|Implemented in this survey?|
The Democratic Party of Japan, taking office by its landscape victory at the 2009 Lower House election, has declared that it will stop the collapse of the medical system and take the anxiety on it prevailing in Japanese society. Specific measures include: to increase health care expenditure and human resources, to develop measures against major health problems, and to abolish the Health Insurance for the Old-Old.
This report analyses health policy of the DPC that won the 2009 Lower House Election by a landslide. Among various issues on health care provided by its manifesto for the 2009 election, the following two policy issues seem prominent: to allocate additional funds for health care and to take drastic measures to develop health human resources; and to abolish the Health Care Insurance for the Old-Old implemented in 2008 (cf. survey 2008 (12)).
In its manifesto the DPJ declared that it would increase health spending as a proportion of GDP up to the OECD average. It also manifested that physician density would be increased up to the OECD average by boosting the capacity of medical schools by 50 percent. It was announced that the hospital sector would be given priority to gain more resources than the primary sector, since efforts to contain health expenditure since 2000 have led to physician shortages particularly in the hospital sector. The party also proclaimed that it would abolish the Health Care Insurance for the Old-Old and maintain universal health insurance, although no alternative insurance plans have been announced.
The DPJ has announced only main ideas of health policy. Policy objectives and measures are yet to be unveiled.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
Since the enactment of the Health Insurance for Old-Old has been controversial and attracted public attention, the proposed abolishment of the insurance has been highly visible and controversial. The government will need to establish an alternative insurance, which probably will have a systemic impact. Since the policy of the new government was proposed in a particular context of the 2009 election, it seems to be system-dependent.
The Democratic Party of Japan won the Lower House Election in August 2009 and captured 308 of 480 seats. The defeated Liberal Democratic Party went out of power for the second time since 1955: the power shift from the LDP to the DPJ is a historical event in the Japanese politics. It formed a coalition with two small parties: the Social Democratic Party and Kokumin Shinto (People's New Party). The DPJ is starting to "make politics work for people's life" (DPJ 2009).
The DPJ proclaimed that it would make the government more politician-led rather than bureaucrat-administered, concentrate power of decision-making in the Cabinet and the Prime Minister's Office, transform the Japanese society from a vertically organized society of vested interests into a horizontal society bound by human ties, and decentralize the government.
|Implemented in this survey?|
Since its establishment in 1998, the Democratic Party of Japan has published various policies on health care. In 2001 the DPJ published a plan of health care reform. The plan included the
following policies: introduction of gate-keeping system, abolishment of pharmaceutical price regulation, compulsory disclosure of medical records, re-structure of hospitals, enhancement of
competition between providers, privatisation of public hospitals, and re-organization of public health insurances. Those policies seemed more radical than those of the government at that moment: some
relied heavily on market mechanisms; others would have changed the existing public health insurances.
Health care policies of the DPJ changed significantly between 2001 and 2009 (Niki 2009). Its 2007 manifesto declared that the party would solve physician shortage and develop secure and safe health care. Delivering quality cancer care was also prioritized. Furthermore, in the 2009 manifest the party moved on to the point that increase of health care spending and physician density was necessary.
The Koizumi administration took strong measures for cost containment and advocated market-oriented health care reform. The post-Koizumi LDP, however, has gradually been altering its health policy.
For example, the LDP government formally decided to ease cost containment measures. Also, the government formerly had reduced the national quota of medical schools, but decided to increase it before
Health policy of the DPJ and the LDP has similarities and differences. The LDP insisted that the Health Insurance for the Old-Old could be modified to achieve more equitable and reliable health care; the DPJ denounced the insurance for causing age discrimination and argued its abolition. The LDP proposed a raise of tax to increase funds for health care and public pensions. On the other hand, the DPJ made a public commitment not to raise the consumption tax rate for four years, while the party declared that health care funding shall be increased to the OECD average. To finance this, the DPJ wants to increase the efficiency of public administration and gain some funds from "special accounts"of the government.
No particular legislation has been taken.
It's too early to expect any outcomes. Currently, the new government is busy making a budget for the 2010 fiscal year. Policy measures will probably be developed in early 2010.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
It's too early to expect impacts of the policy ideas of the new Government, because they have not created particular policy measures.
Democratic Parity of Japan (2009) The Democratic Parity of Japan's Platform for Government: Putting People's Lives First.
Niki, R. (2009) Health Policy of the Democratic Parity of Japan: An Analysis of its features and feasibility. Modern Thought (Gendai Shiso) 37 (13): 180-188 (In Japanese).
Ryozo Matsuda is a professor in health policy at the College of Social Sciences, Ritsumeikan University. He also serves as an executive board member of the Institue of Human Sciences, Ritsumeikan University.