Otaki J
Primary Care Unit, Hokkaido University Medical Hospital, Sapporo, Japan.
Acad Med. 1998 Jun;73(6):662-8. doi: 10.1097/00001888-199806000-00013.
Involved in global competition and with a rapidly aging population, Japan is experiencing major reform in its medical care system and medical education system. Although compulsory national health insurance and accessibility to medical care are supported by the overwhelming majority of the Japanese people, rapidly increasing medical costs have been an important problem. The Japanese government is in the midst of changing the health insurance system from fee-for-service to capitation, and it moved in the 1980s to reduce the number of new physicians as a way to control expenditures. With the lessening of government regulation in the 1990s, each medical school has begun to revise its curriculum to cope with the increasing amount of medical information available and to promote efficient learning. Because postgraduate clinical training programs with defined, comprehensive curricula are rare, and because virtually all clinical training is in inpatient settings, Japanese physicians' clinical competence tends to be insufficient for providing first-class community-based primary care. Japan must try to develop effective education systems in order to deliver better and more efficient medical care, especially primary care.
由于参与全球竞争以及人口迅速老龄化，日本正在对其医疗体系和医学教育体系进行重大改革。尽管国家强制医疗保险以及医疗服务的可及性得到了绝大多数日本人的支持，但医疗费用的迅速上涨一直是一个重要问题。日本政府正在将医疗保险体系从按服务收费制转变为按人头预付制，并且在20世纪80年代采取措施减少新医生的数量以控制开支。随着20世纪90年代政府监管的放松，各医学院校开始修订课程，以应对日益增多的医学信息，并促进高效学习。由于明确、全面的课程体系的研究生临床培训项目很少，而且几乎所有临床培训都在住院环境中进行，日本医生的临床能力往往不足以提供一流的社区初级保健服务。日本必须努力发展有效的教育体系，以便提供更好、更高效的医疗服务，尤其是初级保健服务。
