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The Japanese Society of Neurology decided to aim to convert neurology, which is currently a subspecialty of internal medicine, to a basic specialty in the Japanese medical specialty system at the special general meeting of corporate members in January 2018. Because the details of new specialty system in Japan remain unstable, the committee to promote achievement of neurology as a basic specialty planned to hold a special symposium regarding the specialty system at the 60th annual meeting of the Japanese Society of Neurology in May 2019. This article compiles the abstracts of speakers in this symposium. Speakers were from Ministry of Health, Labour and Welfare, the Japan Medical Association, and our society members. We discussed the reason why neurology should be a basic specialty, the consideration indispensable for the regional health care as a basic specialty, how to reach our goal, and problems to overcome. Based on the decision at the special general meeting of corporate members mentioned above and such discussion, we will continue making best efforts to achieve neurology as a basic specialty through negotiation with relevant players including the Japanese Society of Internal Medicine.

Japan's national health expenditure has been increasing by 5% annually (approximately 1.3 trillion yen) and is expected to reach 30 trillion yen in the 1999 fiscal year. This increase is mostly due to the country's rapid aging rate. However, Japan's current slow economic growth, combined with a decrease in the average number of children per family, raises the issue of how these health-expenditure increases can be afforded as the health care system continues to provide appropriate levels of essential health care services. To understand these health-expenditure trends, one must first recognize that the Japanese health care system is characterized by the country's social health insurance system, which is based on the Social Insurance Act. It is also important to consider the impact the medical fee schedule has on clinical practices. This article reviews the situation surrounding national health-care expenditures and the related issue of social health-insurance reform. In this, several topics closely connected with cancer therapies are also examined.