By Charles F. Andrain (auth.)
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A unitary state, Japan has also concentrated powers in the central bureaucracy that followed the Prussian model at the close of the nineteenth century. Yet as in the other three societies, the regional governments and especially the cities handle preventive care measures. Unlike the entrepreneurial model, which draws a sharp distinction between the 'private' market and the 'public' government, under organic corporatism the boundaries between structural sectors seem fuzzier. Central, regional, and local governments intermingle as their leaders participate in policy consultations.
The provincial government's health ministry usually appoints their members, controls their budgets, and specifies their operational procedures. Although board members view themselves as representatives of the local citizenry, their elitist background (high incomes, university education) and lack of information about citizens' preferences for health policies mean that low-income people gain little empowerment over local decisionmaking. Agencies in cities and towns also cannot effectively shape general health care provision.
Greater bureaucratic standardization has emerged, as reflected in uniform standards for medical treatment and categorization of illnesses. Under managedcare plans in health maintenance organizations, health providers and their patients face more restricted choices than before. Managers in government agencies and oligopolistic insurance corporations make key health decisions. Rather than clearly separated, the private and public health sectors reveal fuzzy boundaries. Managers move from government health agencies to private health insurance corporations.