PREVENTIVE MEDICAL SERVICES NOT COVERED BY PUBLIC HEALTH INSURANCE AT DAIKO MEDICAL CENTER IN JAPAN, 2004–2011

Preventive medical services not covered by public health insurance started in the Daiko Medical Center of Nagoya University in June, 2004. Those services included: 1) Helicobacter pylori (H. pylori) diagnosis and eradication treatments, for which CYP2C19 genotyping was introduced in November 2005; 2) smoking cessation support with genotype tests of CYP1A1 Ile462Val, GSTM1 present/null, GSTT1 present/null, and NQO1 Pro187Ser; 3) advice on alcohol consumption with genotype tests of ADH Arg47His and ALDH2 Glu487Lys; 4) advice on folate-associated diseases with a genotype test of MTHFR C677T; 5) advice on a tumor marker CA19-9 with genotype tests of Lewis and Secretor genes; and 6) raloxifene prescription aimed to prevent breast cancer for high-risk postmenopausal women. A total of 683 patients visited the Center until it closed in March 2011. Those given diagnoses and eradication treatments for H. pylori numbered 567, followed by 44 for smoking cessation support, 35 for advice on folate-associated diseases, 26 for advice on alcohol consumption, 8 for CA19-9, and 3 for raloxifene prescription. Around 2004, public interest in H. pylori was relatively high, but thereafter patient numbers dropped markedly. The Center closed in March 2011 due to the reduction in patient visits. Our unique trial showed that continuing to provide uninsured preventive services at a clinic was difficult in Japan without the affiliation of hospitals/clinics providing medical services covered by public health insurance.