Despite large revenues in terms of reimbursement from health insurance, many cardiovascular centers in Japan are losing money. On the other hand, manufacturers of cardiac interventional devices are making money in Japan. A big price disparity exists in the field of cardiac interventions between Japan and the West according to many surveys, the first among them being published by JETRO (Japan External Trade Commission) in 1996. Since then, the Central Social Insurance Medical Council has been discussing this issue, but the gap has not been dissolved. The IHEP (Institute for Health Economics and Policy) report on the actual condition of distribution channels for medical devices in 1997, describes several reasons for the high prices of medical equipment and devices in Japan. Among them, the high prices are best explained for by well-acknowledged fact that the sole importing distributors, which are often subsidiaries of the US manufacturers, set high prices (70% of the purchase price of hospitals) when the devices reach Japan. While we proposed several practical approaches to address this problem, we consider the high government-set prices of the devices must be dealt with first. Why is it bad to leave the government-set reimbursement price of medical devices so high, given the fact that hospitals are able to earn the margin profit because the actual price that they pay to distributors is significantly lower than the reimbursement price ? Because, if the total health expenditure of Japan can not be increased in amount due to the government budgetary problems, then the remaining budget left over to cover physician fees will likely be decreased and will eventually hurt the hospitals financial state. The government should take quick action to eliminate the existing price disparity.

The working group on the medical education system in the Japan Society for Medical Education had 2 meetings in 1997. In those meetings, members of the working group discussed on the following 4 problems related to the medical education;
1) System to accept the graduates of other departments (Gakushi) into medical school
2) Clinical professorship
3) Post-graduate universities
4) Education in the department of general medicine (Sogo-shinryo-bu)
The results of the discussions are reported.

A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competence. The format was designed based on several major reports concerning postgraduate clinical training in primary medical care. We found that more than 70% of Jichi Medical School graduates trained in the multi-specialty rotation style in general hospitals that were certified by the Ministry of Health and Welfare. Our results also suggested that these graduates obtained a relatively high level of clinical competence in performing physical examinations, basic laboratory testing, clinical procedures, and various treatments.

A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competences attained in certain technical items. The responses from graduates of classes 1984 through 1987 were analysed, and the questionnaire was found to be highly reliable and moderately valid. The coefficient variable was 0.942, and the relevant variable was 0.934 using the half-split method. The content was clear, because items in the questionnaire were selected from published official reports. In the construction validity, 4 meaningful groups of items were found by factor-analysis. Yearly analysis using such a questionnaire may clarify some of the problems experienced by trainees and training hospitals, and would encourage the trainees to undergo a process of selfevaluation.

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.
The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.
Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.

The 82 nd and 83 rd National Examination for Physicians' License, which were held in 1988 and 1989 respectively, were evaluated from question to question as well as in all the questions as a whole to set minimum pass scores and analysis “relevance” and “difficulty” in a matrix utilizing a modified Ebel's method.
The evaluators were teachers in different disciplines in nationwide medical schools and teaching hospitals and clinical trainees who had taken and passed the immediate past examinations.
Following data processing, the questionable and difficult questions were on the decrease compared with the preceding year, and it was tentatively concluded that the National Examinations have gradually improved year by year.