Japan’s long-term care regulations focused on structure – rationale and future prospects

Regulations are ostensibly implemented to improve quality and contain public expenditures, and also to show the public that the government is responding to abuses reported by the media. When regulations are revised, professional organizations tend to lobby for upgrading qualification and staffing level requirements because it would advance their status. On the other hand, provider organizations tend to lobby against any revisions that would increase their costs. Their opposing positions could theoretically lead to an ideal balance, skilfully mediated by the government organization responsible for drafting and implementing the regulations. However, in the Japanese context, it has led to a sub-optimal compromise that does not necessarily reflect the needs of society. The government organization also has a major stake because its power and budget would be expanded by supporting and leveraging the power of the interest groups (Lowi, 1979). As a practical issue, a phase-in period is needed for the government agency to develop the capacity to enforce new regulations and for the organizations affected by them to be able to comply with the new requirements. Therefore, the regulations on the provision of long-term care services can only be understood from the underlying motives of the parties immediately concerned. This chapter will begin by presenting the historical background in which long-term care developed in Japan. Next the existing regulations governing long-term care providers will be described, followed by the reasons why they have been focused on the structural aspects of staffing levels, qualifications and facility standards rather than on measurable resident outcomes. The final section looks at the future prospects for monitoring quality in long-term care.