Discussion
4.1. Comparisons with Western countries The results of the questionnaire survey show that
indicators related to waiting/delay, cancelation, and employee competence were not “preferred” by the Japanese health-care experts although they were commonly used in the previous studies in Western countries. In contrast, the indicators related to workload, such as overtime, length of service and the number of staff per bed, were assigned high “usefulness” by the respondents for Japanese hospital management. But these indicators were not frequently used in Western countries. These discrepancies between Japan and other countries with respect to the content of the indicator sets can be well explained by the characteristics of the healthcare system in Japan and its medical culture. Japan has a public health insurance system covering the entire population, which was once recognized as one of the best and most responsive healthcare systems byWHO [50]. This system offers the Japanese patients the total free to choose any hospital or clinic regardless of their socioeconomic circumstances. According to Hisashige[51], one characteristic of the Japanese healthcare system is high accessibility. The unrestricted access to even tertiary hospitals results in no waiting lists for treatment. Because provision is weighted toward outpatient treatment, Japan has one of the highest rates of physician visits and the lowest rate of hospital admissions among developed countries. This leads to the indicators of waiting/delay are not so important in Japan. The relative useless of indicators related to cancelation may be due in part to characteristics of the social structure and cultural values of Japan.