Regime Analysis of Health Service Policy Change in Japan

Abstract

In the middle of 1980, the health service policy in Japan shifted from the supply promotion programs to the restraint programs. Generally this period has been characterized by the spread of neoliberal projects including market deregulation and state decentralization. The Ministry of Health and Welfare, however, contrarily introduced and strengthened the direct regulations such as the containment of hospitalbeds and the control of medical institutions. The article examines this policy change process in this period.

We analyze the policy change comprehensively through the policy regime model that Carter A. Wilson suggests. This model that focuses on power arrangements, policy paradigms, organizations and policies is useful in explaining both stability and change in public policies. Normally these factors maintain long-term stability. However, policy changes occur when regimes become stressed and all the factors change : stressors/enablers impact on policy regimes, then alternative policy paradigms arise, legitimacy crises occur, power arrangements shift, administrative organizations arereorganized, and goals of policy change.

This case study describes the four stages in the health service policy regime change. At the first stage, stressors-the crisis of the post-war welfare state, the aging of the population, the transition of the disease structure and so on-pressured the policy regime. At the second stage, an alternative paradigm arose, an old paradigm lost credibility and then legitimacy crisis occurred. The rise of the alternative paradigm that controls the health service system led to discredit the dominant paradigm of supply promotion. The third stage in the regime change involved power arrangement shifts. In the health service policy network, a professional community consisting of medical officers and the Japan Medical Association was shaped and the SDPJ (Social Democratic Party, Japan) became weak due to the decline of the classbased labor movement. At the last stage, the medical offices in the Ministry of Health and Welfare were reorganized, and the new policy programs and direct regulations to control health service system were implemented in the mid-80s.