The Mainichi answers some common questions readers may have about the promotion of family doctors in Japan.
Question: Why are family doctors being promoted in Japan?
Answer: The aim is to divide up the roles of major hospitals, which provide specialized care, and accessible local small- and medium-sized hospitals and clinics. With the fiscal 2016 changes to medical service fees paid to medical institutions, general family doctors, as well as those who care for patients under the age of 3 or those with dementia, were newly acknowledged.
Q: What exactly does it mean to divide up their roles?
A: Family doctors tend to patients with common illnesses, while major hospitals provide treatment requiring more complex types of care. The government envisages patients first going to be seen at a medical institution close to them, and then going to a major hospital for treatment by way of a referral letter from their primary care physician, if it is deemed necessary. The role of the family doctors is to first determine the severity of one's illness. Under a new system that started in April, patients are required to pay an initial surcharge of at least 5,000 yen on their first visit to a major hospital if they do not have a referral letter. This is to discourage people from going to major hospitals for minor ailments.
Q: How are family doctors operated in other countries?
A: France has a system under which people aged 16 or over register with a primary care physician on a voluntary basis, and patients pay 30 percent of the medical treatment expenses. It is possible to visit a major hospital directly, but the personal costs can run as high as 70 percent in such cases, so almost all people register.
In Britain, treatment under the public health service is free in principle, but people first register at a clinic with a family doctor, and are normally seen there first. If necessary, the family doctor introduces the patient to a specialist. People can't see a specialist without a referral letter, and it has been pointed out that it takes a long time to be seen by a specialist due to budget and staff shortages.
Q: Will Japan introduce the similar system to countries like France and Britain?
A: In Japan, the fundamental concept is "free access," allowing patients to freely choose the medical institution where they will be seen. It would be difficult to make major changes to this system. Though patients will face additional costs if they visit a major hospital without a referral letter, the system is more lax than those in France and Britain.