Co-production in Japanese health care cooperatives: Findings of the survey

Research background              Health and elder care in most developed countries face a complex and partly contradictory mix of financial, social and political challenges. Fiscal strains combined with NPM... [ view full abstract ]

Research background

             Health and elder care in most developed countries face a complex and partly contradictory mix of financial, social and political challenges. Fiscal strains combined with NPM agendas have caused severe cutbacks and calls for greater efficiency in public and elder health care, resulting in a growing concern about service quality. Our project explores a possibility to address these issues from a new perspective that emphasizes greater user participation. It is based on the idea that the patients and clients can play a more active part in the provision of their own care services. It asks how health and elder care services can be provided when professionals and patients/clients act as ‘partners’ and where the two parties co-produce the service through their mutual contributions. Institutions that enrich the work environment and promote a multi-stakeholder dialog between the staff and clients can also facilitate better service quality.

            Japan has a unique health care system with not just one, but two user-owned cooperative health and elder care providers. They are Koseiren (based on agricultural co-op) and Medical co-ops. These two co-op health care systems have nearly 60,000 hospital beds (or about 5 % of total beds in Japan, but more than both Finland and Sweden combined). We expect that they probably differ from each other and from public hospitals and ‘nonprofit’ hospitals or Medical Corporations in terms of the social values they promote. Their social values are reflected in their governance model, relations with the staff and relations between the staff, patients and volunteers.

Methodological consideration

              We will introduce three key concepts in this paper: co-production, work environment and multi-stakeholder dialog and governance. E. Ostrom and her colleagues analyzed the role of citizens in the provision of public services in terms of co-production (Parks et al., 1981 & 1999). The concept of co-production was originally developed by Ostrom during the 1970s to describe and delimit the involvement of ordinary citizens in the production of public services (Ostrom 1999). Recently there has been a renewed interest in the study of co-production (Pestoff & Brandsen 2006 & 2009, Alford 2009, Pestoff et al 2011). Co-production can achieve better quality services and/or result in the provision of more services, often at a lower price, than is possible without citizen participation. We also discuss work life stress in Karasek & Thorell (1990), the concept of multi-stakeholder governance in Vidal (2013) and in Vamstad (2007, 2012). 

Our survey and analytical model

              This paper treats a part of results of the Survey of Japanese Health Care Cooperatives which was conducted in 2013 and in 2016. In 2013 survey, we interviewed 9 health care cooperatives in Japan and collected documents and basic data of them for analysis. In 2016 survey, we distributed 7,520 questionnaires to professionals and administrative staffs in hospitals and eldercare services in 8 cooperative organizations (5,414 respondents). We have also distributed 2,750 questionnaires for patients and 980 for volunteers (in progress). This survey was financed by the Mitsubishi Foundation, the Japan Society for the Promotion of Science and Osaka University. The project is conducted within the framework of an established cooperation between senior researchers at Osaka University and Ersta Sköndal University College in Stockholm. And we work together with the Consumer Co-operative Institute of Japan, JA Zenkoren, Japanese Health and Welfare Co-operative Federation.

              Figure 1 shows our analytical model.  The model is comprised of three pillars: 1) the national and regional institutional and environmental conditions for hospital, 2) each hospital’s organizational setting, 3) the intervening variables for closer scrutiny. We use the outputs and outcomes which come from the collected data and questionnaire survey result for the analysis.