Nevertheless, the absence of a coordinating physician produces significant structural weaknesses. The health sector is fragmented due to its hospital-centric nature, weak primary care provision, and a lack of coordination among medical institutions. When patients manage multiple conditions across independent specialists, no single physician assumes responsibility for synthesizing their overall care. Furthermore, the system generates overutilization: the free-access model has led to excessive demand, with the frequency of doctor visits per patient in Japan far outstripping the OECD average, placing considerable financial pressure on the national insurance system and contributing to overcrowded hospital facilities.psychiatrist remains possible. This flexible model preserves the GP's coordinating role for complex presentations, while eliminating unnecessary delays for conditions that clearly fall within a specialist's domain.For Japan, progress would involve cultivating a voluntary but meaningfully incentivized kakari-tsuke-i framework — one in which patients are guided toward registering with a family physician who coordinates their overall health, while retaining the right to seek direct specialist care when the nature of their condition is straightforward. For Hungary, reform efforts would benefit from reducing referral bottlenecks for routine specialist visits, thereby alleviating pressure on an already overburdened GP workforce. Japan's system operates on an entirely different premise. The two systems reflect fundamentally different There is no strict gatekeeper system in Japan; patients are not required to have a regular primary care doctor. Patients go directly to specialists, often working in clinics. While Japan has a concept known as kakari-tsuke-i ( かかりつけ医 ) — a preferred physician whom patients may consult regularly — this arrangement carries no mandatory gatekeeping function. There is no formal GP in Japan; in order to receive treatment, patients visit each specialist clinic directly. The most evident advantage of this system is its capacity for rapid, direct specialist access. Patients hold freedom of choice to visit any clinic or hospital nationwide and may self-refer to specialists without first consulting a GP. This, combined with government-regulated pricing, keeps care broadly accessible: a routine clinic visit costs approximately ¥3,000 – ¥5,000 out-of-pocket. philosophies. Hungary prioritizes coordination and cost containment at the expense of access speed; Japan prioritizes individual choice at the expense of holistic oversight. Neither, as currently constituted, represents an optimal solution.Japan's own health policy discourse has begun to recognize this gap. As Japanese society ages and chronic conditions become increasingly prevalent, it will become necessary to have more general practitioners that patients can routinely consult, in order to prevent diseases or the worsening of symptoms. A functional precedent already exists in several European countries: in the Netherlands, for instance, GP gatekeeping is maintained, but direct access to a dermatologist, ophthalmologist, gynecologist, and 16Japan: The Free-Access Specialist SystemToward a Combined Model
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