We protest against amendments to Medical Care Act, which promote hospital bed reductions and tolerate doctors’ long working hours

Kurosawa Koichi
Secretary General
the National Confederation of Trade Unions (Zenroren)
May 21, 2021

The Diet on May 21 enacted a bill to amend the Medical Care Act, which the government of Prime Minister Suga Yoshihide has promoted to streamline the healthcare system. The measure is ostensibly aimed at ensuring a system that provides quality and appropriate medical care in an effective manner.

The legislation is supposed to promote “work-style reforms for medical doctors” and “medical services reforms.” But it in fact will do nothing about a shortage of doctors. It tolerates doctors’ excessively long working hours and pushing ahead with hospital bed reductions. How can one say that these measures can lead to “quality and appropriate medical care”? The adverse amendments were railroaded through the Diet at a time when the frontline medical professionals are dealing with a coronavirus crisis. We protest about the mercilessness with indignation.

The amended law provides that “measures shall be taken to shorten doctors’ working hours and ensure that they can work in good health.” The number of doctors in Japan is 130,000 short of OECD levels. That is why doctors in hospitals are forced to endure excessively long working hours. Doctors’ deaths and suicides from overwork are not rare. The amended law mentions nothing about the need to resolve a dearth of doctors. It rather encourages medical schools to slash the number of students.

Secondly, the amended law sets the maximum hours of overtime at 1,860 a year. It is 155 hours per month, which is nearly double the average “karoshi (death from overwork) criteria” of 80 hours overtime. In other words, doctors will be forced to work in the karoshi red zone. Doctors are humans to begin with. What the government must do is set the goal for improving doctors’ working conditions to the levels of workers in other sectors, speed up the effort to increase doctors, and make plans to shorten the doctors’ working hours to free them from excessively long working hours.

Thirdly, the amended law talks about promoting task shifting and task sharing with workers engaged in other types of work as part of the effort to shorten the doctors’ working hours. But it could lead to declines in quality of professional work of doctors and make it difficult to ensure the safety. Medical institutions are facing a shortage of not only doctors but nurses and care givers. Shifting a part of doctors’ work on to nurses who have completed a training course for specific performance and to other medical-related workers will not solve the problems of frontline workers’ work style.

Fourthly, the amended law calls for “support to medical institutions towards realizing a plan for regional healthcare. But the plan is about eliminating and consolidating hospitals. Reducing hospital beds could lead to cutbacks in the number of doctors, nurses, and other healthcare -related workers in the region. It could discourage residents from visiting doctors, undermine their health, and have adverse impacts on the regional economy. The consumption tax has been raised with the promise of improving the social security programs. However, it is absolutely unacceptable that the consumption tax revenue is used to reduce the number of hospital beds.

Now that the vulnerability of Japan’s healthcare system has been laid bare amid the coronavirus pandemic, the problem cannot be solved by reorganizing or consolidating local government-run or publicly funded hospitals, or by turning municipal hospitals into independent agency-run hospitals or by privatizing them. The need now is to secure and improve medical treatment for infectious diseases, help deficit-ridden medical institutions make up for losses, make staff reinforcement plans to drastically improve the doctors’ working conditions and implement them, improve the work environment for healthcare professionals engaged in emergency response, and improve medical services in general at public-run and privately-owned medical institutions. In addition, it is necessary to study on the future healthcare system by establishing a panel to examine the overall state of healthcare systems, including the family doctor system as well as hospitals.

We oppose the amended Medical Care Act and the additional resolution and demand an overhaul of the nation’s healthcare policy with a view to realizing a safe and secure healthcare system, which is called for by the people, and protecting the health and livelihoods of medical professionals. The government must fulfill its responsibility for staffing more doctors and nurses to immediately set to improve and expand the healthcare system.