American English, British English and Japanese English

Now, I am studying American accents using CDs and books. When I talk to American people, they usually understand my English. Some native speakers say that they can recognize every words I speak. However, it looks like the TOEFL requires more than that. I should speak English more like American native speakers. So I am studying to improve my accents.
Nevertheless, I am still dissatisfied with it.

A few weeks ago, I went on a trip to England. It was my first time to visit there, so I enjoyed seeing around a lot. There are many different things and cultures from American and Japanese ones. They were interesting for me.
English they are using is also different. I could not understand what they said, and I asked them to repeat it. Since I did not think that British English was very different from American English, I was afraid that my listening skill had become worse. However, when I came back the US and talked with an immigration officer, I understood her completely. So I was relieved that my listening skill was still ok. I understand that American English and British English are different, even though they are both English.

What I want to say here is, there are many types of English, such as British English and Indian English. Even in the US, people in northern area and southern area speak different English. Then, why they do not accept “Japanese English”? Chines English, Russian English, Spanish English, …? Of course, if people cannot understand the English, it is a problem; but if people understand the English with a little effort, it is just a variation, isn’t it?
What do you think?

Difference of the health insurance systems in Japan and the US

Since I was studying for the pharmacy exam and learned about the health insurance system in the US, I would like to talk about the difference between the health insurance systems in Japan and the US. I thought that it was interesting. ( I will not talk about the affordable care here.)

First, the Japanese insurance system is much simpler than the Americans one, All Japanese people are provided insurance by the government, which is pretty cheap. So when they go see doctors, they just have to pay 30% of the total costs. However, only about 50% of Americans enroll in health insurance, because it is very expensive. Even though there are Medicare and Medicaid for special needs, most of insurances are private and each insurance company covers the medical cost differently. People have to pay for part of the cost as deductible, coinsurance or co-pay.

Secondly, Japanese people can go to any clinics and hospitals they like. This means, there is no primary doctors in Japan. However, Americans usually have to go see their primary doctors first (although it depends on HMOs or PPOs). Primary doctors recommend specialists for their patients, if they need more medication. Therefore, it takes more time and effort for patients to get treatments.

Finally, American insurance companies authorize for medical services. Physicians need to obtain approval from their patients’ health insurance plans to prescribe a specific medication for you. This is called prior authorization. Prior authorization is a technique for minimizing costs, wherein benefits are only paid if the medical care has been pre-approved by the insurance company. Japanese insurance does not have such a system, so people can get any medication as they want.

I think that the Japanese medical system is better, but government medical cost have been increasing, which is a big problem. Health is the most important thing in life, so we should think about medical care.

TOEFL is more than an English exam

I have to take TOEFL which is a test often used for measuring English skill of non-native English speakers applying for universities in the US. Even though I am not going to a school, I need it to become a pharmacist here. It is very important for pharmacists to have good communication with patients and doctors so they need to use English fluently. I agree with that. However, TOEFL is very tricky. I heard that even average native speakers can get score 80 out of 120. Many international students are required to get around 80 for entering their universities and over 90 for some good graduate schools.  I am required score much more than that.

In the test, you have to listen to university levels of lectures for 5-10 minutes each and then answer questions about the lectures or write those summaries and your opinions. Please think about it. Do you remember all the details if you are not familiar with or not interested in the topic? Can you write a good essay within 20 minute?  Can you make a good one-minutes-speech just right after you asked to state your experiences or opinions about something? I cannot do that even in Japanese.

This is more than just an English exam. I have to prepare for it seriously.