POLICY RECONFIGURATION:

INDONESIAN NURSES AND CARE-

WORKERS IN JAPAN
As part of the Economic Partnership Agreement between Japan and Indonesia, a total of
1,360 Indonesian and Filipino candidates for registered nurse or certified care worker
entered Japan between 2008 and 2011. This flow of human capital was part of the
negotiation since the Indonesian lobbies put pressure on this topic. Southeast countries
have supplied international need for care workers and nurses, mainly for the USA and
Europe. These migrants have to fulfil the academic requirements and around 3 years of
work experience. After being accepted and placed in a hospital or care facility, they have
3 years to pass the national examination to fully be considered nurses or care workers, and
not just candidates. They have to rapidly learn a very complex language with a very time
consuming writing system. This condition is central because they work is considered
“emotional labour” since they have to comprehend the necessities of their patients.
Nevertheless, the current state of the policy is worrisome since the passing rate of the
national examination are very low. Only 4.0% of the non-Japanese candidates passing. In
the other hand, 91.8% of the Japanese passed this examination.

In this essay we’re going to propose a reform to the current policy. Not only addressing the
demand but also the supply side of the migration flow. First we’re going to see the
complete details of the policy and highlight the stakeholders. After, we’re going to review
the economic burdens and financial viability for both care facilities and Japanese
taxpayers. Also, we’re going to see surveys on this topic to see the general feeling of the
facilities and also nurses and care workers. Finally, we’re going to propose a reform.

REQUIEREMENTS

According to Ohno Shun in his research call Southeast Asian Nurses and Caregiving
Workers Transcending the National Boundaries: An Overview of Indonesian and Filipino
Workers in Japan and Abroad, the requierements for Indonesian nurses are:

Indonesian candidates for the Nurse Course are required

to obtain a nurse license in Indonesia and have two or
more years’ experience working as a nurse. The minimum
two-years’ experience, one shorter than Filipino
candidates, is due to the similarity of Indonesia’s
educational system to Japan’s.

And the ones for care-workers are:

 Indonesian candidates for the Certified Care-Worker
Course are able to apply only to the Probationer Course.
They are required to graduate from the three-year
nursing vocational school or a four-year college, or
graduate from the same-year vocational school or
college in any major plus obtain a caregiver certificate
accredited by the Indonesian government.

If they’re selected, a hospital or care facility will be assigned and they candidacy period
will start when they arrive to Japan. Indonesian candidates are required to study standard
Japanese for six months at the language training institution. During the period of
candidacy, in addition to working, they learn Japanese sufficiently to pass the national
exam in nursing or caregiving, one of main purposes of the EPA programs. According to
Setyowati et al. and Wako, the Japanese government does not regulate the ratio of daily
work and learning hours for foreign candidates at their workplaces, and the conditions vary
widely depending on the assigned hospital or care facility. Nevertheless, the Japanese
government pays the candidates travel, accommodations and daily expenses during their
intensive Japanese language training. However, the employers have to paid for the
intensive Japanese language training but also commission for matching the candidate
and their salaries. This have led to many hospitals to impose a nearly fulltime work and
minimize their leaning hours to actually make the worker worth.

Candidates who pass the national exam become formally registered nurses or certified
care workers, qualified to remain in Japan and work under a “designated activity visa”
that can be extended indefinitely.

The Japanese Nursing Association lobby for equal salary among Japanese and non-
Japanese to avoid cheap labour and replacement of national nurses and care workers.
This organization demanded this conditions to the Japanese government:

1) obtained a nurse license by passing the national examination of Japan,

2) were sufficiently proficient in Japanese for safe nursing practices,
3) were employed under the terms of the job the same as or better than those of
Japanese nurses, and
4) no mutual recognition of the nurse license with the other country.

The JNA was very cautious in accepting foreign nurses, considering the priority of hiring
Japanese nurses.

As Indonesian nursing candidates struggle to pass the exam, they are not permitted to
perform professional nursing duties they could have otherwise performed in their home
country. This could be considered a ‘‘brain waste’’. These healthcare workers are
overqualified to perform assigned tasks and frustration for this situation is inevitable.
However, it is important to note that even in this condition they’re better off because the
wages they receive are sufficiently larger than in Indonesia.
The nurse candidates may take the exam three times within three years whereas the
certified care-worker candidates may take it only once over four years because a
precondition for taking the certified care-worker exam even for Japanese examinees
includes working three years at a care facility.

As we can see in the Fig. 1 made by Nozomi Yagi, Tim K. Mackey, Bryan A. Liang, Lorna
Gerlt in Policy Review: Japan–Philippines Economic Partnership Agreement (JPEPA)—
Analysis of a failed nurse migration policy, the passing rate for non-Japanese is very low. In
the first year that the examination was made for non-Japanese (2010), only one non-
Japanese passed. The next year, 2011, also just one passed. And for 2012, a total of 13
passed the examination.

In 2012, the test was modified by easing certain language requirements, specifically by
placing Hiragana rubric in Chinese characters as well as placing an English translation in
medical terminology. This was designed to allow ease of reading and comprehension. The
passing rate slightly improved, but still worrisome.

ECONOMIC BURDENS AND FINANCIAL VIABILITY

Given the overall low pass rate of the Economic Partnership Agreement Indonesian nurses
seeking Japanese entry, the resultant program cost and administrative requirements have
become excessively burdensome to both the Japanese government and accepting
hospitals. One report estimated the cost to the Japanese taxpayer was approximately
US$1 million for each successful EPA nurse candidate (Idei, 2012). In addition, accepting
hospitals must provide educational support to Japan–Philippines Economic Partnership
Agreement nurse candidates and payment of matching fees, a portion of language
training fees, and annual dues to Japanese International Corporation of Welfare Services.

In this section we’re going to summarize the economic burdens that Kunio Tsubota, Reiko
Ogawa, Shun Ohno and Yuko Ohara-Hirano presents in A study on the cost and willingness
to recruit EPA foreign nurses and care workers in Japan: from the angle of hospitals and
care facilities.

The estimated average fixed cost per EPA worker was 801,000 yen for nurse and 799,000
yen for CW. This cost includes commissions paid to official intermediaries and travel costs

The average variable expense per nurse was 50,000 yen per month, nearly the double of
that for CW because of the need of higher training. This cost includes expenses associated
with language training and preparation for national exams allowances for food
accommodation and others. Also the government subsidies treated as negative variable
cost.

Employment of one EPA worker required additional staff labour of 43 hours per month for
nurse and 20 hours for CW. The opportunity costs of additional staff labour and salaries was
estimated at 360,000 yen per month per EPA nurse and 277,000 yen per CW on average

The total cash expense per EPA worker is 2.6 million yen for nurse and 2.1 million yen for CW.

The total economic cost for the whole contract period was computed at 13.6 million yen
per nurse (3 years) and 13.5 million yen per CW (4 years) or 6.2 million yen and 3.4 million
yen if salaries were excluded.

This situation is critical and the need for reform is urgent because hospitals and care
facilities are currently suffering from economic burdens that may discourage them to
accept others EPA workers. Japanese policy makers should embrace and facilitate this
kind of migration since the necessity of this worker will be vital given the expected ageing
of society.