Abstracts & Papers in Stream 1

This paper is presented to study the transformation of Japanese disability policy (JDP) in this decade and to discuss its future direction. During this decade, JDP has changed significantly. On the one hand, it has been influenced by the global trend of policy-making, such as New Capitalism and New Public Management, and the application of foreign models like community care, care management and quasi-market system. On the other hand, it also has been affected by the limited policy options that policy makers could afford to take under the hard structural reformation (kōzō kaikaku) policy adopted by Koizumi Administration. These circumstances made JDP once consistent with the direction of the long-term care insurance (LTCI) program for aged population that started in 2000. After the regime changed in August, 2009, however, JDP seems to turn in opposite direction. Why is this change taking place now? What kind of challenges JDP has faced in the decade?
In order to answer these questions, this paper analyzes JDP in comparison with LTCI in six points; coverage, fairness, benefits, service delivery, relationship with other sectors, and cost controlling. From this study, it was found that the weak side of LTCI was revealed when its system was partly adopted by JDP; for example, the failure of the assessment of mental status and the standard care time methodology.  The differences between persons with disabilities under 65 and the aged ones in various areas also articulated LTCI's defects; i.e. difference of the needs and wants, the attitude toward institutionalization, and the notion gap between the rights of "the beneficiary" and those "on an equal basis with others". This study will contribute to the discussion not only on JDP but also shortcomings of LTCI in Japan.

Full paper: HiroshiTakebata_EASP_2010_Where should the Japanese disability policy go.pdf

This paper analyses continuity and change in Japanese health policy since the 1980s when health care reform started. It begins with a brief description of historical development of political and economic institutions of the Japanese health care system, which has been based on statutory health insurance funded from premiums and subsidies from national and local tax. Then, the paper analyzes continuity and change in Japanese health care policy in terms of context, actors, process and content. First, health care policy has continued to be a major area of the entire social security system, but, with ageing population, is made more regarded as a part of an integrated social security system, including long-term care and pension. Globalization seems to only indirectly influence health care policy, although international ideas and statistics have been increasingly evident in political discourse. Second, new actors including patients' organizations, the media and think-tanks have emerged and physicians' political power has slightly been waning, particularly in the last
decade. Physicians, however, participate in political debates more individually. Third, process of policy-making in health care has become open with the public by disclosing minuets of extra-ministerial councils using the Internet. Consensus-building at extra-ministerial councils have continued to be dominant in the policy-making process, although supra-ministry bodies occasionally took initiatives. Evidences, rather than opinions, become often used in policy-making process, but rarely presented in coherent ways. Finally, the principle of universal health insurance, as well as significant amount of co-payments, has been maintained. Mixed funding has continued with introduction of formal risk-adjustment measures. Market mechanism has been dominant in the delivery of health care services although some planning and coordinating mechanisms have been developed. The paper concludes with theoretical interpretations on continuity and change in health policy with the findings.