The iron triangle of Japan's health care

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7482.55 (Published 06 January 2005) Cite this as: BMJ 2005;330:55
  1. James Kondo, associate professor (kondo@hsp.u-tokyo.ac.jp)
  1. Healthcare Policy Unit, Research Center for Advanced Science and Technology, University of Tokyo, Komaba, Meguro-ku, Tokyo 153-8904, Japan

The Japan Medical Association is losing its grip on healthcare policy

Medical associations around the world influence healthcare policies in their respective countries. Policy makers turn to professionals for guidance on complex issues, so it is only natural that medical associations exert their influence through their knowledge. However, expertise alone cannot explain the influence of the Japan Medical Association on healthcare policy in post war Japan. The association's post war foundation was built during the 25 year presidency of Taro Takemi from 1957 to 1982. Takemi's uncle-in-law, Shigeru Yoshida, was Japan's first post war prime minister. This connection gave Takemi and the association unrivalled access to Yoshida and his successors in the ruling party. Through its influence on the ruling party, the association forced Japan's Ministry of Health, Labour, and Welfare to take heed and dictated much of healthcare policy.

Building on the legacy that Takemi created, currently the association boasts a membership of 159 000, a budget of 16bn yen (£83.4m; $155m; €119m), and an annual political donation fund of …

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