[HGPI Policy Column] No. 15 – From the Dementia Team – How Should the Public React to the Policy Evaluation System in Japan?
date : 9/1/2020
On May 12, 2020, the Ministry of Internal Affairs and Communications (MIC) presented its recommendations for dementia policy based on the results of its third-party evaluation survey, which examined Initial-phase Intensive Support Teams for Dementia and medical centers for dementia.
Measures to evaluate policy in Japan mostly fall into two categories: each Ministry conducts its own internal evaluations and the MIC conducts third-party evaluations. The recommendations presented in the MIC report that is the subject of this column were based on the results of a third-party evaluation.
Members of civil society must shoulder a portion of the responsibility for the effects of policies by electing the right people to represent them in the policy-decision process. In other words, to improve policy, the public must take action and vote.
In our previous column, we introduced Alzheimer’s Disease International’s (ADI) latest report evaluating dementia policy in every country around the world entitled, “From Plan to Impact III – Maintaining Dementia as a Priority in Unprecedented Times.” Japan was considered to have advanced dementia policy and, among the five Stages 1-5, it was rated 5A. To rise to the highest rank, 5B, the report indicated that Japan has room to grow in terms of fiscal measures and policy evaluation. In this column, we will examine the policy evaluation system in Japan using the latest evaluation results of dementia policy as an example.
Japan’s Policy Evaluation System
The policy evaluation system in Japan can be categorized into two types of evaluations, internal evaluations and third-party evaluations. During internal evaluations, each Ministry determines which policies to evaluate and conducts before-and-after comparisons to gauge their quality. Meanwhile, third-party evaluations are conducted by the MIC and target policies that involve multiple agencies, require whole-of-government cooperation and integrated promotion, or require objective and rigorous evaluation. Internal evaluations are conducted according to the National Government Organization Act and the Act for Establishment of the Cabinet Office while third-party evaluations are conducted according to the Act for Establishment of the Ministry of Internal Affairs and Communications. These laws operate according to an administrative action called the Government Policy Evaluation Act, which also stipulates the formulation of basic guidelines and guidelines for policy evaluation.
The Third Party Evaluation of Dementia Policy Conducted by MIC
On May 12, 2020, the MIC presented the results of a third-party evaluation of dementia policy it conducted and recommendations based on those results. An English translation of those recommendations is provided below.
In the field of dementia, in which early intervention and treatment is considered important, the Ministry of Internal Affairs and Communications (MIC) conducted a survey to evaluate current measures to support people with dementia, elderly people suspected of having dementia, and the families of both groups. Based on the results of that evaluation, the Minister of Internal Affairs and Communications recommends the following to the Minister of Health, Labour and Welfare:
(1) After gathering and analyzing real-world examples from each region, provide municipalities with options concerning support schemes and evaluation indices that can be selected flexibly according to local circumstances;
(2) Properly evaluate the operations of medical centers for dementia, which are the core of the medical treatment system for dementia.
These recommendations were based on the results of an Administrative Evaluation Bureau (AEB) Survey conducted by the MIC from August 2018, and represent recommendations from the Minister of Internal Affairs to the Minister of Health, Labour and Welfare. The MIC website also announced the start of the evaluation on July 31, 2018.
The AEB is responsible for providing third-party evaluations, the basic guidelines for which are outlined in the Administrative Evaluation Program. In addition to conducting surveys focused on specific themes and presenting the results of those surveys to promote improvements in AEB Surveys, the AEB reviews internal evaluations conducted by each Ministry in reports called “Policy Evaluation Promotions.” The MIC also provides administrative consultations as part of a framework in which the MIC processes and works to resolve complaints, opinions, and requests expressed by members of the public to the Government. The MIC then utilizes the lessons learned over the course of that process to improve Government administration and public systems. An AEB survey similar to the one recently conducted on dementia policy called the “Survey on the Utilization of Specialized Staff in Schools” was conducted in 2018. Recommendations were made to the Minister of Health, Labour and Welfare based on the results of both of those surveys.
Moving on, we will share an outline of the recommendations made by the MIC based on the results of their survey on dementia policy conducted by the AEB from August 2018. This survey examined the operations of Initial-phase Intensive Support Teams for Dementia and evaluated medical centers for dementia. An English translation of the recommendations made by the MIC based on the results of that survey is provided below.
“Operations of Initial-phase Intensive Support Teams for Dementia”
1. Regarding placement, number of active teams, and results of support provided by Initial-phase Intensive Support Teams for Dementia
- Teams are placed at facilities like integrated community care centers, healthcare facilities, and municipal organizations.
- The number of active teams varies by region and is not affected by municipal population sizes or the number of elderly people living in the region.
- A variance in the ratio of elderly people per support team of up to 33 times was found among municipalities of approximately the same size.
2. Initial-phase Intensive Support Teams for Dementia Involves engagement with those receiving support
- Support provided tends to focus on difficult issues rather than the initial stages of dementia.
3. Evaluation of the implementation status and effectiveness of Initial-phase Intensive Support Teams for Dementia
- At the national and municipal level, the intended effects of initial-phase intensive support on elderly people with dementia are unclear at both the national and municipal level.
1. Gather and analyze examples of support for elderly people with dementia based on factors like municipality size, the number of elderly people in the region, and the placement of support teams and examine the division of roles between support teams and integrated community care centers. Based on those findings, present municipalities with support scheme options that can be selected according to the real-world circumstances in the community.
2. Clarify the intended effects of initial-phase intensive support on elderly people with dementia and provide municipalities evaluation indices to evaluate those effects.
“Evaluation of Medical Centers for Dementia”
1. Evaluation of medical center operations on a national scale
- Fourteen of the 29 or 48.3% of administrative divisions examined in the survey (including six ordinance-designated cities) had not yet implemented measures to evaluate medical center operations.
2. Evaluation of functions and structure related to provision of care by medical centers in each area and in each prefecture as a whole
- The priority of project evaluations based on project objectives is unclear in each region or in prefectures as a whole.
- Medical centers in at least 10 of the 23 prefectures surveyed (43.5%) recorded the number of differential diagnoses (which serves as the basis for evaluating operations) in their operation results reports, so reporting is uneven.
1. Reassess the need to evaluate the activities of each medical center at the prefectural level or at other higher levels of administration.
2. Evaluations of the functions and structure of care provided by medical centers in each region and prefecture as a whole should be clearly outlined in the guidelines for medical center implementation. Measures should be taken to improve operation results reports to remove variances in recording methods used to track the number of differential diagnoses and other evaluation indices in said reports.
The Next Step: Promote Action from Civil Society
Moving forward, we must track the improvements that are made to dementia policy in response to these recommendations. Even though it is called a “third-party evaluation,” AEB Surveys are still evaluations conducted internally within the Government. If we wish for MIC evaluations and efforts for improvement made in response to these recommendations to have sufficient compelling force, establishing a policy evaluation organization that could act as a fourth governing body in addition to the legislative, executive, and judicial bodies might be a viable option. However, in practice, the body that enacts policy is the administration. Or, to be more specific, the authority to make the decisions to enact policy rests with the legislative branch, the Diet. Therefore, the responsibility to evaluate policy should not be borne by the administration alone. That responsibility should also be shouldered by legislation.
In other words, that responsibility also rests with us, the citizens, who must select our representatives through elections. It is our responsibility to make sure that action is being taken to make improvements based on policy evaluations like those discussed above.
A work by famed political scholar Masao Maruyama describes the importance of political engagement among the public as thus:
“It is because people who do not engage in or aspire to politics as a profession engage in political activities that democracy can be kept alive and vivid.”
Masao Maruyama. 1960, “Attitude Determination in the Modern Era.” Thought and Behavior in Modern Japanese Politics, Special Edition, p459.
Here, Professor Maruyama points out civil society’s “sins of omission.” If we do not make requests or proposals to improve politics and policy because we believe we, as individuals, lack significant authority, the combined effect of many people failing to engage causes in great mistakes to occur. As a result, the final policy deviates significantly from what was originally envisioned. In other words, choosing to do nothing can have dire consequences.
I am reminded once again of the importance of maintaining a stance in which we pay close attention to the Government and legislation’s future actions in response to these recommendations and communicate the thoughts and feelings of those directly involved on both sides of caregiving.
Ministry of Internal Affairs and Communications. “Evaluation of Community Support for Elderly People with Dementia and Recommendations Based on Evaluation Results.”
Junro Nishide, 2020. Why Can’t Policy be Tested? Keiso Shobo, 2020.
Masao Maruyama, 1960. Thought and Behavior in Modern Japanese Politics, Special Edition. Miraisha, 2006.
About the author
Shunichiro Kurita (HGPI Manager; Steering Committee Member, Designing for Dementia Hub)