[Modifications in health and welfare jobs transferred to thirty-five participating "core cities"]

The aim of this study was to determine modifications in health and welfare jobs transferred to thirty-five participating "core cities.

We focused on health and welfare jobs in the following sectors: (1) local welfare; (2) health care; (3) city planning; (4) environmental protection; (5) education; and (6) urban revitalization. We developed a self-report questionnaire regarding implementation of administrative jobs transferred from prefectures to the core cities with attention to affects of changes in the jobs on the city administrative efficiency and the health of both the citizens and the city officials. The questionnaire, consisting of 27 multiple-choice and 12 open-ended questions, was forwarded via e-mail to lead city officials of the thirty-five core cities in mid-February 2008.

Twenty-seven cities responded to the questionnaire in mid-March 2008 (collection rate: 77%). The core cities incorporated almost all the jobs transferred from the prefectures, in spite of some limitations regarding time taken for delivering assistive equipment to disabled children, implementing wider administrative plans and establishing educational centers. Almost all core cities answered that they implemented their jobs independently, autonomously and systematically. Seventeen out of 27 core cities established new health care centers during the transition period and increased their number of staff. The majority of these 17 answered that establishment of organizations directly providing services to citizens contributed to improvement in the efficiency of the administrative jobs.

The core cities incorporated almost all the jobs transferred from the prefectures in spite of some limitations. The core cities which established their new health care centers during this transition period increased their number of staff to address modifications to the work load.