Japan Adjusted Doctor Numbers Since the 70s... Numerous Excellent Regional Hospitals as Measures to Prevent Concentration [Essential Medical Solutions]

Flexible Adjustment of Medical School Quotas Increased and Decreased
Prevention of Concentration in Specific Departments and Regions with Allocation Indicators and Caps
Discussion on Medical Fee Increases and Treatment Improvements

Editor's NoteThe medical crisis caused by the collective resignation of residents has entered its fifteenth day as of the 4th, yet the government and the medical community continue their standoff. There are divergent interpretations on both sides regarding the core policy of medical reform, the ‘solution to the avoidance of essential medical care.’ The positions of both parties sharply differ on the effectiveness of the government’s ‘Essential Medical Care Package’ policy, which was proposed alongside an increase of 2,000 medical school quotas. In this regard, this article examines the three key issues related to the government’s solution for essential medical care (① Ban on Mixed Medical Treatment ② Special Act on Medical Accident Handling ③ Regional Essential Doctor System) and also reviews cases of essential medical care policies in advanced countries.

① The control link for the expansion of non-reimbursable expenses worth 32 trillion won, the remaining issue of the ‘Ban on Mixed Medical Treatment’

② The core trigger, the Special Act on Medical Accident Handling... Narrowing the gap with medical stakeholders

③ Japan has focused on measures and resolving maldistribution since the 1970s... Recommendations for Korea

④ Concerns over the reoccurrence of the closure of Seonam Medical School... To ensure the effectiveness of the Regional Essential Doctor System

Japan, which has experienced low birth rates and aging issues ahead of Korea, has been discussing comprehensive medical measures for a long time, including considering medical school quotas since the 1970s. Although conflicts over maldistribution and medical fees persist, Japan differs from Korea in that the government has established nominal systems to resolve and prevent these issues proactively.

Controversial Medical School Quotas... Adjusted Considering Side Effects

In the 1970s, the Ministry of Health, Labour and Welfare (a Japanese government agency combining Korea’s Ministry of Health and Welfare, Ministry of Employment and Labor, and Ministry of Gender Equality and Family) implemented a strategy to establish medical schools in every prefecture with the goal of securing 150 doctors per 100,000 people by 1985. With the establishment of the Okinawa Ryukyu University Medical School in 1979, all prefectures in Japan had medical schools, resulting in the largest-ever medical school quota in 1981.

In 1982, the government began reducing medical school quotas, stating that “a reasonable training plan will be established and reviewed to avoid an oversupply of doctors.” However, in 2004, with the introduction of the clinical training system, a phenomenon of doctors leaving rural areas occurred. This system requires training in all specialties over two years, and since training could be done not only at university hospitals but also at private hospitals, doctors from rural university hospitals moved elsewhere.

In response to these side effects, the Japanese government decided in 2008 to increase medical school quotas to the largest scale ever. This policy is still maintained today. The medical school quota, which was 7,793 in 2008, gradually increased to 8,486 in 2009 and has reached about 9,403 this year.

Now, there are discussions about gradually reducing medical school quotas due to low birth rates and aging. In January, the Ministry of Health, Labour and Welfare reviewed the current trend of doctor increases. Organizations such as the Japan Hospital Association argue that “from 2029, the supply and demand of doctors will balance, and thereafter, due to population decline, there will be an oversupply of doctors,” adding that “if the 2024 admission quota is maintained, by 2050, one out of every 85 eighteen-year-olds will enter medical school.”

Focus on Preventing Doctor Concentration in Specific Regions and Specialties

Doctor concentration in specific regions and specialties also occurs in Japan. The Japan Medical Association’s Comprehensive Policy Research Organization pointed out that “doctors are concentrated in Tokyo, and the number of dermatologists and plastic surgeons is also increasing,” adding that “no matter how many doctors are increased, it is inevitable that doctors will be drawn to specialties with non-reimbursable treatments.” Similar to Korea, Japan also faces medical litigation risks, and specialties such as obstetrics and gynecology and emergency medicine, which have long working hours, are considered undesirable.

However, Japan has established institutional foundations to somewhat alleviate this. Japan publishes a ‘Doctor Maldistribution Index’ indicating the adequacy of doctors by region, and the government and local governments use this to devise countermeasures. Since 2018, the government has implemented a ‘ceiling system’ that sets an upper limit on the number of doctors accepted in areas where the required number is met, to prevent concentration in metropolitan areas or specific specialties. However, exceptions are made for specialties with relatively fewer doctors, such as surgery, obstetrics and gynecology, and emergency medicine.

[Image source=Yonhap News]

Each prefecture, equivalent to local governments, also establishes plans to secure doctors and takes measures accordingly. For example, Yamanashi Prefecture, which falls below the national average on the Doctor Maldistribution Index, provided scholarships last November to two high school students within the prefecture who agreed to graduate from a medical school in the prefecture and work in designated specialties. Such scholarship programs are already in place at three medical schools within the prefecture.

To maintain the number of local doctors, steady human and material investments are also being made in regional base national university hospitals. As a result, unlike Korea where only the ‘Big 5’ hospitals thrive and local national university hospitals struggle with doctor and patient outflow, the situation of local hospitals in Japan is not bad. Recently, in the Newsweek ranking of the world’s best hospitals, except for one, all Korean hospitals were located in the metropolitan area, whereas about half of the Japanese hospitals were located outside the metropolitan area.

Although Japan faces similar essential medical care issues as Korea, it is noteworthy that discussions on raising medical fees and improving working conditions are also underway. Last month, the Central Social Insurance Medical Council (Chuikyo) reported a revision plan to the Minister of Health, Labour and Welfare to raise fees for initial consultations, follow-up consultations, and basic hospitalization fees. This is the first fee increase since 2004, aiming to promote overall wage increases for medical workers. There are high expectations within Japan that the fee increase will be used not only to raise base salaries for nurses, nursing assistants, and medical technicians but also to improve working conditions through talent acquisition.

Experts have long focused on Japan’s structure of achieving social consensus on the medical insurance system and gradually changing through procedures. Policy Committee Member Jeong Hyeong-jun of the Health and Medical Organizations Federation explained in a phone interview with Asia Economy, “Japan values systems and procedures. The central government announces policies but does not demand changes unilaterally without social consensus,” adding, “The process of reaching consensus is also smooth. By fundamentally banning mixed medical treatment, patients came to see doctors as people who think of patients rather than money, building trust, which led to consensus on fee increases and quota expansions.”