Rhetorical Strategies that Legitimized Exploitation: Lessons from Assistant Nursing in Japan, 1951–2000

Abstract

Japan’s national health insurance system controls health care prices, in a country where many private hospitals and clinics are owned by physicians. These physicians, as managers, need to minimize their labor costs while simultaneously appealing that they work for the public benefit. This paradox forms an essential aspect of Japanese hospital history. However, it has not been well studied. We shed light on this aspect by analyzing how private hospitals approach cost-control measures. We argue that, despite nurses and major mass media widely calling for the abolition of assistant nursing due to low wages and oppressive work conditions, the physicians’ professional association pursued a rhetorical strategy, declaring that maintaining assistant nursing was in the public benefit. This study shows how the association veiled its financial self-interests through a rhetorical strategy of criticism and persuasion. We make three contributions. First, we broaden the historical understanding of global health care by studying Japanese medical management history. Second, we address the broader issue of the consequences of rhetorical strategies when used by those in power. Third, through an inductive approach, we contribute to expanding business history methodologies.