Compared to any countries in the world, Japan has a health care system that costs half as much and

often achieves better medical outcomes. It does so by banning insurance company profits and limiting doctor fees. Japanese people visit a doctor nearly 14 times a year, more than four times as often as people in Western countries. Concerning about the need of health care, people living in Japan will straightly go to hospitals or private clinics when they need one, since there are no primary health care as we have it in Indonesia. In Japan, patients are free to choose physicians or health facilities and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians, and private clinics must be owned and operated also by physicians. In Indonesia, patients are supposed to go to primary health care first before going to any hospitals, in order to filter the patient flow that frequently happens in hospitals. And there are some hospitals in Indonesia that are actually running to find more profit in every day.

Patients who come to hospitals in Japan are questioned about their major complaints, and directed to department most closely related to their stories, and the treatment plan will be conducted from there. If we have infectious and tropical disease positioned as the top of prevalence chart in Indonesia, Japan has cardiovascular and malignancy cases at the top. If we are to compare about the patients, here in Japan, most patients are in their old times, which means they are in late adulthood or elderly. Adolescent or young adults are rarely seen as patients here in the hospital I had worked for one month. And concerning about cardiovascular and malignancy problems, these patients will go through some additional examination, such as X-Ray, or CT-Scan, or anything else, to screen for any other illness present other than previous findings based on their major complaints. Some people will say this as over-diagnosis, but I personally say this is a pretty good method of conducting a thorough examination of the patient. Since health insurance is mandatory for every Japanese resident, underwent some expensive additional examination or therapy would not be such a big problem, because the insurance company will cover most price costs for their clients health needs. The health care system in Japan provides healthcare services, including screening examinations, prenatal care and infectious disease control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered through a universal health care insurance system that provides relative equality of access, with fees set by a government committee. Compared to our local Indonesian health insurance companies who got the money from their clients, Japanese health insurance companies receive money flow from the government itself. Clients pay taxes to the government and their money is used for health insurance companies for their own health needs. It is like a cycle of money flow. With low health care cost, there will be questions about quality control and gaps in treatment for urgent care, since Japanese hospitals will experience a "crowding out" effect, with space for emergency care and serious medical conditions sometimes overwhelmed by a flood of patients seeking routine treatment. When you need beds for your patients who are in emergency conditions, but the beds are occupied by other patients with less urgent condition. The government has been unable to reduce the length of hospital stays, and the doctors are overworked as you can see.
I personally think that Indonesian doctor-patient relationship is much better than they have in Japan. We have been taught to build an interpersonal relationship to patients, understanding their personal worries and fears, being a friend rather

than just stranger. In the hospital I had worked, I often saw some doctors barely spoke to their patients. Maybe because I was in surgery ward, or maybe it depends on the personality of the supervising doctor, so they did not take communication skills as something matters, I am not sure. Anyways, they gave preoperative informed consent in a very brief explanation, even explaining the whole operative procedure and mistakes possibilities during the operation. That one was good to adopt. In Japan, medical students go through a six-years education, consisting 4 years of preclinical education and 2 years of clinical education, before they finally work as doctors. After they graduate from medical school, they will have to take national examination for newly graduated doctors. We have the same method in Indonesia, those who have finished their medical school should take the examination. But we have to take the examination once in every 5 years, if Im not mistaken. This Japanese examination only has a written test, but Indonesian also has a practical examination other than just written test. Moreover, freshly graduated Japanese doctors could freely choose the hospital they want to work at, unlike Indonesia. Indonesian doctors are placed selectively random, based on the need of doctors in each region in Indonesia. A little bit uncomfortable, but stands for justice, nevertheless. Japanese people produce cars, electronics and other modern technology, yet have the highest life expectancy an lowest infant mortality rates among any population in the world. Such thing could only happen not only because of the people who are concerned about their health themselves, but also supported by a good health care system. I fully hope that Indonesia would have a good health care system as Japan, thus awareness of seeking health care would be increased, leading to improving national health.

Ajib Diptyanusa Kurume University Japan