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Cablegate: The Doctor Will Not See You Now - Japan's

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PP RUEHFK RUEHGH RUEHKSO RUEHNAG RUEHNH
DE RUEHKO #0118/01 0150901
ZNR UUUUU ZZH
P 150901Z JAN 08
FM AMEMBASSY TOKYO
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INFO RUEHBJ/AMEMBASSY BEIJING PRIORITY 1101
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RUEHNAG/AMCONSUL NAGOYA PRIORITY 4152
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RUCPDOC/DEPT OF COMMERCE WASHINGTON DC PRIORITY
RUEHBS/USEU BRUSSELS PRIORITY
RUEHGV/USMISSION GENEVA PRIORITY 3228
RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY

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E.O. 12958: N/A
TAGS: ECON ETRD JA PGOV
SUBJECT: THE DOCTOR WILL NOT SEE YOU NOW - JAPAN'S
PHYSICIAN SHORTAGE.

REF: 07 TOKYO 5080

1. (SBU) Summary: Japan faces an acute shortage of hospital
physicians, particularly in rural areas. One expert
estimated the country needs 55,000 new doctors to staff
adequately its hospitals. Harsh working conditions and low
pay cause many doctors to enter private practice, a step
which means they generally lose hospital privileges. The
Ministry of Health, Labor and Welfare (MHLW) is increasing
the number of medical school scholarships at prefectural
universities and requesting hospitals seek "volunteers" to
practice in the countryside for stints of several months.
Solving the problem, however, will require creativity and
flexibility on the part of the GOJ, including allowing
foreign physicians greater leeway to practice in Japan and
developing new remote treatment technologies. End summary.

2. (SBU) In August 2007, eight separate hospitals in western
Japan, claiming to have no physicians available, refused care
to a woman in premature labor. The woman was finally
admitted to a ninth hospital, but only after the ambulance in
which she was traveling crashed, causing her to miscarry.
This incident highlights the shortage of doctors,
particularly in rural areas.

Doctor Shortage Acute
----------------------
3. (SBU) According to 2005 data, Japan has 1.9 physicians
per 1000 people, ranking it 27 out of the 30 OECD member
countries. Nevertheless, the number of doctor consultations
per capita on an annual basis is 13.8, perhaps the world's
highest. Specialists are in particularly short supply;
estimates put the number of practicing obstetricians in Japan
at only 8,000. Japan Municipal Hospital Association Chairman
Tetsuro Koyamada told emboff he estimates the country needs
55,000 more doctors to staff adequately its hospitals.

Underpaid and Overworked
------------------------
4. (SBU) There are several reasons for the shortfall. First,
working conditions in Japanese hospitals are particularly
harsh. A recent survey revealed more than 30% of hospital
doctors had worked an entire month without a day off and 70%
had worked the day after night-shift duty. Second, hospital
physicians earn an average of $93,500, half the wage of
private practice physicians and less than the average
commercial airline pilot. Doctors in private practice
generally lose their hospital privileges.

5. (SBU) Finally, changes made to Japan's medical residency
program have contributed to the lack of doctors in rural
areas. Previously, medical schools had sole authority to
determine where graduates could complete their residencies.
The schools coordinated with regional hospitals and
governments to ensure staffing needs were met. The system
came to be seen as draconian and in 2003 the Ministry of
Health, Labor and Welfare (MHLW) revised the regulations
allowing students more freedom. As a result, most stay in
the big cities to complete their training.

The Countryside is Lovely This Time of Year
-------------------------------------------
6. (SBU) Responding to public pressure, MHLW is attempting to
rectify the urban-rural disparity. According to MHLW's
Masatsugu Ashida, the GOJ has, among other things, increased
the number of scholarships at prefectural medical schools for
students who agree to practice in that prefecture for two
years after obtaining a medical license. In addition, MHLW
has reduced the number of residency positions in Japan's big

TOKYO 00000118 002 OF 002


cities to force students to serve in prefectural hospitals,
Ashida said.

7. (SBU) The MHLW also, according to Ashida, has launched a
program to recruit physicians to volunteer to practice in
rural areas for several month stints. These volunteers
receive no incentive pay or benefits except experience, he
noted. The MHLW will, however, provide subsidies to
hospitals that "encourage" doctors to participate and will
also "suggest" how many doctors each hospital provide.
Finally, the Ministry will assist physicians in compensating
patients who successfully sue for malpractice. Ashida said
MHLW has requested a budget equivalent to $142 million to
fund these initiatives. (The Ministry of Finance is
currently considering the request, but given the Cabinet
mandate to curb healthcare spending by $1.9 billion annually
for the next five years (reftel), even this modest funding is
uncertain.)

"Time is Running Out"
---------------------
8. (SBU) Prefectural governments are also striving to address
the shortage. In November 2007, Niigata prefecture proposed
the central government to create a "special zone" in which
foreign doctors without a Japanese medical license, but who
had studied or trained in Japan, could practice medicine.
Established under former Prime Minister Koizumi, special
zones allow Japan to implement reform on a trial basis in a
limited area. If successful, the measure can be expanded
nationwide. Niigata prefectural government office of
healthcare and insurance official Hideo Teruta stated, that
while the government has rejected similar proposals before,
he is hopeful the gravity of the doctor shortage will result
in an approval this time. "Time is running out," Teruta said.

Comment
-------
9. (SBU) As discussed in ref, Japan's overall healthcare
system is in need of reform and solving the rural physicians
shortage will require creative approaches beyond fiscal and
commercial restructuring. If resistance to expanding
immigration for skilled professionals persists, Japan may
once again turn to technological solutions, or
"telemedicine," where U.S. firms in such sectors as
telecommunications, homecare technologies, personal emergency
response systems, and medical monitoring devices could reap
the benefits. End Comment.


DONOVAN

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