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Acceptance of Foreign Nurses and Care Workers
- A Potential Panacea for Resource Shortage? -

Hisashi Uemura,
Professor, School of Human Sciences, Waseda University

EPA has been signed as a mutual interest between two countries

Indonesian candidates for nurses and care workers arrived in Japan based on the Japan-Indonesia Economic Partnership Agreement (EPA). They are scheduled to take Japanese national licenses to be qualified. According to the Agreement, for two years starting from fiscal 2008, Japan is supposed to accept up to 1,000 nurses and care workers and the scheduled number for the first year is 500, of which 200 are nurses and 300 are care workers. However, the number of the first arrivals on August 7th was only 205 (after that another three arrived), which does not meet the scheduled number.

Hospitals and nursing care establishments are suffering from a severe resource shortage of nurses and care workers. In hospitals current shortfall of nurses are approximately 40,000, while nursing care establishments will need 400,000 to 600,000 new care workers by 2014 as estimated. Since staffing of nurses is directly connected with the hospital revenue under the current medical remuneration system, the shortage of nurses is an issue of critical importance to operation of hospitals. On the other hand, Indonesia has been facing a high unemployment rate of nearly 10% and people have to find the job overseas. It is said that when an Indonesian nurse earns a monthly salary of approximately 200,000 yen in Japan, he/she is able to support a family of 10 in Indonesia. Such interests of both countries probably made them sign the EPA.

Foreign Workers Have Difficulties in Settling in Japan

However, it is too early to expect that foreign workers will come in flocks to hospitals and nursing care establishments in Japan. These Indonesian workers must study for and pass the Japan's national examinations, within three years for nurses and four years for care workers to become the qualified professionals. Those who cannot pass the examinations are bound to leave the country. On the other hand, hospitals and nursing care establishments that are going to accept these workers have such obligations as to conclude employment agreements at the same level of salaries as Japanese workers. In addition to salaries, these institutions are required to bear approximately 600,000 yen per head expense for language education support as well as provide systems of professional training for the Indonesian workers. Some have very skeptical opinions about this scheme - is it really possible for these Indonesian nurses and care workers to perfect Japanese language and pass the national examinations that are full of technical terms and Kanji characters, even if only candidates with certain Japanese language level are selected? If they fail the national examinations and have to go back home, all the money spent by the hospitals and nursing care establishments results in the waste of money. Here arises a question whether the number of medical and nursing facilities willing to accept these foreign workers will increase or not in spite of this large risk involved in this scheme. Even if they pass the examinations and obtain licenses to work in these facilities, there is another concern that the difference in medical standards, lifestyle and/or religious beliefs might cause troubles.

It is reported that for Indonesia, the purpose of dispatching these nurses and care workers is to expand human exchange and the Indonesian government intends to dispatch workers to the fields other than the medical and nursing by taking advantage of this scheme. According to the statements made by some of the Indonesian candidates arrived in Japan, their real motives to come to Japan is to learn Japanese advanced technologies/skills and go back home to make use of them rather than follow the scheduled course of "passing the Japanese examination and stay on to work in Japan". Although the Japan-Philippines EPA to accept Filipino nurses and care workers has been signed on September 9, 2006, earlier than the Japan-Indonesia EPA, it seems almost certain that the actual dispatch of nurses shall be delayed until fiscal 2009 due to the delay of ratification in the Philippines. There is also a doubt whether it is really possible to accept all of the initially scheduled 1000 Indonesian nurses and care workers or not. The bottom line of the government's intention might be that, putting aside the future developments, they would like only to keep up appearances.

Preposterous Policies and Debates

The workplaces of nursing and care taking were labeled "3K" - "Kitsui" (hard), "Kitanai" (dirty) and "Kiken" (dangerous) - and their continual resource shortage was a serious issue. However, since the "bubble" economy time, continuous efforts in increasing the specialized nature of nursing and care taking professions and in improving education systems for the professions have been made in order to make the nursing and care taking highly professional and socially significant work with good future prospects. Finally such efforts have born fruits and the conventional 3K image has been cast aside. These careers have become the choice of many highly-motivated young people. However, the situation is changing again and the nursing and care taking fields are facing restrictions due to the cut back of governmental budget. Remuneration for medical services and nursing care benefits are reduced. Fees for nurses and care workers have been controlled low. Given insufficient employment conditions, the nursing and care taking fields are no longer attractive workplaces for young people, and will inevitably fall into the resource shortage again. This can be described as politics-made resource shortage. It is preposterous to make up for the resource shortage by importing inexpensive labor when the shortage was caused by the cost-saving politics, though the opening of labor market might be inevitable as a global trend. Since the medical and care fields are supported by the "Public Pricing System", sharing of the costs is unavoidable if the society wants to secure quality human resources. In order to solve the resource shortage of nurses and care workers, there is no other way for the nation to accept and share the costs involved in securing manpower for nursing and care service.

Hisashi Uemura,
Professor, School of Human Sciences, Waseda University

Born in Gifu Prefecture on March 23, 1952
Graduated from Kyoto University Faculty of Law in 1975
Joined the Ministry of Health and Welfare (at that time) in the same year Took many positions in government agencies including Law Counselor for Cabinet Legislation Bureau, Division Manager of Health and Social Statistics Division, Ministry of Health and Welfare, Division Manager of Planning and Pension Management Division, Social Insurance Agency, Deputy Director of National Institute of Population and Social Security Research
Was an Affiliate Professor of Graduate School of Law, Faculty of Law, Kyoto University from April 2001 to March 2003
Is Professor of School of Human Sciences, Waseda University since April 2004

Recent books are:
"Shakai hosho wo toinaosu" Chuo Hoki Publishing Co., Ltd., 2003
"Korede wakaru iryo hosho seido" (supervised) Minerva Publishing Co., Ltd., 2007
"Wakamono ga motomeru nenkin kaikaku" Chuo Hoki Publishing Co., Ltd., 2008
"Zusetsu: Korekara hajimeru shakai hosho" (wrote and edited) Nihon Kajo Publishing, Co., Ltd., 2008