What A Waste Of Taxpayers Money

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A program ostensibly designed to bring foreign health care workers to Japan to alleviate labour shortages has become a huge waste of taxpayers' money.

Off to a bad start

Prime Minister Koizumi decided to start accepting Philippine nurses and caregivers in 2006 – this was part of trying to advance an economic partnership then being negotiated between the countries. The following year Japan started accepting nurses and caregivers from Indonesia through a similar economic partnership agreement. At that time it was planned to admit 1,000 caregivers in the first two years of the programs. To date, about 1,400 nurses and caregivers have come to Japan.

Underling the initiative was Japan's desire to find somewhere to send industrial waste, while the Philippines wanted to send workers overseas to make money that they could repatriate to their home country. Thus at its core the policy had nothing to do with nursing care from the start.

JPY8 billon spent and only 104 pass!

Japan's Ministry of Health, Labour and Welfare (locally known as “KoRoSho”) has a reluctance to admit foreign labourers. It was concerned that an influx of foreign caregivers would adversely impact the employment of Japanese. As a result, KoRoSho put in place a certification exam. Foreign nurses come to Japan on 3-year and caregivers on 4-year visas. To extend their visas, they have to pass this exam.

However they must take the exam in Japanese, just like Japanese nationals. Nurses can take it three times, starting from the year following their entry to Japan. Caregivers can only take it once because they need three years' work experience as part of their qualification. Although both nurses and caregivers can re-sit the annual exam a year later if they score high enough, they are subject to deportation if they don't pass.

Over the 3-year period from 2009 to 2011, less than 3% of foreign nurses passed (although the pass rate did increase to 11%, 47 out of 415, in 2011). This is much lower than the approximately 90% pass rate for Japanese nationals. In January 2012, 95 caregivers that entered Japan in 2009 sat the exam for the first time – 38% passed which is again much lower than the 60% pass rate of Japanese nationals. The language barrier is undoubtedly holding foreign nurses and caregivers back.

According to KoRoSho, Japan will be short 700,000 caregivers by 2025. However, the ministry does not view foreign caregivers as a step towards solving these labour shortages. Rather it is seen as an international contribution to human resource development. Yet even this perspective is not plausible for the nurses that come to Japan are already qualified in their home countries. In the case of caregivers, even if they become certified in Japan it would be useless to them on returning home as the care facilities in Japan are more advanced than the ones in their home country.

So around JPY8 billion in taxpayers' money has been spent since 2008, a large amount of which has been for Japanese language training and exam preparation initiatives. To date only 104 caregivers have passed. That works out at JPY80,000,000 per person who passed!

Care facilities no long want foreign workers

Starting with a target of accepting 2,000 nurses and caregivers in 2 years, after 4 years only 70% of this number has been achieved. Care facilities must pay foreign workers as much as Japanese nationals. Yet no matter how much training they provide, the foreign workers still have a lower chance of passing the required exam. So fairly well as soon as these foreign workers become productive in their new environment, the facilities stand the risk of losing them via deportation. The result - the care facilities are disillusioned with the program and are declining to accept foreign nurses and caregivers.

After much media criticism of the low pass rate, KoRoSho is making things easier for the foreign exam-takers. From 2012 the exam text was made easier to read. From 2013 additional exam time will be given to foreigners. But these adjustments miss the core point, as these incremental measures won't make more care facilities want to accept program participants.

Vested Interests

Facilities looking to employ foreign nurses and caregivers must pay an upfront a placement fee of JPY160,000 and JPY360,000 for Japanese language training per worker.

Former health ministry officials (under the Japanese practice known as amakudari or “jobs for the old boys”) have a monopoly on the placement business. Even then, all

that the placement organisations do is to match available nurses and caregivers with facilities seeking workers. The rest of the recruitment process is left to the workers' home countries meaning getting JPY160,000 per placement for very little effort is good money. Similarly, Japanese language training is handled by organisations with ties to the Ministry of Economy, Trade and Industry and Ministry of Foreign Affairs, both of which are involved in the economic partnership agreements. There is no need for these organisations to be involved with Japanese language training – such involvement only adds to costs.

Time to Rethink

The first step is to discuss whether foreign nurses and caregivers are necessary. If so, the discussion needs to turn to how many, from where and how to ensure they are adequately qualified. Such fundamental questions need to come well ahead of the currently proposed incremental changes to the exams.

Yet the current flawed system continues to move ahead without any sign of change, for in April the government agreed to start admitting nurses and caregivers from Vietnam on the same basis as those currently in this scheme.