Future of visually impaired massage practitioners in Asian countries based on the present situation of visually impaired massage practitioners in Japan

Visually impaired persons have been engaged in the massage business for 300 years in Japan. Currently, the unified law is applicable to acupuncturists, moxibustionists and massage practitioners, and visually impaired massage practitioners are regarded as medical workers (particularly as co-medical workers), similar to nurses and physical therapists.

The length of education for visually impaired massage practitioners is the same as that for nurses and physical therapists. They must complete 3 years of education after graduating from senior high school and will then be given a license  granted by the Minister if they pass a national examination. This examination can be taken either in braille, in enlarged characters, or orally. However, visually impaired persons are not favored in any other way, and the contents of the examination and the passing mark are the same regardless of the presence or absence of visual impairment. Such education and national examination systems have been in use for 100 years. In this way, efforts have been made to maintain a high level of occupational competence while simultaneously enabling unique measures for disability persons to be established within the social system in Japan.

Based on the present conditions in Japan, several proposals are being made for the education of visually impaired massage practitioners in Asian countries as a basis for future discussions.

In recent years, various medical treatment methods have been established as a result of progress in medical technologies, even for diseases that have been considered difficult to treat. On the other hand, the frequency of medical accidents and medical lawsuits has also increased, and a fundamental reconsideration of medical systems is required.

In the massage business in Asian countries, the histories, cultures, business administration, and administrative policies for visually impaired persons differ in each country. Therefore, discussions concerning visually impaired massage practitioners must eventually be made for each country, and not for Asian countries as a whole. On such an occasion, I think that the national reports presented in this seminar may provide a model and sample items for determining the objectives and methodologies in each country, together with confirming the cultural aspects and economic growth rates in each country.

1. To construct a system in which physicians actively support or agree that massage is an effective and useful treatment for patients and healthy persons. Such a system should of course be constructed for license holders, who should be distinguished from unlicensed practitioners.

Medical expenses in Japan have already reached 3.3 billion yen and are considered to continue to increase in the future. Particularly as the baby-boom generation reaches an elderly age, an increase in medical expenses for elderly citizens will become a reality.

Under such circumstances, various companies and individuals have planned to begin working in medical and health care areas, perceiving this change as a business opportunity. Examples include spa massage, aromatherapy, Pilates exercise, chiropractic treatment, Chinese body chiropractic treatment, Thai old style massage, Chinese Tuina, and contact lens clinics. However, most of these businesses eventually close, partly because their business models are unsustainable and because many such workers are unlicensed.

Any attempt to enter into a medical or health care area as a business opportunity should only be made after fully understanding the medical systems that are at the core of these areas.

When services are newly provided, the first step is to clarify what business models are needed, to whom and what added value is provided, and from where profits are generated.

As one of the possible directions of a business, a system can be considered in which added value is provided to the medical area, such as medical institutions and physicians, and with the resulting findings, information, channel and clout, services are provided to surrounding people to gain profits. The above-mentioned added value provided to the medical area could be a contribution to the management of medical institutions or a contribution to the improvement of the quality of medical care.

Suppose that a massage treatment or physical therapy exists that is effective for patients with a chronic phase disease, such as hypertension or hyperlipidemia. Even if the mass media reports that such practices are effective, the business boom may soon disappear. Even if advertising efforts are continued, these treatments and therapies are unnecessary for the general public in the first place; hence, this type of promotional strategy is ineffective.

However, the situation might differ if consultations were made with cardiovascular physicians acting as a channel (although scientific evidence would of course be necessary). Consultations provided by a family doctor based on the health condition of the patient would likely be the most effective means of promoting such medical services.

In this case, an introduction fee for the consultation could be paid, and part of the treatment fee could be repaid to the doctor. In this manner, added values, a contribution to hospital management and an improved quality of life (QOL) for the patient would be provided; in return for these benefits, a role as a channel and promotion from the view point of an expert would be provided. Such practices could provide new evidence and contribute to preventive medicine by monitoring and analyzing changes in health status caused by such treatment methods. Patients would be able to receive treatments without cause for suspicion because such treatments would be known to provide health benefits to the patients and experts could guarantee such benefits. Patients would be more likely to pay for such services.

2. Coverage of massage treatment by health insurance. Medical care in Japan is characterized by the universal health insurance system. Because of this universal health insurance system, the coverage of massage treatment by health insurance requires a national agreement, and such agreements can be difficult to obtain, unlike in the US where coverage can be authorized by private insurance companies. However, it is important to confront this difficulty as an obstacle that must be overcome, and the system should not be modeled after that in the US.

Throughout the world, most advanced countries, except the US, have some form of universal health insurance.

In Japan, the universal health insurance system started with the revision of the National Health Insurance Act in 1961, and all Japanese citizens are obligated to have public health insurance.
(1) Payment of insurance fees: "Policyholders" pay insurance fees to the insurance society.
(2) Payment of fees for medical examination and treatment: When one gets sick, he/she goes to an insurance medical institution, such as a hospital, shows the insurance card, receives treatment, and pays part of the treatment fees at the reception window (usually 30% of the medical fees).
(3) Submission of receipt: Each medical institution makes a receipt for each patient and submits it to the examination organization.
(4) Examination and payment request: The examination organization checks the submitted receipt and sends the bill to the insurer.
(5) Payment of the amount claimed: The "insurer" checks the receipt and pays the amount claimed to the examination organization.
(6) Payment of remuneration for medical services: The examination organization remunerates the medical services to the insurance medical institution. (If the patient paid 30% of the fees at the reception window, the insurance medical institution receives the remaining 70% at this time.)

In this way, one can receive the same medical services everywhere in Japan by paying part of the fees if one shows the insurance card. This system is unique to Japan. Massage treatment is covered by health insurance.

Treatment methods that are not covered by health insurance are not recognized as medical services, and the social diffusion of such methods cannot be expected. A study of massage as a technique covered by health insurance based on medical research and system planning is needed in the future.

3. To establish a license system or, if already established, to enable visually impaired persons to take an examination. As long as the WHO recommends the promotion of massage as medicine, massage must be developed within medical services. In this regard, the massage business by visually impaired persons has to be considered independently of welfare. In other words, equality in the massage business must be secured. Thus, the WHO manual for therapy guidelines prepared in Japan and the original curriculum plans in Asia prepared by AMIN should be considered carefully in each country, and appropriate medical curriculums should be constructed and realized in each country.

4. To expand the massage business to include not only massage but also rehabilitation treatment in general, and particularly to enable the performance of therapeutic exercise, stretching and physical therapy. To do this, an improvement of the educational level has to be planned, and there are merits and demerits in its evaluations. Therefore, serious and time-consuming discussions are necessary. In particular, discussions by personnel involved in the education of visually impaired massage practitioners are required.

5. To consider the active utilization of one's own visual impairment in medical interviews and interactions with patients, in other words, interactions with patients using recognition and techniques of peer counseling are required in patient understanding, and this cannot be done by massage practitioners without visual impairment.

The country report comes from: Graduate School of Comprehensive Human Sciences,University of  Tsukuba