used receipt data obtained for the years 2002 to 2006; this study expands the analysis period four more years with respect to respondents who were included in previous analyses. Ninety users and 118 non-users were included in both analyses. Using rigorous statistical methods, including system generalized method of moments (GMM), this paper demonstrates that telecare users require fewer days of treatment and lower medical expenditure than non-users with respect to the chronic diseases of stroke, hypertension, heart failure, and diabetes. To date, there have been no publications examining the long-term economic effects of the use of telemedicine, so the current study presents a new facet to the research in this field.

Relation between telecare implementation and number of treatment days in a Japanese town.

We analysed data on the medical expenditure of 199 telecare users in Nishi-aizu Town, Fukushima Prefecture, which has one of the oldest ongoing telecare implementations in Japan. As controls, 450 out of 3528 non-users residents covered by National Health Insurance were randomly selected in the same age and sex ratios as the telecare users. An analysis by the Generalized Method of Moments (GMM) was conducted in order to examine causality, i.e. that telecare use reduces the number of treatment days. To reduce sample selection bias, the presence of chronic diseases, age and education were added as control variables in the estimation. The results show that the treatment days of those who had chronic diseases were greater than those who did not have chronic diseases by 8.7 days per year (P < 0.10), and they were increased by 5.6 days (P < 0.01) according to their age. Finally, telecare use decreased treatment days by 3.1 days (P < 0.05).

Measuring the effect of telecare on medical expenditures without bias using the propensity score matching method.

OBJECTIVE: This article examines the effect of telecare on medical expenditures for chronic diseases using survey data from Nishi-aizu Town, Fukushima Prefecture, Japan. The study uses the propensity score matching (PSM) method, a rigorous analytical method that overcomes sample selection bias, a common problem when using survey data. SUBJECTS AND METHODS: One hundred ninety-nine users (treatment) of telecare and 209 nonusers (control) were selected from residents, and their medical expenditures were obtained from the National Health Insurance scheme for comparison. Individual characteristics of the two groups, including age, sex, income, and health conditions, were compared, and variables that contained biases were specified by a t test. After calculation of their propensity scores and elimination of biases, the effect of telecare on medical expenditures was estimated. To obtain robust results, four different matching methods were applied: caliper matching, single nearest-neighbor matching, Epanechnikov kernel matching, and biweight kernel matching. RESULTS: No independent variable showed significant differences between the two groups after matching, indicating that selection biases were successfully eliminated using PSM. Using PSM, we saw a decrease in medical expenditures in Japanese yen of 25,538-39,936 (USD 319.23-499.20) per year per user and a decrease in the number of treatment days of 2.6-4.0 days. In comparison, our previous analyses using the same data underestimated the effects of telecare. PSM provides greater effects by reducing bias. CONCLUSIONS: Using PSM to compare subjects in two groups with similar characteristics except for their use or nonuse of telecare, we demonstrated that the treatment group has lower medical expenditures for chronic diseases than the control group. Proper matching is important in evaluating the impact of telecare interventions. Limitations of PSM include its requirement for a large number of samples and the limited ability to explain why and how telemedicine produces these effects. Other empirical methods are required to identify the mechanism of how telemedicine works.

Does telecare reduce the number of treatment days?

This paper analyzes the effect of telecare in reducing the number of days required for the treatment of telecare users. Statistical analysis was conducted on panel data about 400 individuals from 2002 to 2006 in Nishi-aizu Town, Fukushima Prefecture, Japan. Three estimation models were used, namely the Instrument Variable, Instrument Variable Panel, and system GMM (Generalized Method of Moments) methods, both to demonstrate causality and to ensure the robustness of the results. We attempted to reduce sample selection bias in this framework by controlling variables with bias. A negative correlation between outpatient days and telecare use was observed with the former two methods, while the system GMM proved causality for the effect of telecare in reducing the number of outpatient days. Telecare use reduced outpatient days in telecare users by 2.0 days per year. This result is consistent with those of other telecare implementations in the US and the UK.

Efficient health information management systems using wireless communications technology to aid disaster victims.

Japan is an earthquake-prone country, and disasters have a devastating effect on the lives of residents in stricken areas. Shelters can be constructed in order to secure the physical safety of residents, but there are no such provisions for the shock of experiencing a disaster, losing property and friends, and transitioning to an unfamiliar life in a shelter, all of which can lead to mental disorders. Caretakers such as medical doctors and nurses who are dispatched to disaster sites also face difficulties in the disruption of communications and transportation, thus a system able to secure efficient health management in those facilities is also required. This paper proposes a health information management system that utilizes mobile phone cameras and mark-sensing cards to improve recovery conditions in disaster-stricken areas.

Effect of e-health on medical expenditures of outpatients with lifestyle-related diseases.

We analyzed the effect of e-health on medical expenditures in Nishi-aizu Town, Fukushima Prefecture, Japan, using panel data of medical expenditures for about 400 residents from 2002 to 2006. The Nishi-aizu Town system was introduced in 1994 and is still successfully operating as one of the longest running implementations of e-health in Japan. The town office maintains a register of receipts for medical expenditures paid by the National Health Insurance system and provides data on e-health users, allowing users and nonusers of e-health and their respective costs to be distinguished. Here, we focus on patients with lifestyle-related diseases such as high blood pressure, diabetes, stroke, heart failure, etc. This article postulates that e-health reduces medical expenditures via two mechanisms, decreasing travel expenses and preventing symptoms from worsening. The former implies that e-health monitoring allows patients at home to visit medical institutions less frequently, and the latter that the symptoms experienced by e-health users are less severe than those experienced by nonusers. We termed these the travel cost effect and opportunity cost effect, respectively. Chronic conditions tend not to occur singly, and many patients have more than one; for example, patients with high blood pressure or diabetes also likely have heart disease at the same time. This multiplicity of conditions hampers cost analysis. Among methodological issues, a number of recent empirical health analyses have focused on the endogenous problem of explanatory variables. Here, we solved this problem using the generalized method moments (GMM) system, which allows treatment of not only the endogenous problem of explanatory variables but also the dynamic relationship among variables, which arise due to the chronic time-lagged effect of lifestyle-related diseases on patients. We also examined a second important methodological problem related to reverse correlation between the medical expenditures of an outpatient and e-health and took sampling biases into consideration. We concluded that this control of endogeneity through system GMM confirms that the relationship between the medical expenditures of an outpatient and e-health shows causation rather than simple correlation and that e-health use, duration of e-health use, and frequency of e-health use can reduce outpatient medical expenditures for lifestyle-related diseases.

Automatic identification of apnea through acoustic analysis for at-home screening.

OBJECTIVE: Although many studies have analyzed breathing sounds in the diagnosis of obstructive sleep apnea syndrome, the recording of snoring sounds at home is hampered by the various background noises of daily life. Recordings also frequently include talking during sleep, which may infringe the privacy of patients. MATERIALS AND METHODS: A recording system used a bone conduction microphone to record snoring sounds. This microphone reduced background noise. A simple system transmitted recorded breathing sound data for screening at a hospital as envelope data instead of complete sound recordings, thereby decreasing data volume and protecting privacy. RESULTS: In periods in which blood oxygen levels (SpO2) were drastically decreased, the probability of apnea as deduced from the envelope curve of breathing sounds was consistent with SpO2 values. CONCLUSIONS: This method provides a basis for telemonitoring of sleep apnea syndrome.

Empirical analysis of the reduction of medical expenditures by e-health.

This paper aims to examine reduction of medical expenditures by utilizing the system of Nishi-aizu Town, Fukushima Prefecture. The town office has been implementing it since 1994 and keeps receipts on medical expenditures of its approximately 4,000 residents paid by National Health Insurance for 5 years from 2002 to 2006. We select (1) users; and (2) non-users of the e-health system, and by comparing their medical expenditures, we examine: (i) difference in medical expenditures between two groups; and (ii) negative correlation between medical expenditures and the length of usage of the e-health system. We find that total medical expenditures of users are larger than those of non-users, whereas by restricting to lifestyle-related illnesses such as high blood pressure, cerebral infarction, strokes, and diabetes, medical expenditures of users are found to be smaller than those of non-users. The results we obtained here provide the rigorous economic foundation of the e-health system.

An empirical approach to estimating the effect of e-health on medical expenditure.

We studied the e-health system used in Nishi-aizu Town in Fukushima Prefecture in Japan. The system allows elderly people at home to transmit vital signs data to the Town's health centre, where nurses provide advice based on the data. Our hypothesis was that the e-health system in Nishi-aizu Town reduced the need to visit clinics. We attempted to prove this by a regression analysis, in which days for treatment were compared between users and non-users of e-health. The results showed that days for treatment of e-health users were shorter than those of non-users by 1.6 days per year. Thus the total reduction in expenditure as a result of fewer hospital visits (emergency and elective) was about 16,000 yen per year. In a previous study, we proved that in Nishi-aizu Town the medical expenditure of e-health users was smaller than those of non-users by 15,688 yen. The results of the present study therefore coincide with those of the previous one and show that the reduction of medical expenditure is principally caused by the reduction of days for treatment.

An empirical analysis of the reduction in medical expenditure by e-health users.

We examined the medical expenditure of elderly residents who used an e-health system in Nishiaizu town. Since 1994, health-related data, such as blood pressure, ECG and blood oxygen, have been transmitted to a remote medical institution via a telecommunications network. We selected 412 users from the list of registered e-health users in the town. We also selected 450 residents who were not e-health users. We sent them questionnaires and obtained 199 valid responses from e-health users and 209 from non-users. Then we examined the receipts of these 408 people, which were kept in paper form in the town office. Based on a multiple regression analysis, we found that users of the e-health system had lower medical expenditure for lifestyle-related illness than non-users. The medical expenditure of e-health users was lower than that of non-users by 15,302 yen (US $133) per year. This amount was approximately 21% of the average annual medical expenditure of the residents. The results also showed that: long-time users of e-health had lower medical expenditure on lifestyle-related illness; long-time users of e-health had lower medical expenditure than those who used it for a shorter time; e-health had more effect on people with diseases than those without.

An economic evaluation of Japanese telemedicine, focusing on teleradiology and telepathology.

We collected information by postal survey from 622 medical institutions reported to be using telemedicine in Japan. The questionnaire asked about willingness to pay (WTP) for telemedicine and willingness to undertake (WTU) it. The Kernel Estimation Method was used to obtain WTP for teleradiology (4379 yen), telepathology (9526 yen), teleconferencing (2084 yen) and teleconsultation (633 yen). The estimated WTU were teleradiology (3875 yen), telepathology (17,918 yen), teleconferencing (3230 yen) and teleconsultation (3643 yen). These values are larger than the current charges that customers actually pay or providers receive. Multiplying these values by the number of medical institutions that had implemented telemedicine allows the total annual benefits of telemedicine to be estimated, e.g. for teleradiology, the annual benefit in terms of WTP and WTU (millions of yen per year) were 140.20 and 1101.75, respectively. Based on the results of the survey, specific policy measures to promote telemedicine further include improvement of quality and reimbursement.

On the evaluation of economic benefits of Japanese telemedicine and factors for its promotion.

This paper attempts to estimate economic values of telemedicine and to extract factors that promote telemedicine through the use of survey data. This is the first analysis aimed at evaluating telemedicine in Japan. We utilized the Contingent Valuation Method and estimated demand functions of telemedicine. Because the number of institutions replying with willingness to pay (WTP) and willingness to undertake (WTU) is relatively small, the Kernel Estimation Method was applied. After estimating WTP and WTU, by multiplying the number of medical institutions currently implementing telemedicine, the whole value in Japan was obtained. By using the Tobit Model, factors that influence WTP and WTU were extracted. Estimated WTP was 35.23 dollars for teleradiology and 162.89 dollars for telepathology. WTU estimated was 39.81 dollars for teleradiology and 86.59 dollars for telepathology. Estimated economic benefits in Japan for 1 year were 1.27 million dollars for WTP of teleradiology and 278,600 dollars for telepathology. WTU is 10 million dollars for teleradiology and 393,400 dollars for telepathology. Medical institutions with the following characteristics tend to reply larger WTP: (1) university hospitals, (2) internal medicine, (3) radiology, and (4) use of video conference systems. Regarding WTU, the following characteristics influence WTU: (1) use of a personal computer, (2) use of telepathology equipment, (3) high satisfaction with the quality of telemedicine, and (4) experience base of telemedicine. Based on the nationwide survey on telemedicine, the total value of telemedicine in Japan was estimated. In addition to the evaluation, quantitative aspects of implementation of telemedicine, such as factors to promote telemedicine, are analyzed. These can provide useful information for further implementation of telemedicine not only in Japan but in other countries as well.

An empirical analysis of a telehealth system in terms of cost-sharing.

We interviewed 348 users of a home telemonitoring system and asked questions about their willingness to pay (WTP). Assuming that the functional form of demand was logistic, the best estimate of the WTP was yen 4519 per user per month. We also analysed how the benefits of the system (expressed in terms of WTP) were attributed to four factors: stabilizing illness; enhancement of health consciousness; less anxiety in day-to-day life; and a decrease in medical expenditures. All except the last were significant. According to the resulting model, individual users should bear yen 2763 in costs, while society should reimburse yen 349. Surprisingly, the value of yen 2763 obtained here is very close to the amount ( yen 2500) actually charged by Kamaishi City.

[Home-medical-care and IT--for the further diffusion of the tele-health system].

In this study, we examined the economic benefit of the tele-health system based on a field survey performed in Kamaishi City in Iwate Prefecture, Nishiaizu Town and Katsurao Village in Fukushima Prefecture, and Sangawa Town in Kagawa Prefecture. The economic benefit analyzed here was based upon willingness to pay (WTP). The cost items of the system included those of initial introduction and maintenance; the former included costs of equipment and software, whereas the latter the salaries of staff and others. We compared the benefit to cost ratio (B/C ratio) among these cases. We also discussed measures to further expand the tele-health system.