Every other year the Central Social Insurance Medical Council (Chuikyo) determines how much health insurance societies must pay to medical institutions for medical treatments. The 165,000-member Japan Medical Association, which includes private and hospital doctors and traditionally has supported the Liberal Democratic Party, has customarily had three representatives on the 20-member council. But things have changed drastically under the new government.

Health and welfare minister Akira Nagatsuma has decided to remove the three JMA-linked council members. They will be replaced by a member of the Ibaraki Prefectural Medical Association — which rebelled against the JMA leadership and supported the Democratic Party of Japan in the Aug. 30 Lower House election — a member of the Kyoto Prefectural Medical Association, which keeps the JMA at a distance, and the dean of Yamagata University's medical school.

The collapse of medical services, especially in rural regions, is attributed to the fact that many hospital doctors have quit their jobs citing harsh working conditions. These exits have sometimes led to the closure of hospital departments. Although Mr. Nagatsuma's move smacks to some of political retaliation against the JMA, apparently the DPJ wants to improve the quality of medical services in rural regions by raising remuneration paid to hospitals. Chuikyo is scheduled to revise the amounts paid for medical treatment in fiscal 2010.

The JMA has tended to emphasize the interests of private doctors. It quashed an attempt by Chuikyo in fiscal 2008 to greatly increase wages for hospital workers, which would have involved lowering fees paid to private doctors for followup examinations.

Chuikyo's priority is clear: to change the remuneration system so that working conditions are improved for obstetricians, pediatricians and emergency medical service doctors at hospitals. At the same time, Chuikyo should devise a way to reward private doctors who make special efforts to serve patients in local communities. The newly appointed Chuikyo members should work to the ultimate goal of serving the greater good.