Healthcare: Japan s case

Transcription

1 Healthcare: Japan s case for Workshop MigraNon and CompeNNveness: Japan and the United States (March 22-23, 2012) INOUE Assistant Professor Women s University jinoue@otsuma.ac.jp

2 Outline Industry Profile 2. Migrant Employment PaPerns 3. The Effects of Migrants 4. Links between MigraNon, Labor and Other Policie 5. AlternaNve OpNons and Scenarios 6. Concluding Remarks

3 1. Industry Profile Small expenditure on health 8% of GDP (2008) ó US(16%) and FRA (11%) 2,878 USD per capita ó 3,101 USD (OECD avg.) But, labor market is growing in the number of employed persons (Chart 1) in the number of un- fulfillment of job offers (Chart 3) in the number of pracncing physicians/nurses (Chart 4 and 7) Geographically imbalanced distribunon of workers physicians and nurses (Fig. 1 and 4: below the OECD avg.)

4 2. Migrant Employment PaPerns Small number of immigrant workers less than 1 % of total workers (e.g. physicians: Chart 4) Similarity in the role of local/migrant workers (e.g. physicians: Chart 11) Similarity in the distribunon of local/migrant workers physicians: Figure 1) Local/migrant workers and the area of no- physicians physicians: Figure 5) => Immigrant workers cannot be alternanve or soluno for staff shortage, imbalanced distribunon between urban/rural areas.

5 3. The Effects of Migrants conclusions of the previous secnon imply that the small number of immigrant pracnnoners cannot have substannal impact on the recruitment remuneranon and retennon of local/japanese pracnnoner No impact on recruitment: The MHLW does not figure in foreign pracnnoners when it make human-resource plan, although Japan is faced with staff shortage No impact on remuneranon/pay: RemuneraNon in healthcare sector is lower than other sectors (Chart 16 and 17) It correlates to the self- employed or not, and the size of hospital/clinic (Chart 18 and 21) No impact on retennon (length of work) RetenNon tends to be shorter than other sectors (Chart 22 and 23) It correlates to the self- employed or not, and the size of hospital/clinic (Chart 24 and 27)

6 4. Links between MigraNon, Labor and Other Policies General Policy Framework- The MHLW does not allow mutual recogninon of qualificanons/licenses The MHLW does not see healthcare as the sector of compennveness It does not figure in immigrant worker Therefore, Immigrants have to pass the nanonal exams held in Japan, if they want to pracnce in Japan Also, fluency in Japanese is reviewed before taking exams (intervie test) Furthermore cernficanon of passing the Japanese- Languag Proficiency Test is required (Grade N1) to take exams (*when immigrants do not graduate from Japanese junior- and senior-high schools)

7 4. Links between MigraNon, Labor and Other Policies Bilateral Agreement under EPA- Under the EPA, nurses and care workers from Indonesia and Philippines are allowed to work and pracnce in Japan temporally (not more than 3 years) They can stay and pracnce as they wish a>er passin the nanonal exams in Japan, but very few people can pass them (Table 1and 3) So far, the EPA does not funcnon, due to conflicnng polincal interests in a single policy framework promonng internanonal cooperanon (MOFA) not a solunon for the staff- shortage (MHLW) protecnng nanonal labor market (equal pay) (JHA) welcoming immigrant colleagues, even if educanonal and financial burden becomes heavier (host hospitals/clinics)

8 5. AlternaNve OpNons and Scenarios The MHLW makes it difficult for us to have an open and construcnve discussion on immigrant workers the MHLW understands that the healthcare sector is not the sector of compennveness, and it refuses to invite immigrant workers and emphasized to mobilize local workers, students, as well as early-renre worker reluctant to improve the EPA arrangement (ó MOFA and the cabinet) However, the MHLW s approach is too caunous, because requiring language proficiency easily consntutes a barrier for immigrant even in English- speaking countries (e.g. UK) bilateral arrangement (such as the EPA) is a convenient tool for controlling immigrants (by introducing quota) A Full- course of regulanon protects nanonal labor market, as the MHLW believes in. INOUE (Otsuma Women's Univeristy)

9 6. Concluding Remarks This case study is probably a special case, because the MHLW does not see healthcare as the sector of compeccveness the MHLW strongly regulates the inflow of immigrant workers, and atempts to mobilize only local workers, students and early- recrement workers to solve the staff- shortage even under the EPA, Japan caucously uses two barriers: naconal exams and fluency of language However, Japan would have to discuss the recruitment of immigrant praccconers, in case of unprecedented aging populacon and severe staff shortage as well as imbalanced distribucon between urban and rural areas To be prepared for such situacon, further comparacve studies between industries and countries are required to see the effect of regulacons on immigrants, market and society

10 Thank you very much for your atencon!!

11 References Inoue, Jun [2010], Migra-on of Nurses in the EU, the UK, and Japan: Regulatory Bodies and Push- Pull Factors in the Interna-onal Mobility of Skilled Prac--oners, Discussion Paper Series A No.526, InsCtute of Economic Research, Hitotsubashi Univeristy., [2011], (writen in Japanese) Regulatory Framework of MigraCon of Nurses in Japan: Comparing with the Cases in the EU and the UK, Journal of Health Care and Society 21:1 (Tokyo: The Health Care Science InsCtuCon), pp Ministry of Health, Labour and Welfare, Basic Survey on Wage Structure, Tokyo., Report on Public Health Administra-on and Services, Tokyo., Survey on Employment Trends, Tokyo., Survey on No- doctor Districts, Tokyo., Survey of Physicians, Den-sts and Pharmacists, Tokyo. [2006], Annual report on health, labour and welfare, Tokyo. [2007], Annual report on health, labour and welfare, Tokyo. [2009], Annual Health, labour and welfare, Tokyo. [2010], Annual report on health, labour and welfare, Tokyo. [2011], Annual report on health, labour and welfare, Tokyo. Nimonjiya, Osamu [2008], (writen in Japanese) Betonamujin kangoshi yousei sien jigyou kara miete- kuru gaikokujinn seisaku no kadai, in Japan Economic Research InsCtute ed.,gaikokujinnroudousya ukeire seisaku no kadai to houkou (Japan Economic Research InsCtute), pp Nursing and Midwifery Council (UK), The Nursing and Midwifery Council Sta-s-cal Analysis of the Register, London. OECD [2011], OECD Health Data 2011, Paris. (Available at htp:// StaCsCcal Survey Department, StaCsCcs Bureau, Ministry of Internal Affairs and CommunicaCons, Annual reports on the labour force survey, Tokyo.

12 Chart 1: Employed persons by industry Source: StaCsCcal Survey Department, StaCsCcs Bureau, Ministry of Internal Affairs and CommunicaCons, Annual reports on the labour force survey. 70,000 63,300 63,160 63,290 63,560 63,820 64,120 63,850 62,820 62,570 60,000 50,000 Services Medical, health care and welfare Thousand persons 40,000 30,000 4,740 5,020 5,310 5,530 5,710 5,790 5,980 6,210 6,530 InformaCon and communicacons Finance and insurance Wholesale and retail trade Manufacturing ConstrucCon 20,000 Agriculture, Forestry and Fisheries Total 10, backto1

13 Chart 3: The number of un- fulfillment of job offers in major industrial sectors (thousands) Source: Ministry of Health, Labour and Welfare, Survey on Employment Trends ConstrucCon Manufacturing Finance and Insurance Medical, health care and welfare Total back

14 Chart 4 (lea): The number of registered physicians in Japan (Total and Foreign praceeoners) Source: Ministry of Health, Labour and Welfare, Survey on Physicians, Den-sts and Pharmacists. Chart 7 (right): The number of registered nurses in Japan *no data of foreign praceeoners Source: Ministry of Health, Labour and Welfare, Report on Public Health Administra-on and Services. 300,000 2,600 1,200,000 Total 290, , , , , , , , , ,000 2,473 2,489 2,483 2,476 2,442 2, , , , , , , ,500 2,400 2,300 2,200 2,100 2,000 Foreign praceeoners 1,000, , , , , , , , , , , , , , Total Foreign praccconers Total Part- Cme/Dispatched backto1 backto2

15 Chart 11: Components of registered physicians in 2010 Source: Ministry of Health, Labour and Welfare, Survey on Physicians, Den-sts and Pharmacists. Founders/Presidents of Hospitals Physicians of Hospitals (excluding medical schools) Teaching Staffs of Medical Schools Foreign Physician Other Staffs of Medical Schools Founders/Presidents of Clinics Physicians of Clinics (excluding medical schools) Founders/Presidents of Long- Cme Care Facilicites Physicians of Long- Cme Care FaciliCes Japanese Physicians Staffs of EducaConal InsCtuCons except medical schools Physicians of AdministraCve Bodies and Public Health Services Others (including no jobs and don't know) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% backto2

16 Chart 16 (lea): Comparison of remuneraeon by industry, and the number of workforce (2002) * * No specific data for informacon communicacon Source: Ministry of Health, Labour and Welfare, Basic Survey on Wage Structure. Chart 17 (right): Comparison of remuneraeon by industry, and the number of workforce (2010) Source: Ministry of Health, Labour and Welfare, Basic Survey on Wage Structure. Thousand Yen Over 1, Thousand Yen Over 1, backto3

17 Chart 18 (lea): Trend in remuneraeon of physicians by the number of workforce Source: Ministry of Health, Labour and Welfare, Basic Survey on Wage Structure. Chart 21 (right): Trend in remuneraeon of nurses by the number of workforce Source: Ministry of Health, Labour and Welfare, Basic Survey on Wage Structure Thousand Yen Over 1, Thousand Yen Over 1, backto3

18 Chart 22 (lea): Comparison of reteneon by industry, and the number of workforce (2002) * * No specific data for informacon communicacon Source: Ministry of Health, Labour and Welfare, Basic Survey on Wage Structure. Chart 23 (right): Comparison of reteneon by industry, and the number of workforce (2010) Source: Ministry of Health, Labour and Welfare, Basic Survey on Wage Structure. Years Over 1, Years Over 1, backto3

19 Chart 24 (lea): RetenEon/Length of services by the number of workforce: Physicians Source: Ministry of Health, Labour and Welfare, Basic Survey on Wage Structure. Chart 27 (right): RetenEon/Length of services by the number of workforce: Nurses Source: Ministry of Health, Labour and Welfare, Basic Survey on Wage Structure Years 6 4 Over 1, Years Over 1, backto3

20 Figure 1: Physicians per 1,000 inhabitants and the number of foreign physicians Source: Ministry of Health, Labour and Welfare, Survey of Physicians, Den-sts and Pharmacists. backto1 backto2

21 Figure 4: Nurses per 1,000 inhabitants (No data of the number of foreign nurses) Source: Ministry of Health, Labour and Welfare, Report on Public Health Administra-on and Services. back

22 Figure 5: Areas with no physicians (2009) and the number of foreign physicians (2010) Source: Ministry of Health, Labour and Welfare, Report on Public Health Administra-on and Services.; idem, Survey on No- doctor Districts. backto2

23 Table 1 (lea): Accepted Candidates for nurses and cerefied care workers by the EPA arrangement: Indonesian case Source: htp:// (Accessed on 27 February, 2012) Table 3 (right): Results of the naeonal nurse examinaeon in 2011: Under the EPA arrangement (Indonesian candidates) Source: htp:// at/2r bqj.pdf (Accessed on 5 January, 2012) Candidate for Nurses Candidate for CerEfied Care Workers Total Entrants in 2008 Entrants in 2009 Entrants in 2010 Applicants Successful candidate RaEo of success % % % backto4