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454 Masahira Anesaki and Tsunetsugu Munakata Among inpatients acute and chronic patients were mixed, and the average length of stay was more than 30 days. The increase of enrollment in medical schools continued until 1979 when the 80th and last medical school opened in Okinawa. Concern over the future potential for an excessive supply of physicians had already started. A series of amendments to the Medical Service Act began in 1985. The amendments were meant to effect cost-containment and to solve accumulated problems caused by the mainly ``laissez-faire'' system of health care delivery. The First Amendment to Medical Service Act asked each prefecture to demarcate secondary medical care or hospital care service zones alongwith the estimation of the needed number of hospital beds for each zone. In zones where the number of hospital beds exceeded the estimated number, new increases in hospital beds were not allowed. The Second Amendment in 1992 classified hospitals' function accordingto two opposite purposes. It designated two national medical centers and 80 university hospitals as highly advanced hospitals and specified on the other hand long-term nursingcare units in hospitals. The Third Amendment in 1997 instituted informed consent to treatments in order to protect patients' rights. The Fourth Amendment is still forthcoming. Topics that will possibly be included are: clearer distinction between beds for acute patients and for chronic patients, broader disclosure of medical information, deregulation of restriction of advertisements concerning medical facilities, two-year compulsory postgraduate medical training. Alongwith this series of policies regulatingmedical care delivery, a 1986 government committee on future supply and demand of physicians disclosed its recommendation that the intake of medical students should decrease by 10 percent before 1995. The Japanese counterpart to the Joint Commission on Accreditation of Health Care Organizations (JCAHO) in the USA, the Japan Council for Quality Health Care (JCQHC), was set up in 1995 to assess the quality of hospitals. As of May 1999, 220 hospitals were accredited. Also, care by private nurses or relatives for inpatients, which is a Japanese traditional custom, was abolished in September 1998 after a few years' preparation. Policies on Care Delivery and Financing for the Aging Population In 1989 the ``Ten-Year Strategy to Promote Health and Welfare for the Elderly in the Twenty-first Century'' (the Gold Plan) was adopted. This plan included numerical targets to be completed by the end of the twentieth century for health and welfare personnel and for domiciliary and institutional care facilities for the elderly. In 1995 those targets were revised (the New Gold Plan). To finance the care for the elderly in the twenty-first century, as prepared by the Gold Plan, the Japanese government prepared the Long-Term Nursing Care Insurance Plan of 1997. This social insurance will be enacted on April 1, 2000 when the fiscal as well as the academic year starts in Japan at the first year of the new millennium.
Health, Illness, and Health Policy in Japan 455 Conclusion onclusion The national health policy and its outcome are a combined product of the ten components (noted at the beginning of this chapter) and the country's natural and sociocultural histories. The main principle of Japan's health policy after World War II has been equal access to health care for everyone, mainly through health insurance (Campbell and Ikegami 1998; Maruyama, Shimizu, and Tsurumaki 1998). This fundamental egalitarian principle has been successful, but it has sacrificed or ignored efficiency and amenity in health care delivery. Japan's health care service is at a turningpoint. Rationalization and competition are beingintroduced. In this situation, it is becomingimportant how equity and patients' rights should be protected. References Anesaki, Masahira. 1977. ``Problems of Health and Medical Sociology.'' Pp. 401±2 in Japanese Society of Health and Medical Sociology. Achievements and Problems of Health and Medical Sociology. Tokyo: Kakiuchi Shuppan. (In Japanese). Campbell, John C. and Naoki Ikegami. 1998. The Art of Balance in Health Policy. Cambridge: Cambridge University Press. Japan Ministry of Health and Welfare. 1999. A Guide Book for Understanding Disease Related to Daily Habits. Tokyo. Maruyama, Meridith E., Louise P. Shimizu, and Nancy S. Tsurumaki. 1995 (1st edition) and 1998 (revised edition). Japan Health Handbook. Tokyo, New York, London: Kodansha International. Munakata, T. 1990. ``Research Report on the Mental Health of Overseas Japanese Business People and Family.'' Tokyo: Japan Overseas Medical Fund. ÐÐ . 1991. Theory of Stress Management. Tokyo: Shogakukan. Munakata, T., Department of Health Narashino City, and Chiba Medical Association. 1991. ``A Longitudinal Study of Stress and Mental Health in a Community Population.'' Tokyo: Japan Ministry of Health and Welfare. National Index of Health & Welfare: National Tendency of Health [Kokumin Eisei No Doukou]. 1998. Tokyo: Japan Health and Welfare Statistics Association. Powell, Margaret and Masahira Anesaki. 1990. Health Care in Japan. London and New York: Routledge.
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The Blackwell Companion to Medical
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BLACKWELL COMPANIONS TO SOCIOLOGY T
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Copyright # Blackwell Publishers Lt
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vi Contents 9 The Convergence and D
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Contributors Masahira Anesaki, Ph.D
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x Contributors Kristina Orfali, Ph.
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xii Preface Talcott Parsons in the
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Part I Substantive Topics
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4 William C. Cockerham By the end o
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6 William C. Cockerham and physicia
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8 William C. Cockerham of the ``neg
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10 William C. Cockerham values are
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12 William C. Cockerham their treat
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14 William C. Cockerham notably the
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16 William C. Cockerham poststructu
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18 William C. Cockerham determinist
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20 William C. Cockerham Callinicos,
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22 William C. Cockerham Ritzer, Geo
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24 Stella Quah values, beliefs, and
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26 Stella Quah 1951: 11) defined cu
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28 Stella Quah that culture might e
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30 Stella Quah health status were o
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32 Stella Quah cultural variations
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34 Stella Quah disease. However, ``
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36 Stella Quah amongothers. These a
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38 Stella Quah References Adler, Sh
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40 Stella Quah Ledesma, Rita V. 199
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42 Stella Quah ÐÐ. 1969. People i
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44 Sarah Nettleton sociology of emb
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46 Sarah Nettleton particularly med
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48 Sarah Nettleton Thus the body co
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50 Sarah Nettleton conventional ide
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52 Sarah Nettleton embodied social
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54 Sarah Nettleton ``re-embodiment.
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56 Sarah Nettleton social identity,
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58 Sarah Nettleton More knowledge,
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60 Sarah Nettleton undermine social
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62 Sarah Nettleton Featherstone, M.
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4 Health and Social Stratification
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66 Eero Lahelma mid-seventeenth cen
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68 Eero Lahelma evidence was obtain
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70 Eero Lahelma between countries.
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72 Eero Lahelma Occupational Classi
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74 Eero Lahelma live in families, h
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76 Eero Lahelma Table 4.2 ``Hard''
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78 Eero Lahelma Figure 4.3 Summary
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80 Eero Lahelma Table 4.3 Age-adjus
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82 Eero Lahelma Table 4.4 Mortality
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84 Eero Lahelma women there was a t
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86 Eero Lahelma largely accounts fo
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88 Eero Lahelma inequalities show a
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90 Eero Lahelma Cavelaars, AdrieÈn
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92 Eero Lahelma distribution of hea
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5 From Women's Health to a Gender A
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96 Sara Arber and Hilary Thomas the
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98 Sara Arber and Hilary Thomas Thi
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100 Sara Arber and Hilary Thomas th
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102 Sara Arber and Hilary Thomas th
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104 Sara Arber and Hilary Thomas 4
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106 Sara Arber and Hilary Thomas Ge
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108 Sara Arber and Hilary Thomas Am
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110 Sara Arber and Hilary Thomas Ar
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112 Sara Arber and Hilary Thomas Ma
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6 Work Stress and Health Johannes S
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116 Johannes Siegrist terms of soci
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118 Johannes Siegrist high psycholo
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120 Johannes Siegrist Of the ten pr
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122 Johannes Siegrist stronger in m
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124 Johannes Siegrist Edwards, J. R
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7 Migration, Health, and Stress Jud
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128 Judith T. Shuval 1989; Hammar 1
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130 Judith T. Shuval (personal skil
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132 Judith T. Shuval But when migra
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134 Judith T. Shuval they are to en
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136 Judith T. Shuval adaptive funct
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138 Judith T. Shuval The prevailing
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140 Judith T. Shuval large numbers
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142 Judith T. Shuval Kritz, M. M.,
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8 Health Professions and Occupation
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146 Elianne Riska of its expertise
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148 Elianne Riska Figure 8.1 Theore
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150 Elianne Riska vanguard that wil
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152 Elianne Riska The body is seen
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154 Elianne Riska research has give
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156 Elianne Riska Fisher, Sue. 1986
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158 Elianne Riska Wilsford, David.
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160 Fred Stevens International nter
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162 Fred Stevens accessible for eve
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164 Fred Stevens provision of healt
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166 Fred Stevens actors: the medica
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168 Fred Stevens second-level hospi
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170 Fred Stevens issues of health a
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172 Fred Stevens in southern Europe
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174 Fred Stevens countries seem to
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176 Fred Stevens Selznick, Philip.
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The Americas
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The American Health Care System 181
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11 The Evolution of Health Care in
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The Evolution of Health Care in Can
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Medical Sociology in Mexico 215 thi
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The aforementioned trend is an indi
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Medical Sociology in Mexico 219 poo
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Medical Sociology in Mexico 221 on
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Medical Sociology in Mexico 223 bee
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Medical Sociology in Mexico 225 Add
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Medical Sociology in Mexico 227 Bro
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Medical Sociology in Mexico 229 Ð
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Medical Sociology in Mexico 231 Ð
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13 Social Science and Health in Bra
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Social Science and Health in Brazil
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Western Europe
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Medical Sociology in Great Britain
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15 The French Paradoxes Kristina Or
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The French Paradoxes 265 Conditions
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The French Paradoxes 267 clearly th
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The link between unemployment and h
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The French Paradoxes 271 of deaths
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there are also a great many occupat
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The French Paradoxes 275 since 1994
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The French Paradoxes 277 care insti
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The French Paradoxes 279 as a field
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The French Paradoxes 281 3 Active l
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The French Paradoxes 283 CREDOC. 19
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The French Paradoxes 285 Orfali, Kr
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16 Medical Sociology in Germany Ola
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Medical Sociology in Germany 289 al
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Medical Sociology in Germany 291 pr
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Medical Sociology in Germany 293 co
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Medical Sociology in Germany 295 Cl
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Medical Sociology in Germany 297 Sc
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Table 17.1 Sex-specific life expect
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Society, Health, and Health Care in
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Russia and Eastern Europe
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The Russian Health Care Experiment
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In and Out of Communism 335 resourc
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In and Out of Communism 337 levels
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In and Out of Communism 339 fat ros
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In and Out of Communism 341 associa
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In and Out of Communism 343 Funds r
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In and Out of Communism 345 of empi
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20 Transformation of the Health Car
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Transformation of the Health Care S
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21 Health and Health Care in South
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Health and Health Care in South Afr
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22 Health, Health Care, and Medical
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Table 22.1 Social characteristics o
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Health, Health Care, and Medical Ed
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Page 447 and 448: Medicine and Health Care in Austral
Page 457 and 458: 25 Health, Illness, and Health Poli
Page 459 and 460: Health, Illness, and Health Policy
Page 469: Health, Illness, and Health Policy
Page 473 and 474: Transformation of Health Care in th
Page 499 and 500: Abbott, Andrew, 149 Abbott, Pamela,
Page 501 and 502: Arvidsson, Ola, 311, 313 asbestos,
Page 503 and 504: health services to ethnic groups, 1
Page 505 and 506: Chu, K., 188 Chu, Li, 461 church, s
Page 507 and 508: professional home care, 172 smoking
Page 509 and 510: and culture, 26 health status in Au
Page 511 and 512: inequalities in life expectancy, 10
Page 513 and 514: government involvement, 163, 164±9
Page 515 and 516: Hull, D., 131 Human Genome Project,
Page 517 and 518: job stress, 104, 114±23 Johanet, G
Page 519 and 520: United States, 101, 300, 430 life s
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symbolic interaction, 8 United Stat
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Israel, 413, 414 Jordan, 407 moveme
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poverty Africa, 370 Brazil, 235±6
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Sanborn, K. O., 31 Sandbach, F. R.,
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Britain, 247, 248 culture, 23, 25,
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Tetelboin, Carolina, 222 Thailand,
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water pollution, 350 Watson, J., 51
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