Doctors in Japan oppose government plans to reform universal healthcare system.

The Japan Medical Association (JMA), the largest doctors’ group in the country, which represents most private practices and local clinics, is opposing reforms of the universal healthcare system proposed by the government as part of its attempts to deregulate the economy. PrimeMinister Shinzo Abe, who took power in December 2012, has included healthcare reform as a central pillar of the “third arrow” of his economic plans, which have been dubbed “Abenomics.” The issue of most concern to doctors is an end to the current ban on mixed public and private treatments, which is seen as vital in maintaining the universal nature of the health insurance and care system, established in 1961. The ban means that, if a patient wants to combine a treatment that is not covered by the public health insurance with one that is, they have to pay privately for both. That has discouraged the use of the private sector. There are some exceptions, for new cancer treatments, for example. Doctors fear that a reformed system could mean that some new treatments will not be covered under the public insurance system due to an assumption that patients would be able to pay for them as an additional top-up to their “basic” treatment. Joe Kurosu, a private practitioner in Tokyo, said, “The fear is that this will lead to a breakdown in the current national healthcare system. If new treatments begin to be provided by the private sector, then there’ll be no incentive for the government to start paying for them through national health insurance; so there’ll be a big gap that will open up between those that can afford to pay and those that can’t. “Behind that are the worries that doctors in smaller clinics have of losing patients if they can’t provide the latest treatments.” Tsunehiro Akashi, a doctor who works at a small clinic in Yokohama, said that private practices would be able to find ways to survive, but faced “a significant loss of income.” Akashi added, “Because of the economic and fiscal problems, the government is looking for ways to reduce the costs of the national healthcare system.” The government has also recently begun negotiations on joining the Trans-Pacific Partnership (TPP), a free trade agreement that some doctors see as a way to force open the Japanese medical market for big US medical companies and domestic corporations. Akashi said, “Foreign companies will probably need to work with local partners while they try and get a foothold in the market, and will then try and go it alone after a few years. That’s the way these things usually work.” Although the 165 000 member Japan Medical Association is actively opposing both the TPP and the health insurance reforms, its political influence is waning. It was a traditionally strong lobby within the conservative Liberal Democratic Party (LDP), which ruled Japan almost continuously for more than half a century from 1955 onwards. However, when the left of centre Democratic Party of Japan took power in 2009, the JMA largely switched allegiance, only to find itself going back into the arms of the LDP when it returned to government at the end of 2012. The medical profession was now attempting to appeal directly to the general population, according to Akashi, who said that he was “not too optimistic of success.” Kurosu added, “Public opinion isn’t very sympathetic to doctors these days. We’re seen as a fairly wealthy group which gets tax breaks anyway.”