Co-production of Health and Elder Care – Cooperative models in Japan

Victor Pestoff | Johan Vamstad | Yayoi Saito

EMES Conferences Selected Papers Series, ECSP-5EMES-28

Health and elder care in most developed countries faces a complex and partly contradictory mix of financial, social and political challenges. Fiscal strains combined with New Public Management agendas have caused severe cutbacks and calls for greater efficiency in public and elder health care, resulting in a growing concern about service quality. The purpose of this project is to explore a possibility to address these issues from a new perspective that emphasizes greater user participation, based on the idea that the patients and clients can play a more active part in the provision of their own care services. This project proposes to explore how health and elder care services can be provided when professionals and patients/clients act as ‘partners’ and where the two parties co-produce the service through their mutual contributions. Institutions that promote a multi-stakeholder dialog between the staff and clients and those that enrich the work environment can also facilitate better service quality.

Japan has a unique health care system with not just one, but two user-owned cooperative health care providers that also provide elder care to their members. Together, these two co-op health care systems have nearly 50,000 hospital beds (or about 5 % of total beds). However, they probably differ from each other and from public hospitals and ‘nonprofit’ hospitals or Medical Corporations (Iryo hojin) in terms of the social values they promote. Their social values will be reflected in their governance model, their relations with the staff and the relations between the staff, the patients and volunteers. This project aims to collect unique empirical data from patients, medical professionals and volunteers at nine different cooperative hospitals across Japan and compare it with similar data from two public or nonprofit hospitals. It will produce an extensive and rich material describing how the health care cooperatives in Japan organize their care according to the principle of co-production, but also in which
kind of organizational setting this is possible.

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