Late last month, the Japan Medical Association elected Toshio Nakagawa, the group’s vice president, as president. He defeated Yoshitake Yokokura, who was seeking a fifth term. Yokokura had been particularly close to the Prime Minister Shinzo Abe’s administration, and the JMA is a key supporter of Abe and the Liberal Democratic Party. Here’s a closer look at the group, its political connections and what a change of leadership might mean.

What is the Japan Medical Association?

The JMA was first founded in 1916 as a medical organization dedicated to keeping up with the latest Western, as opposed to traditional Chinese, medical techniques. Each prefecture has its own chapter.

As of December 2019, there were about 173,000 members. These include self-employed physicians as well as those working at hospitals and clinics. One of the association’s internationally famous members is Kyoto University professor Shinya Yamanaka, who was co-awarded the 2012 Nobel Prize for Physiology or Medicine with Sir John Gurdon, a biologist at Cambridge University.

The JMA is heavily involved in education, supporting medical studies at universities and working to provide continuing education for its members on the latest medical techniques being developed in Japan and internationally. It also cooperates with international bodies like the World Health Organization.

Is the association also involved in political lobbying and activities?

A key goal of the association is to lobby the government for its policies and to provide expert recommendation on health policy issues. It has long backed LDP candidates, including some JMA members who ran with LDP support. In 2010, there was a split in the organization and three members ran in that year’s Upper House election representing not only the LDP, but also two other parties including the Democratic Party of Japan, which was then in power. All three JMA-supported candidates lost.

After the LDP-friendly Yokokura was first elected JMA president in 2012, the association backed a winning, LDP-supported candidate in the 2013 Upper House election, coinciding with Abe’s return to power. Since then, under Yokokura, the JMA has largely continued to stick with the LDP at election time. Political fund reports submitted to the Internal Affairs and Communications Ministry show that in 2018, the JMA’s political lobbying group donated nearly ¥500 million to political parties, with the LDP receiving the lion’s share.

Two JMA-supported Upper House members with the LDP who won office after Yokokura was elected are Takashi Hanyuda, a former JMA vice president, and Hanako Jimi, current Parliamentary Vice Minister of Health, Labor and Welfare.

What kinds of issues is the JMA most concerned about?

Protecting its members against lawsuits for clinical malpractice is a major issue.

But in terms of lobbying, getting the government to adjust medical treatment fees from the national health insurance system so they are in line with the cost of living is an area where the JMA applies regular political pressure. There were severe fights among ministries that wanted to decrease the fees paid by public insurance from the national budget. But Yokokura successfully won an increase.

A more recent issue the JMA has had to face is the question of online medical treatment.

In April, as the coronavirus was spreading, the ban on initial treatment via smartphones and telephones was lifted as a temporary measure. However, the JMA’s position is that face-to-face treatment should be the basic principle and that once the coronavirus threat has ended, the ban on online treatment should be put back in place. Some in the JMA may be worried about a higher risk of misdiagnosis if there is no face-to-face treatment. But the organization also wants to protect members at local low-tech clinics from losing business to newer high-tech clinics or urban physicians adept at using the latest technology. The Abe administration, which regards deregulation of the medical sector as part of an economic growth strategy, has indicated that, as there is no end in sight yet to the coronavirus, it wanted to consider making online initial treatment a permanent measure.

Are things expected to change under Nakagawa?

Following his election, some in the LDP expressed concern about changing leadership at a time when Japan is still grappling with the coronavirus. Especially as Yokokura had forged close relations with the Abe administration. Furthermore, Yokokura is very close to Deputy Prime Minister and Finance Minister Taro Aso, who has a powerful say in medical fees. He, like Aso, also comes from Fukuoka.

Nakagawa said after his victory that while the JMA would “of course” continue to support the LDP at election time, it also needs to consider how to do that and what to say. Nakagawa supported Yokokura’s approach during his time as president and said he views himself as Yokokura’s successor. But some worry that Nakagawa’s outspokenness could cause problems, given that Yokokura preferred a consensus-building approach. In a meeting with LDP Secretary-General Toshihiro Nikai last week, he repeated his assurances. But the loss of Yokokura, a trusted Abe ally, has raised concern that Nakagawa’s presidency could mean cooler relations between the JMA and the Abe administration.

That, in turn, could create political problems for Abe. The government relies on the group’s members to provide not only election support, but also expert advice on the coronavirus. The group’s support is also crucial to any administration in power for drafting policies that deal with mid- and long-term medical and health care issues related to Japan’s aging society.

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