Strategies of Health Care Functions in Japan: An Application of Parsons’ Theory

This presentation analyzes the strategies of health care functions, especially primary care function, in Japan, using Parsons’ discussion of control modes (symbolic generalized media).

Japan’s public health care insurance basically adopts the free access system, which we can consult any physician in clinic or hospital with the insurance card. Many patients go to hospital with many physicians at the first visit, so that hospitals are crowded with patients. The government and health care providers have recently introduced the various measures that encourage people to have their family physician.

Firstly, the government has introduced the control strategies using medical fees. Since 2016, patients have had to pay extra fees whenever they go to large hospitals at the first visit. This control strategy is inducement (money). Secondly, Japan Medical Association, which is the professional organization of physicians in Japan, started the three years training program to improve primary care ability for practitioners in 2016. Practitioners get the certification after taking this program. It is expected that patients admit the primary care ability of practitioners with the certification and go to them instead of hospitals at the first visit. This control strategy is a kind of persuasion (influence).

Inducement and persuasion are positive sanctions in the Parsons’ paradigm while coercion (power) and activation of commitments (generalization of commitments) are negative sanctions. Coercion and activation of commitments have not been introduced yet. Therefore, positive sanctions are the control strategies which are likely to be introduced.