Thoracic surgery residency program and health care system in the United States.

The Japanese Board of General Surgery as well as the Japanese Board of Thoracic Surgery voted to change the educational and training requirements for certification eligibility. The health care system has been modified due to a reduction of the budget for national health care, such as introduction of Diagnosis Related Groups (DRG)/Prospective Payment System (PPS). Several problems regarding the system have already been discussed in the United States, ranging from 30-year experience of residency program to 20-year experience of health care system. In a residency requirement, training period became longer in Japan than in the United States, although number of cases required is ten times less in Japan. The General Surgery Board now became mandatory in Japan, whereas optional in the United States. Interprogram transfer is possible in the United States, but not in Japan. Quality control has been organized for Thoracic Surgery in the United States, but the Japanese counterpart needs more work. In health care system, health insurance is mandatory and operated publicly in Japan while the United States counterpart is mostly optional and managed privately. Malpractice suits are 7-8 times more frequent in the United States. DRG/PPS health care system was temporarily useful in reducing the national budget for health care in the United States. However, an incentive to treat patients with uncomplicated diseases and short hospital stay increased the expenditure. In order to control this, Peer Review Organization has been established and restricted the physician's activities. Because health insurance is optional in the United States, people opt for cheaper health insurance with greater benefits. So the health insurance companies with huge number of customers have had strong opinions over physicians and hospitals. This also has created restrictions on practice. These potential problems may occur shortly in the Japanese residency program and health care system as well. Thus, preventive strategies may be needed.