Japan health system in crisis

Editorial - The Japan Times Wednesday 21st November, 2007

Medical services are collapsing in many parts of Japan.

Doctor shortages are especially acute in obstetric-gynecological, pediatric and emergency care departments. It is high time that the government, lawmakers and the public seriously start discussing how to increase the number of doctors and nurses and how to improve their working conditions, including securing sufficient budgetary funds.

A telling statistic in the current crisis is that, in 2006, 667 pregnant women being transported by ambulance were refused admittance by three or more hospitals. Also, as many as 1,012 pregnant women had to wait more than 30 minutes in ambulances until a hospital could be found that would accept them.

According to the Organization for Economic Cooperation and Development, Japan has two physicians per 1,000 people (as of 2004), almost the lowest among developed countries. As a result, a Japanese doctor must see more patients than in other developed countries. Working conditions for hospital doctors in Japan are harsh, with some doctors on duty for up to 36 hours straight.

At the root of the problem is the attitude of the health ministry and the Japan Medical Association. Since the 1980s, they have pushed the policy of restraining quotas for medical schools, believing that there would be too many doctors. The current situation shows how wrong they were. Their policy must be fundamentally changed.

The government also should increase remuneration for medical treatment and help improve working conditions for hospital doctors, although budget problems must be cleared.

The current medical internship system that started in 2004 is also responsible for the crisis. Those who have obtained a medical license must intern at hospitals for two years, but many of them choose hospitals in major cities, shunning university hospitals. As a result, the latter have had to call back doctors they had sent to core hospitals in the countryside. Measures must be devised to assign doctors who have finished internships at urban hospitals to hospital positions in the countryside for a certain period.

Footnote: Japan's Suicide rate is the highest of any developed country, and ranks within the top-ten countries in the world. A study published in 2006, indicated that health problems were a significant factor in almost 50% of Japan's suicides in 2006.