Health care collapse. Medical reform. Doctor shortages. Exhaustion in the medical profession. All these words you hear a lot in Japan. It seems like there’s never a shortage of stories describing the critical state of the health care system. Although Health Minister Yoichi Masuzoe is showing political leadership to improve the situation, the problems are quite daunting. For the past 20 years I myself have been quite vocal about health policy issues in Japan and have been taking action in different areas. The health care system is one of the major challenges that Japanese politics needs to address. It is hard to imagine in a megacity like Tokyo that a pregnant woman recently could have died from brain hemorrhage after various hospitals, even a university hospital, turned her away.
My opinions were carried on the “My View” column of the Asahi Shimbun newspaper’s morning edition on October 30 under the title of “Health care reform: Grasp reality and set up fundamental laws.” As the title suggests, I think that, in the end, what is necessary is the introduction of fundamental laws. Considering the current political climate, I hope parties will draft their manifestos on health care reform, along with the pension issue, and make it into a priority policy that will be debated across party lines. In a society where safety is not ensured, you cannot expect action or vitality because people will be worried. The following are the main points I raised in the column, as I struggled to keep the text within the newspaper’s space constraints.
”Health care reform: Grasp reality and set up fundamental laws”
●Amid mounting calls to address the doctor shortages and problems with emergency medical services, Health Minister Masuzoe has started drafting a ministry policy guideline entitled “Vision to secure medical services of sense of security and hope.” Last month he convened an expert panel and released the mid-term plan, but I have doubts about it. It does not offer an analysis of the current situation, nor does it provide a long-term vision. The plan basically relies on a dramatic increase in the number of physicians. I would like to offer my frank advice from a standpoint of having worked in the medical field in both Japan and the United States for over 40 years and served as Special Advisor to the Abe Cabinet on health policy issues.
●The mid-term plan asserts that it “aims to increase the number of medical students by about 50 percent.” However, it does not explain how they will be trained or distributed (by geography or specialty). Simply increasing the number of doctors without considering social conditions will not solve problems. It is necessary to increase the number of doctors per citizen. At the same time, it is important to take a systematic approach.
●Firstly, the uneven geographical distribution of doctors needs to be addressed. Kyoto Prefecture has the highest number of doctors with 292; More than twice the number in the lowest prefecture of Saitama, which has 142. Although each hospital has a set number of posts for regular staff, there is no fixed number or framework by region or municipality. By adjusting the number of residents according to local needs, I believe geographical inequalities will diminish dramatically. If it is made mandatory for residents to work in areas without doctors for several months from the second year of their residency, it would provide them with diverse work experience as well as reduce doctor-less areas.
●The uneven distribution of doctors by specialty is also a widely recognized problem. There is a shortage in surgeons and obstetricians, while on the other hand psychiatrists and plastic surgeons are increasing. In order to provide adequate medical care to people, the medical training system needs to undergo a dramatic reform. The medical world itself should decide on the numbers for physicians by specialty and clarify the necessary qualifications. When I spent 15 years in a university hospital in the United States, doctors were also working as researchers and teachers. We learned from each other and built a strong sense of responsibility through a friendly rivalry. Japan should learn from such strict professional training methods and qualification standards in the US.
●There is also room to improve the institutions that provide medical care. Although Japanese hospitals have an extremely large number of beds compared to those in other developed countries, the facilities are not evenly distributed geographically. Many similar medical institutions are clustered together in a small area. By drafting medical plans by municipality, overlaps in services and facilities can be reduced to enable a better quality and balanced medical care. This will help increase the number of doctors per patient, and as a result create better working conditions for doctors. Such municipality-based planning should also work to prevent incidents like the recent case where numerous institutions rejected the admission of a pregnant woman. So it’s not only the number of doctors that needs to increase, but reform is necessary in the system and management of medical institutions.
●All the above is my private opinion. I believe that the mid-term plan does not recognize the current situation this way or offer specific methods for reform like this. The experts invited to the panel must have conveyed the pressing needs of those working in the field.
●What is important for Japanese people is not a simple increase in the number of doctors, but more high quality doctors. It is necessary to train physicians not only in their practice, but in a way that they can gain diverse work experience, a strong sense of responsibility, and a wide scope of judgment. In the Canadian and US “medical school” system, which has spread to Australia and South Korea, a college graduate without a bachelor degree in medicine can aspire to become a doctor by attending a 4-year graduate medical program. Now is a good time to promote this system in Japan.
●As there is great public attention in health care in Japan right now, it is the right time to begin setting up new fundamental laws that stipulate the basic principles, instead of haphazardly addressing problems as they arise.
That’s all I want to mention. I will continue to speak out about health care issues, not just from my own position but from a broader perspective, and will maintain the point of view of the public. I also intend to continue with my various activities at the Health Policy Institute Japan. I hope you will extend your kind support.