The purpose of this study is to clarify the mechanisms behind the deletion of the "evaluation work" during the qualification law's formation process. Utilizing J. W. Kingdon's Multiple Streams Approach, this research aims to explore how political and social contexts influenced the policy formation process, providing vital implication for the advancement of the PT profession.
This study focuses on the period before the 1965 law's enactment. Using minutes of meetings, specialist journals, policy documents, etc., the actions of stakeholders were organized chronologically alongside social background and events. The policy process was then analyzed using a model that depicts the three independent streams of problems, policies, and politics, as well as their interactions.
Policy windows facilitating the 1965 enactment of the Qualifications Act were identified. While previous studies have emphasized the political activities of organizations of the visually impaired, this study presents a different interpretation. The PT qualification system was reorganized by the Medical Bureau of Ministry of Health as a rehabilitation policy, making it difficult for the visually impaired to engage as policy actors. However, the Medical Bureau's refusal to admit visually impaired to PT schools led to discrimination issues, and they ultimately became involved as actors again. Furthermore, the Medical Bureau's claim of lacking knowledge on educating visually impaired became a policy window, leading to PT courses at schools for the visually impaired.
Even after a PT training course that incorporated reasonable accommodations for the visually impaired was established, based on the example of the UK, the Medical Affairs Bureau did not change its stance of absolute disqualification on the grounds of visual impairment. In addition to the support given to the visually impaired by politicians who saw this hard-line stance as a problem, the Medical Affairs Bureau's desire to hurry through the legislation also led to the “evaluation work” and disqualification clause being removed without any discussion of reasonable accommodation.
Legalizing "evaluation work" is crucial for enhancing the autonomy of PTs and enabling direct access for patients. Increased autonomy allows PTs to provide more effective rehabilitation services. To achieve this, it is essential to develop policies that understand the mechanisms outlined above and enhance the education system, ensuring physical therapists acquire the specialized knowledge and skills for independent evaluation work. This will strengthen PTs' position and better meet patient needs.
Multiple Streams Approach
Autonomous evaluation work
