A practice of multidimensional policy analysis: a case of the new medical residency program in Japan

Abstract

The new medical residency program established in 2004 in Japan is criticized for causing maldistribution of doctor over areas and clinical departments, while its objectives are generally accepted. I thus employ Frank Fischer’s multidimensional policy analysis framework to analyze the policy and to produce useful information for “better” design of alternative. Choosing two hospitals with different characteristics at the contextual level, it is verified that the program in each hospital achieved its objectives, and the objectives of the programs are validated based on interview data of 45 stakeholders. At the social level, it is argued that “Matching System” of the new policy triggered the withdrawal of doctors sent from university hospitals, then the maldistribution of doctor, which had not been expected nor intended. At the Social Choice phase, a "map" of social orders with “liberty-equality” axis and “the private-public nature of doctor” one is proposed so that it facilitates dialogue and offers insights into the argument of “better” policy. Finally, I tried to argue the design of “better” policy and suggest possible alternatives by the “map” of social orders.