Last week the medical journal Lancet published the results of a study that found the number of diabetes patients rising rapidly throughout the world. Right now about 10 percent of the world's population suffers from the disease, which is traditionally associated with countries that have higher standards of living, like the United States. However, Lancet reported that diabetes is reaching epidemic proportions in the developing world as well owing to obesity and inactivity. Since diabetes leads to all sorts of serious health problems, including kidney failure, heart attacks and blindness, the epidemic will add an insupportable burden to medical costs in the next century.

Diabetes is on the increase in Japan, too, and is one of the reasons the national health insurance program is in trouble. A recent report on NHK's "Closeup Gendai" showed how local governments are trying to reduce doctor visits among local residents. In Kure, Hiroshima Prefecture, officials have compiled a database of people who may be contributing to "wasteful medical costs." To qualify for the database, a person has to have visited a clinic or hospital at least 15 times during the course of a single month. An official then talks to this person to learn the reason for the frequent visits.

NHK points out that these inquiries are delicate. The doctor-patient relationship is a private one, and the local government is careful not to come across as interfering with that relationship. Nevertheless, many older people, because they pay very little out-of-pocket for a doctor's visit, go to the hospital often even if their medical complaints are very slight. Some have even confessed to going to the hospital for social reasons, to chat with friends or make new ones. In any case, the local government official often suggests other ways of dealing with health problems in order to cut costs, such as asking for generic drugs when filling prescriptions or recommending lifestyle changes that can prevent future illnesses.