How doctors manage public assistance in primary care clinics: a qualitative study in Japan.

Abstract (English)

BACKGROUND: Public assistance (<i>seikatsuhogo</i>), a major public welfare service in Japan to support individuals with socioeconomic difficulties, guarantees access to healthcare services but is also known for being stigmatised. Doctors in primary care settings play important roles in the provision of health care for recipients of public assistance, but doctors' roles, practices, and influences in a welfare service for socioeconomic difficulties have not been explored well. AIM: To explore how doctors manage public assistance in primary care clinics in Japan. METHOD: A qualitative study set in an urban/suburban area in Japan using multiple methods: documentary analysis, observation at primary care clinics and semi-structured interviews with doctors, recipients on public assistance, and stakeholders. The data is inductively and deductively analysed, drawing on critical realism as a philosophical background position. RESULTS: Public assistance is complex and holds room for discretion in nature. The complexity could make navigation and implementation in healthcare confusing for recipients. Doctors did not know much about public assistance, and public assistance was even missing from official learning opportunities for doctors, discussions, and doctors' private lives. However, doctors' power in public assistance operated in obscured ways, and doctors' dilemmas associated with the welfare service were also identified. CONCLUSION: How doctors would better work with welfare services with which they do not have much knowledge should be carefully considered in view of its complexity and doctors' power.