One more comment on health care reform


Lately there has been vibrant movement towards health care reform. But what I think matters the most are the policies at the basis of the actions. It is inevitable that people and parties concerned make comments from their own positions. That is the natural process of politics.

At the same time, however, it is extremely important to discuss policy based on historical background and provide a medium to long-term vision. Government plans tend to become short-sighted.

When I offer my comments on this blog or in books or newspapers, I always try to maintain a broad perspective because I feel that there is a lack of opinions on policy like that.

Recently the Yomiuri newspaper ran a large proposal for health care reform (October 16 morning edition). Following the proposal, it carried an article entitled “Health care renaissance No.4479, Opinions on the proposal from those working in the field: Start with improving efficiency of the medical system” on November 21(page 21), which includes my comments. The following are the main points in the article:

■Many doctors working in the field responded to Yomiuri newspaper’s health care reform proposal, which we ran on October 16. In a four-part series, we will introduce some of the opinions we received as well as those from experts.

■We proposed to counter the doctor shortage by strategically planning the distribution of physicians. There is a noticeable shortage of doctors in rural areas, emergency medical services, and specialty areas such as pediatrics and obstetrics. In order to eliminate such inequalities, we proposed to strategically allocate physicians by setting fixed numbers for geographic distribution and specialty mix.

■The distribution plan would begin with young doctors who just finished their first two years of residency after specializing in medicine at university and who are about to embark on the second half. We proposed that university and core hospitals in the area, the medical association, and local government should set up a municipal organization in charge of allocating the physicians. The allocation would be based on the preference of the doctors, but they would not always be able to work at their first choice if that specialty or region fills up. Some doctors after reading this proposal sent in opinions, saying “Doesn’t this go against the rights to have “freedom of choice in occupation” and ”freedom of living location” that are guaranteed in the constitution?”

I think the discussion has set off on a great start.

■Regarding this point, Professor Yoshitaka Wada of Waseda Law School has commented that “It will be difficult to legislate municipal physician distribution, but it should not be a problem if the medical world itself works out a framework for distribution. By designating a fixed number of doctors for each specialty area, the current imbalance can be corrected to provide an adequate specialty mix of physicians.”

■Vice-director of the Saitama Prefecture Saiseikai Kuribayashi Hospital, Dr. Hiroshi Honda who has also written a book issuing a stern warning about medical equipment says, “I can understand the idea of strategically allocating doctors and believe it is feasible.” He says that even if physicians end up in their second choice in a rural area when their first preference in the city has filled up, they would learn a lot from gaining experience in remote areas. He adds, “However, it should not be a one-way ticket to a rural area. The system should allow doctors to work with the security of knowing that, after a fixed period of time, they are guaranteed to return to a university hospital where they can earn specialty qualifications.”

■Dr. Kiyoshi Kurokawa, a doctor of internal medicine and professor at the National Graduate Institute of Policy Studies, also supports the strategic planning of the distribution of physicians. However, he points out that “Before deciding on the adequate number of doctors for each geographical location and specialty, it is indispensable to improve the efficiency in the current system providing health care.” For instance, he says, local doctors and nurses can work regularly at core hospitals in the area to provide 24-hour emergency medical care. This will help prevent emergency patients from being bounced around hospitals. In addition, he says, university and other hospitals should focus on inpatient care, while it will be more efficient for local private practitioners to participate in outpatient treatment if necessary. Dr. Kurokawa goes on to say, “There are fundamental laws for most important areas like education and the environment, but not in health care. It is high time to set up fundamental health care laws and stipulate the ideas of reform.”

What do you think? Yomiuri newspaper is doing a great job. The journalists in charge of the piece should be very happy if you send in your comments too. I hope everybody will participate in the process of policy-making as much as possible.