Analysis of Japanese occupational health services for small- and medium-scale enterprises in comparison with the Finnish system

The importance of establishing effective occupational health services (OHSs) for small- and medium-scale enterprises (SMEs) has long been stressed. This study aims to characterize the Japanese OHSs for SMEs through comparison with the Finnish services in terms of relevant legislation, frontline providers, supporting organizations, service contents, personnel and subsidiary or special programs. In Finland the Occupational Health Services Act requires all employers to organize OHSs irrespective of the size of the enterprise, and municipal health centers and private medical centers are the two most common service models for SMEs. In Japan the law requires employers with 50 or more employees to appoint one or more occupational health physicians for advisory services, whereas small-scale enterprises (SSEs) with fewer than 50 employees have available the services of the Regional Occupational Health Center. Expert supportive services are available in Finland from the Institute of Occupational Health, and in Japan they are available from the Occupational Health Promotion Center and several other organizations. Subsidiary programs have been developed for occupational health activities in SMEs in Japan. A nationwide action program on SSEs has begun to provide comprehensive services in Finland. In summary, Finland has attained higher coverage of OHSs for SMEs than Japan, not only through legislation but also by using flexible OHS models. Moreover, in Finland the content of the services is determined according to a risk assessment of each workplace and emphasis is placed on prevention, whereas in Japan health management based on a general health examination is the major type of OHS.