In a Q&A with the International Health Co-operative Organisation, Dr. Toshinori Ozeki, vice-president of the IHCO and the Japanese Health and Welfare Co-operative Federation (HeW Coop), talks about what the world can learn from Japan’s health co-ops.
What is the origin of Hew Coop Japan and what are their activities and future projects?
Three health co-operatives were established in 1951, and 11 health cooperatives set up Healthcare Division within Japanese Consumers’ Co-operative Union (JCCU) in 1957. Then, Japanese Health and Welfare Co-operative Federation (HeW CO- OP JAPAN) was established in 2010. Its member co-ops own hospitals, clinics, dental clinics and/or care facilities, engaged in healthcare and long-term care business activities. They also work to build a safe and comfortable community where people can keep living for a long time, including development of a system for members to voluntarily promote their own health, gathering places and voluntary activities for mutual support.
The philosophy of HeW CO-OP JAPAN is “Health and Welfare Co-ops promote health, create a peaceful and lively society“. To this end, we have the 2020 Vision as mid-term goals. The 2020 Vision presents 4 goals: (1) to become an organisation trusted by a community as a provider of healthcare, long- term care and welfare that support people’s lives, (2) to connect with people in a community based on demands and to become a driving force to create a longevity community where people of all generations can enjoy their lives with smile, (3) to establish co-ops in every prefecture and to increase the membership rate (i.e. the proportion of local residents joining the co-op) in each community, and (4) to expand a circle of solidarity and collaboration with a wide range of people in order to build a society where everyone can enjoy A healthy and peaceful life. We develop and implement business plans to accomplish these goals.
What is the level of implementation of the health co-operatives in Japan?
As of June 2015, there are 108 member co-ops, with about 2.9 million individual members. As for the number of facilities, there are 76 hospitals, 344 clinics and 1,366 long-term care facilities. Regarding staff, about 35,000 people work there, including 2,000 doctors as well as other professionals (e.g. nurses, PTs and administrative staff). The total turnover for FY2014 was about 320 billion yen, of which 80% came from healthcare and 20% from long-term care businesses.
How does the collaboration between the public health system and health co-operatives work in Japan?
In Japan, healthcare services are provided based on the public health insurance system. However, the system has several serious problems. For example, patients have to pay a portion of the cost depending on their income and age. The insurance does not cover preventive medicine. Some people in poverty are not able to join the health insurance. In response, HeW CO-OP JAPAN works with other medical associations to urge the national and local governments to cover preventive medicine as well as to reduce the out-of-pocket expenses and insurance premiums. Moreover, we also support a system where people in poverty can receive healthcare without applying for the public assistance or paying the out-of-pocket expenses.
Do you believe that health co-operatives provide a genuine alternative for the development of national health systems? Why?
In the Japanese health insurance system, both public and private (including co-ops) healthcare institutions provide the same healthcare services under the same system. In this sense, our services are not alternative; rather, we are a part of the service providers. However, in recent years, Japanese governments have been trying to encourage co-ops and other entities in the voluntary sector to engage in long-term care prevention activities as cheap substitutes. This is part of the government’s austerity measures. The role as a cheap substitute is not something we strive for. Rather, the goal of HeW CO-OP JAPAN is to have the national and local governments take responsibilities to improve healthcare and welfare.
Meanwhile, in the co-op healthcare model, patients and families play key roles in healthcare and long-term care. We believe this model will guide the ideal healthcare model for the future.
As a board member of the IHCO, what do you think are the challenges of the international co- operative movement in the health sector?
I think it is meaningful (1) to share voluntary health promotion activities by members who play a main role in health maintenance and (2) to exchange learning/ training activities for healthcare professionals who support activities of health and welfare co-ops.
HeW CO-OP JAPAN has three goals in order to realise its philosophy: (1) Health and Welfare Co-ops promote health in the whole community. (2) The local residents and the health/nursing care professionals co-operate with each other. (3) Health and Welfare Co-ops create cooperative activities in a community by the active participation of many people.
I believe our activities should go beyond the mere service provision in healthcare and long-term care for healthy life: We should also set a big and challenging goal to “transform a community,” such as building a healthy community through members’ activities.
What are the initiatives developed by Japanese co-operatives related with the Blueprint for the Co-operative Decade?
I believe HeW CO-OP JAPAN can take the initiative in the area of “participation.” Many advanced countries provide public healthcare. While it is a good thing, patients tend to be passive in such a system. HeW CO-OP JAPAN can promote members’ participation in the health field through (1) their participation in health promotion activities for healthy people and (2) healthcare activities where patients and their families actively participate in treatment. Promoting the health of each person can make a societal contribution to the development of a healthy community.
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