What is it about?
This study examined whether a 2024 change in Japan’s medical reimbursement system was associated with early changes in care for people with dyslipidemia (abnormal cholesterol or triglyceride levels). The new “lifestyle disease management fee” was intended to encourage doctors and patients to make and review treatment plans together, with more attention to diet, exercise, body weight, sleep, smoking, and other lifestyle factors. Researchers analyzed health-insurance claims and laboratory data from about 590,000 adults treated at Japanese acute-care hospitals between 2021 and 2024. They compared care before the policy change with care during the first seven months after it. Cholesterol treatment was common in both periods: statins were prescribed at more than 80% of outpatient visits, and some patients also received ezetimibe, fibrates, or PCSK9 inhibitors. However, only about 58% of visits met the recommended LDL (“bad”) cholesterol target in both periods. Goal attainment was lower among people with previous cardiovascular disease and declined with older age. Rates of heart attack, ischemic stroke, cardiovascular death, heart-failure hospitalization, and all-cause death appeared similar before and shortly after the policy change. However, the post-change period was very short, on average about six months, and included far fewer patient-years of follow-up. Therefore, the study cannot determine whether the new reimbursement system improves long-term cardiovascular outcomes. Overall, the findings show that many patients remain above recommended LDL-cholesterol targets despite frequent use of lipid-lowering medicines. The new fee system may need more time to take hold, and its effect may depend on whether structured lifestyle support and shared treatment planning are delivered in routine practice. Older adults and patients with established cardiovascular disease may particularly benefit from additional, practical, patient-centered lifestyle support alongside appropriate medication.
Featured Image
Photo by Fumiaki Hayashi on Unsplash
Why is it important?
This study provides the first large-scale, real-world description of dyslipidemia care surrounding Japan’s June 2024 transition from a disease-specific management fee to a lifestyle disease management fee. Using laboratory and claims data from approximately 590,000 adults and 23.6 million outpatient visits, we show that LDL-cholesterol target attainment remained limited at about 58% of visits despite high use of statins and combination lipid-lowering therapy. Control was particularly poor in older adults and in patients receiving secondary prevention after established cardiovascular disease. The study is timely because Japan’s reimbursement reform was designed to promote structured, patient-centered treatment plans that address lifestyle, social circumstances, and shared goal setting, not medication alone. Our early post-implementation findings show no detectable short-term change in lipid control, but the available post-revision follow-up was only about six months and was insufficient to judge cardiovascular benefit. Importantly, the numerical similarity in cardiovascular event rates should not be interpreted as proof that the new fee has no effect. These findings identify an important implementation and evidence gap: a reimbursement-policy change by itself may not translate rapidly into improved lipid control unless it is accompanied by practical, scalable support for lifestyle counseling, medication adherence, and shared decision-making. The work highlights older adults and people with prior cardiovascular disease as priority populations for intensified, individualized interventions. It also establishes a nationwide baseline for longer-term evaluations and pragmatic studies of lifestyle-oriented dyslipidemia care.
Perspectives
As a clinician working in an aging society, I have repeatedly seen that prescribing an appropriate lipid-lowering drug is only one part of cardiovascular prevention. Many patients, especially older adults with multiple conditions and those who have already experienced cardiovascular disease, continue to have difficulty reaching LDL-cholesterol targets despite intensive medication. Their care is shaped not only by laboratory values and prescriptions, but also by daily routines, diet, physical activity, sleep, work and family circumstances, health literacy, treatment burden, and the opportunity to discuss realistic goals with their care team. Japan’s 2024 reimbursement reform interested me because it represents an attempt to make these wider aspects of care more visible within routine clinical practice. It asks physicians and patients to develop treatment plans together and gives greater formal attention to lifestyle and social factors. This is an important direction, but our findings remind us that changing a fee category does not automatically change care at the bedside. Building meaningful shared decision-making and sustainable lifestyle support takes time, trained teams, workable clinical processes, and approaches that patients can actually maintain. I hope this publication encourages clinicians, policymakers, researchers, and patients to look beyond the question of whether a cholesterol medicine was prescribed. The more important question is whether our health system helps each person turn evidence-based targets into achievable daily actions. I also hope the study stimulates longer-term research that connects reimbursement policy with what happens in the consultation room, and, ultimately, with fewer cardiovascular events and better quality of life.
SATOSHI YAMASAKI
St. Mary`s Hospital, Kurume, Japan
Read the Original
This page is a summary of: Real world patterns of dyslipidemia care before and after a national fee revision in Japan: A nationwide study using a 30 million patient claims database, PLOS One, September 2026, PLOS,
DOI: 10.1371/journal.pone.0358270.
You can read the full text:
Contributors
The following have contributed to this page
