Considering primary care in Japan.

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.