Deterioration of Local Medical Services Should be Solved by Order-Made Public Choice of Local Governments

Abstract

Research activities in regional science must be organized in response to a variety of social needs, most of which are found seeking the direction of “Customer Centered Innovation” originally advocated by Chesbrough ([2]) . This tendency will lead regional science to the core of “science for society”. This paper presents the thinking and findings of a joint study between medical professionals and regional scientists interested in upgrading policy design competence of local governments for medical services. The research team carried out a series of case studies on local deteriorations in medical service of hospitals managed by local governments and tried to conceive a proper system to draw an individual conceptual map of what specifically caused the deterioration in medical services, assuming each case may have a different map of causes. The findings of this study indicate each local community has suffered deteriorated medical service caused by a set of causes very specific to the community, denying an easy set of policy-mix applicable to each community. This paper also reveals another important factor of “Japanese failure” that has caused many social problems aside from poor medical services. More specifically, we describe findings from “Health Data 2007 of EU” that report considerable difficulties in upgrading medical service systems in Japan have been caused by poor policy generation in the Japanese government sectionalized ministry by ministry, no proper policy discussions often necessary for forming a policy which has cross-ministry components and impacts of the nature. Japan is experiencing a wave of social change that naturally requires a paradigm-change in public choice, but Japanese governments, both central and local, have failed to realize this. Although many policy scientists related to public choice have argued for a long time that governmental organizations must abandon paternalism public choice managed by the government sector, decision processes of public choice in local communities have been improved little so far. The authors conclude that upgrading citizen participation and refining the scientific base of policy design for regional medical systems must be promoted and combine the above stated two activities to render local governments better at building their capacity in policy formulation.JEL Classification: I10, I18, I19