Why reforms succeeded or failed: Policy competition and regulatory adaptation in Japan's postwar health policy.

摘要

This dissertation investigates the position that interest groups occupy in the decision-making process of the government of Japan from case studies in the area of health policy. Three important points are demonstrated. First, the medical associations have created strong interdependent linkages to the party in power and have obtained their policy preferences from within the party's decision-making organs. Second, the policy design process in Japan's leading political party, the Liberal Democratic Party, has left little room for the prime minister's initiatives in health care policy. The party has deconcentrated the policy approval process in various councils over which the prime minister has little or no influence. This stands in sharp contrast to the situation prevailing in most parliamentary systems. Third, the thesis demonstrates how the prime minister can, through the design of supra-partisan national councils for reforms, temporarily bypass the normal policymaking channels of the party and enhance its ability to carry out policy adaptation. Two such national councils are investigated: the Nakasone Provisional Council on Administrative Reform (1981–84) and the Hashimoto Administrative Reform Council (1997–98). The temporary national councils are investigated as institutions complementary to the normal policymaking channels of the ministerial and party committees. In the field of health care, the national councils have introduced policy options which had been rejected for years by the medical body and the party in power. The Hashimoto national council, in particular, introduced market-oriented policies that significantly altered Japan's health care system. Three policy areas are investigated: the introduction of principles of information disclosure through the provision of medical files, the creation of transparent price determination mechanisms, and the attempt at reforming the medical fee schedule. These policy changes are seen as a first step toward the introduction of market principles in Japan's service economy.