The curious (and self-imposed) obstacles in the world of Japanese healthcare

I came across an interesting article in the Wall Street Journal, ‘High Bar for Foreign Nurses in Japan’ (link here)

However, I also wanted to set the context around why this article illustrated some of the really painful self-inflicted punishments the Japanese are currently going through. 

First is the very sad case of a Japanese senior citizen turned away by 25 hospitals in a matter of two hours due to a lack of available doctors, rooms or nurses (story link here) and who subsequently passed away in March this year. 

Next is another very tragic story of a Japanese lady who passed away after 8 hospitals turned her away as she was due to give birth, again citing a lack of doctors or paramedic services. The baby was finally delivered via a caesarean procedure but the mother passed away. This happened a few years back (story link here). There are much more similar and all tragic cases. 


This is becoming a common theme in Japan these days. The medical system is strained, there are not enough doctors, there are not enough nurses, there are not enough manned beds, and the ageing population is straining the emergency services, and the situation looks very bleak.

The article I posted at the top of this post however also explains everything that is potentially wrong with Japan’s underlying policies.

Currently there are plenty of foreign nurses (particularly from Indonesia and the Philippines) who are keen to work in Japan and support the creaking medical infrastructure. However, these nurses are put through a very stringent test (7 hours AND in Japanese!) which they have to pass in three attempts or they are sent back home. However, only less than 15% of the foreign nurses who have come into Japan in the last five years have passed the test. 

The article highlights how Japan has around 30 million people over the age of 65 (or just under a quarter of her total population of 127 million). According to the Japanese Health and Welfare Ministry, they estimate that Japan’s population will keep declining by one million every year until Japan has only a population of 87 million in 2060. By this time, over  40% of Japan’s population will be over the age of 65. 

The above demographic trends will place a huge burden on the social welfare system, as well as cause immense strains on the medical infrastructure and severely disrupt Japan’s economic developments. 

There is also a shortage of nurses (estimated to be around 43,000 by the Health Ministry). 

Some of the reasons for this shortage is due to:

  • poor pay (salary is around US$2,500 per month);
  • very bad working conditions and long working hours leading to poor morale;
  • increasing concerns over medical malpractice lawsuits by patients

One would have assumed that this would mean that Japan would take a more pragmatic view to immigration, particularly in the medical sector. However, it is looking very unlikely under current the current premier, Shinzo Abe. ‘Abenomics’ or a combination of economic policies including that of printing of money quantitative easing, weakening of the yen, and good old Keynesian pump-priming of the economy are helping boost (at least temporarily) the Japanese economy. 

There remains however a fundamental problem with the lack of a sufficient number of economically active individuals to support longer term economic growth. Immigration is one tool that can help mitigate this problem but there seems to be a long standing opposition to immigration and there is still a high level of insular behaviour. Tradition and somewhat misplaced views and tendencies (such as attributing crime mainly to a foreigner influx, or blaming foreigners for salaries being cut, and dilution of Japanese culture) still prevail and according to the article , in a national poll conducted in 2012 by the Japan Association for Public Opinion Research, only 1.7% of respondents said that Japan should promote immigration. 

Japan has tried to bring some of the nurses out of retirement but wages remain low which means less of the nurses are keen on coming back. Wages remain low because public debt remains high in Japan and since the government bears the bulk of the medical costs, they are unwilling to raise salaries and wages for those working in health-care. The Japanese Nursing Association estimated that the turnover rate for nurses in 2011 stood at 10.9 percent, indicating that about 150,000 nurses quit that year.

These are extremely serious conditions which Japan needs to tackle.


From diversity comes strength. Obscurity will follow insularity.

Japan has to decide which is more important. The preservation of Japan’s culture, the well-being of her people, and the ongoing progress of her economy, may well depend on Japan’s ability to look beyond the status quo and embrace a more pragmatic vision of the future. 


What businesses need and what education systems deliver – a widening chasm?

Having had the opportunity to read an excellent article, “Falling short on skills,” published in the latest edition Hay’s Journal (Issue 5 – 2013), I wanted to share some key highlights from the article. (For full article, please click here:

The basic premise of the article was around the increasing phenomenon that is “talent mismatch” where the existing labour force does not possess the requisite skills that businesses need. The level of talent mismatch is increasing despite persistently weak labour data, with widespread unemployment globally.

The article examines what businesses and education provides can do to narrow this mismatch and fill the gap required by economies as they look to emerge from the doldrums of a weak economy and avoid the social pressures and friction that persistent unemployment can induce.

A new index, The Hays Global Skills Index 2012, developed jointly by Hays and Oxford Economics designed to understand the trends within the global professional workforce indicates that the skills employers require and the skillsets possessed by jobseekers is widening.

The Index in a nutshell:

  • 27 countries assessed with strengths and weaknesses of each country’s workforce analysed.
  • Countries are scored between 0.0 and 1.0 – where a score of 5.0 indicates a balanced market for skilled labour; a score of less than 5.0 implies a slack labour market (i.e. few skilled jobs or oversupply of skilled labour); and a score of greater than 5.0 indicates a tight skilled labour market (i.e. insufficient number of skilled employees).
  • Seven factors are considered including, talent mismatch, the local education system’s ability to adapt to the evolution of businesses’ requirements and labour market flexibility.

The Index indicates that most of the countries assessed suffer from labour/workforce issues and do not have stable scores against the indicators used. The reasons for these skills and talent issues stem from different underlying problems inherent in each of the countries. Some of the factors include, ageing workforces (particularly in the case of Japan and Germany), rigid or restrictive immigration policies (a source of real concern in the UK) or lack of sufficient employer and education institutions’ coordination.

In the words of Michael Dickmann, Professor of International HRM at Cranfield School of Management, “When education and businesses don’t coordinate, education can’t adapt.”

There remains an expectations and knowledge gap between what businesses require from graduates of educational institutions and what academics believe businesses need. Another challenge educators and academics face is rapid growth of businesses and their own rapidly evolving needs. It is felt that the immense pace of business growth has outstripped the capacity of local education institutions to meet demand.

The article also provides with a few case studies from the US, the UK, Germany and Japan. Interestingly, the UK has amongst the highest levels of talent mismatch across the countries surveyed. There exists severe skills shortage in sectors from IT to energy to finance. The talent mismatch is being exacerbated through the tightening of immigration rules over skilled workers adding to the UK talent pool.

Japan also has a very high talent mismatch due to a combination of an ageing population, a relatively closed immigration policy, limited diversity and the increasing global demand of Japanese companies.( In a separate article in the Hay’s Journal, reference was made to Japanese firms valuing international perspective amongst jobseekers. In particular, advanced English skills, an interest and ability to adapt to different cultures and accommodate different viewpoints were seen to be very important attributes. They want candidates with a global mindset and firmly believe that this is what is required for both Japanese firms and Japan herself to be successful.)

Germany is also facing challenges in finding skilled staff particularly in view of her ageing population. German companies are turning towards using flexible labour. They are now using open HR structures and work increasingly with freelancers and temporary workers.

It is also noted that in the US that more established and mature firms with developed learning and development functions generally tend to spend a third more on training. In 2012, US businesses spent an average of US$706 per learner (whereas more established companies spent US$867 per learner – or a third more).

The article concludes with a view that no single company, educational establishment, or country has a panacea for this critical issue of global skills shortage. It calls for renewed collaboration between industry, education, and the state to help resolve this challenge.