Japan's medical revolutionary: John Wocher shows the nation's hospitals just how good health care can get at Kameda Medical Center

Japan, Inc., Sept, 2002 by Bruce Rutledge, Jasmine Pui, Craig Mod

HERE'S HOW TO GET smack into the middle of Japan's health-care debate: Ride an express train from Tokyo Station two hours to the southern end of Chiba's Boso Peninsula, get off at the sleepy little station of Awa-Kamogawa, hop in one of the taxis waiting for tourists, ride down a long winding road, past the 'viking' buffet at the Sea World Hotel, past the Sea World park itself and finally to a heliport next to a rocky beach; turn left at the heliport and you've arrived at Kameda Medical Center.

One of the most provocative arguments for more competition in Japan's health-care system sits a stone's throw away from the craggy coast of Chiba prefecture. Kameda has been a family-run hospital for more than 350 years, but lately the complex of 11 buildings has started to turn heads around the world for its cutting-edge approach to hospital care. Its electronic medical records system has turned Kameda into a paperless hospital (see Cradle to Grave--Your Life on a Chip, page 21), its telemedicine services are the digital age's version of a house call (elderly people can be diagnosed from home by specialists even if those doctors aren't at Kameda) and its sun-splashed lobby, staff trained by Japan Airlines and frequently changing art displays are everything that socialized medicine is not.

Movie stars, political figures and other 'VIPs' can check into the hospital via a private entrance off the parking lot, then be whisked up to the sixth floor where private rooms with no names on the door, splendid ocean views and minibars full of fresh juice await. There are steam baths, a Jacuzzi, a fully equipped gym and private restaurants. "It feels like we're in Waikiki," says one young man strolling through the gym.

But Kameda is no elitist hideaway. The hospital treats about 2,500 outpatients a day. On one sultry summer morning, the lobby was packed with patients, family members and friends. By 1:10 pm the cashier's computer terminal showed that 2,137 patients had shown up that day and 1,268 had already been treated and released. Kameda may be tucked into a remote corner of the Kanto region, but it is a leader in promoting the idea that you should consider crossing prefectural lines to get the best medical care.

"I wish we were in Tokyo," says John Wocher, executive vice president of administration at Kameda. Why? Because then more people would know what is possible and begin to demand more out of their hospitals, he says. "Where would you go if cost wasn't a factor? Patients for some reason tend to think that bigger is better or they pick the hospital closest to their home."

World-class care

Wocher is the man behind much of the change at Kameda. He is also the author of the book Nippon no Byoin: Naze Nihon no Byoin wa Dame Nanoka (Japan's Hospitals: Why They Are Bad), published by Nikkei BP in October 2000. Wocher is introducing Japan to a different approach to health care, something more akin to the Mayo Clinic in the US or the Cleveland Clinic, near his hometown of Avon Lake, Ohio. At the Cleveland Clinic, for example, rich patients regularly fly in from the Middle East for treatment. Clevelanders talk of glimpsing harems at the local shopping mall or the hotel connected to the clinic. But in Japan, crossing prefectural lines to get medical care is rare, and while some cross national lines for transplant surgery and other operations that are taboo in Japan, there is little pull to make Japan a place with hospitals that draw patients from overseas.

Wocher is looking to open that market and make Kameda a hospital that draws people from all over the world. Today Kameda is considered one of Japan's best hospitals; it was ranked No. 4 in the nation by Nikkei Business in an August 2001 poll and No. 3 in terms of information disclosure. Wocher boasts that "my friends who are CEOs in the States come out here for their physicals" although he refused to divulge any names.

Wocher is a military man with a long career in Japan. He first came to Japan in the year Tokyo hosted the Olympics. "It was 1964 and I was a wide-eyed 20 year old. I climbed Mount Fuji," Wocher recalls. (For another take on climbing Fujisan and traditional Japanese hospitals, see The Other Side of the Coin below). He retired from the navy as a lieutenant commander in the medical service corps, but he is not a medical doctor--he's a trained health care administrator, a title that is all but unknown in Japan, where medical doctors run the hospitals.

Wocher met the Kameda family through his work at the US naval base in Yokosuka in the early 1980s. The family was looking to tie up with a hospital with a heliport to refer patients and they visited Yokosuka several times. The Kamedas and Wocher struck up a relationship and in 1991 they decided to join forces. "They were looking to take on the necessary evils--quality improvement, risk management--and they didn't want to do it in 100 years, they wanted to do it in three or four," Wocher says of the family. Today Dr. Toshitada Kameda is the center's chairman of the board.