The current shortage and future surplus of doctors: a projection of the future growth of the Japanese medical workforce

<p>Abstract</p> <p>Background</p> <p>Starting in the late 1980s, the Japanese government decreased the number of students accepted into medical school each year in order to reduce healthcare spending. The result of this policy is a serious shortage of doctors in Japan today, which has become a social problem in recent years. In an attempt to solve this problem, the Japanese government decided in 2007 to increase the medical student quota from 7625 to 8848. Furthermore, the Democratic Party of Japan (DPJ), Japan's ruling party after the 2009 election, promised in their manifesto to increase the medical student quota to 1.5 times what it was in 2007, in order to raise the number of medical doctors to more than 3.0 per 1000 persons. It should be noted, however, that this rapid increase in the medical student quota may bring about a serious doctor surplus in the future, especially because the population of Japan is decreasing.</p> <p>The purpose of this research is to project the future growth of the Japanese medical doctor workforce from 2008 to 2050 and to forecast whether the proposed additional increase in the student quota will cause a doctor surplus.</p> <p>Methods</p> <p>Simulation modeling of the Japanese medical workforce.</p> <p>Results</p> <p>Even if the additional increase in the medical student quota promised by the DPJ fails, the number of practitioners is projected to increase from 286 699 (2.25 per 1000 persons) in 2008 to 365 533 (over the national numerical goal of 3.0 per 1000) in 2024. The number of practitioners per 1000 persons is projected to further increase to 3.10 in 2025, to 3.71 in 2035, and to 4.69 in 2050. If the additional increase in the medical student quota promised by the DPJ is realized, the total workforce is projected to rise to 392 331 (3.29 per 1000 persons) in 2025, 464 296 (4.20 per 1,000 persons) in 2035, and 545 230 (5.73 per 1000 persons) in 2050.</p> <p>Conclusions</p> <p>The plan to increase the medical student quota will bring about a serious doctor surplus in the long run.</p

Electoral discourse and the party politicization of sport in multi-level systems: analysis of UK elections 1945–2011

Mandate and accountability theory state that governments should implement the policies that they promised voters. Accordingly, this study addresses a key lacuna by exploring the role of electoral politics in shaping public policy on sport. Attention centres on issue-salience and policy framing in party manifestos in post-war UK elections. In an era of multi-level governance, the analysis also explores the impact of devolution in the UK where, since 1998, sport policy is mandated in four electoral systems in place of earlier, single state-wide ballots. The findings reveal that there has been a sharp increase in issue-salience over recent decades – thereby confirming the party politicization of sport as part of the wider rise of ‘valence politics’. They also show how parties increasingly frame sport proposals to achieve non-sport aims such as promoting social welfare and boosting international standing. Notably, the data underline the territorialization of sport policy following the UK’s move to quasi-federalism – as policy framing is now contingent on ‘regional’ socio-historical factors and party politics, including nation – building by civic nationalist parties

Popularism and Punishment or Rights and Rehabilitation? Electoral Discourse and Structural Policy Narratives on Youth Justice: Westminster Elections, 1964−2010

This study explores the formative origins of youth justice policy and the discursive process of mandate-seeking in party manifestos in Westminster elections. Analysis of issue salience and policy framing reveals: party politicization, a significant increase in issue salience from the 1990s onwards, and a shifting structural policy narrative with inherent contestation and contradictions. The past decade has seen some attempts to revisit pre-1970s welfarist approaches following an extended emphasis on criminalization, incarceration and punishment. This discursive shift has presaged an impressive reduction in levels of incarceration and numbers sentenced, yet international and historical comparative data suggest party programmes need to place continuing emphasis on diversion if full compatibility with the United Nations Convention on the Rights of the Child is to be secured

Party Politicisation and the Formative Phase of Environmental Policy-Making in Multi-level Systems: Electoral Discourse in UK Meso-elections 1998–2011

Despite sustained public demand for parties to act, the environment has been subject to limited issue salience in UK state-wide elections. This article uses qualitative and quantitative methods to explore party politicisation of the environment in regional elections 1998–2011. Contrary to earlier suggestions, the present findings indicate that multi-level systems may facilitate increasing environmental issue salience at the meso level. In part this is a function of nationalist parties' prioritisation of the environment. Overall, electoral discourse is shown to have a key formative role in driving policy divergence owing to inter-polity and inter/intra-party contrasts in salience and framing. From a normative perspective this suggests that the pluralising effect of (quasi-)federalism has the potential to foster greater responsiveness in party programmes through enhanced choice for the environmental issue public. This is an outcome of the expansion of electoral politics following state decentralisation and associated party competition to advance distinctive proposals over rivals