We have a different system for medical insurance. We can not change our patients directly for technical fees and the fee is standardized and lower than that in the United States. For example, the surgical fee of abdominal simple hysterectomy is one fourth of that in the United States. Unfortunately, we realize that we are behind other First World countries in performing operative endoscopy. However, we overcame the problem of insurance reimbursement two years ago, and now we can officially perform operative endoscopy and include almost all disposable devices in our technical fee.
Japan is very tough on the medical supply business.
There are many regulations by our government for all imports, and the medical field is no exception. Our medical advertisements are very limited by law and thus, there is less information available to the patients about modern medical techniques, such as minimally invasive surgery compared to other industrialized countries. Laparoscopic cholecystectomy is now a common procedure in Japan. The general surgeons are invading our field. We, gynecologists, need to make greater efforts to acquire the skills needed to perform M.I.S. in order to meet the emerging patient's demands.