The Day When Japanese Patients Seek Care Elsewhere in Asia

John de Boer (Japan Fellow, Stanford University; Research Associate, GLOCOM)

Over the past several years, Japan has been pressing for free trade agreements with its Asian neighbors in the effort to open up their markets and promote regional economic integration. However, in one crucial aspect, Japan is resisting all initiatives that would liberalize the labor market. As Kiroku Hanai remarked in an article published in the Japan Times (August 23, 2004), in regard to foreign workers, "Japan has maintained the toughest exclusion policy" among industrial nations. As Gregory Clark, a long time advisor to the Japanese government on immigration issues, has pointed out, the rationale behind Japan's stringent immigration policies is based on a concern that increased immigration, particularly among "unskilled" workers, would lead to a rise in crime (Japan Times, August 22, 2004).

While criminal activities attributed to foreign gangs have been swelling, there is no evidence indicating that manual laborers who come to Japan in search of an honest living, regardless of whether they have their papers in order, are responsible for the upsurge in crime on the street. The majority of the 200,000 ‘illegal' immigrants engaged in the construction, agricultural, fishing or entertainment industries are busy trying to make a living and send remittances to their home countries. In other words, they have all to loose by involving themselves in theft and other illicit action. Although this view is a conjecture, the Japanese government's rationale against lifting its ‘exclusion act' seems xenophobic and is reminiscent of the racist policy, under which Japanese migrant laborers suffered vis-à-vis the US during the first three decades of the twentieth century.

Japan clearly needs foreign labor to maintain its standard of living. It is not just the construction, agricultural and entertainment industries that require foreign labor. The fastest growing sector in Japan, healthcare, is also crippled by a lack of workers. According to a Ministry of Health and Welfare report published nearly ten years ago (1996), 27 percent of public and 57 percent of private hospitals do not have a sufficient number of nurses to care for their patients. In all likelihood, these numbers have enlarged as Japan's aging and ailing population continues to grow. Nevertheless, Japan continues to maintain an exclusionary policy towards highly qualified Thai and Filipina nurses, prohibiting them from getting licensed and working in Japan.

Japan's insistence on such a policy makes no sense. For decades, Filipina nurses have gone abroad to places such as Canada, Singapore, America, the United Kingdom and Australia to offer top quality healthcare. To my knowledge, all countries are happy with the service that is being provided and continue to open their markets to foreign healthcare professionals. None of them suggest that these nurses are involved in criminal activity. Despite pleas from Japanese industry and industry lobby groups, such as the Keidanren, the Japanese government has yet to lift the restriction that only permanent residents may sit for national examinations to become licensed nurses.

In the meantime, companies such as Sanyo, Toyota and Matsushita are trying to take advantage of this market opportunity by producing robots to care for the elderly. All are pouring millions of dollars into research trying to develop robots that have human characteristics. All the while, perfectly competent human nurses are available if Japan simply allowed them in.

The cost of maintaining this prohibitive policy could be that the ailing and the aging in Japan chose to seek healthcare elsewhere in Asia instead of being treated by an overworked Japanese nurse or be faced with a robot. Perhaps, this option offers a better way to go anyway. It would prevent educated and highly skilled workers from leaving their own needy population and bring in business at the same time. If Japan is serious about integrating regional economies it should either open up the labor market or face the consequences.