This paper examines how automated multiphasic health testing and services (AMHTS), which were originally developed in the United States but never widely adopted there, gained traction in Japan despite being excluded from the country’s public health insurance system. Drawing on Fitzgerald et al.’s theory of interlocking interactions, we show how Japanese physicians and other stakeholders reframed AMHTS as a streamlined and affordable alternative to Ningen Dokku, Japan’s high-cost, elite medical checkup service. This creative reinterpretation helped spur efforts by actors such as the National Federation of Health Insurance Societies (Kenporen) to provide health screening subsidies outside the formal insurance framework, which supported the widespread adoption of the AMHTS by middle-class consumers. We introduce the concept of the “democratization of premium health services” to explain how care originally designed for elite users was redefined as both accessible and trustworthy. By highlighting how symbolic framing can promote innovation diffusion even beyond formal institutional boundaries, this study contributes to the business history of health care.
