The Nonprofit policy has been a fundamental idea among Japanese medical facilities and for-profit organizations have been prohibited from entering into the hospital market. However recent deregulation movement brings a dispute concerning hospital management as a profitable business. In this paper, we estimated a change which might happen if the regulation were to be removed and considered whether the regulation is really effective or not, to understand an affect of deregulation. The followings are the results, which are attained through this study.
First, we found that the most important changes between before and after deregulation were the availability of profit distribution, that is, there is a nondistribution constraint. Means of financing was also an important factor but not essential. A crucial part was the constraint.
Second, we noticed that there was a confusion of an understanding of nonprofit policy. It should be distinguished ‘nonprofit as a legal status’ and ‘nonprofit as a motivation’. We need to remind that the deregulation can only change nonprofit as a legal status, not as a motivation.
Finally, we did a model analysis from a point of view that is whether the nondistribution constraint regulation can prevent from moral hazard in hospitals or not. As a result, we found that the constraint worked as a prevention of moral hazard under a lower quality premium. However, we could not justify the nondistribution constraint regulation which forces hospitals to follow the constraint.

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This paper is concerned with the welfare implication of regulatory measures which can effectively function as entry barriers in health care markets. The 1985 Amendments to the Medical Service Law required the implementation of a Health Care Plan, where ‘Health Care Areas’ were established aiming for the appropriate allotment of hospital beds to each Area. This Plan determines the threshold numbers of hospital beds medically needed in each Area and it is impossible for new entrants to operate in the Area where the number of beds has already exceeded the threshold. This means that the regulation of hospital beds can effectively create entry barriers which might weaken competition in the health caremarket. Therefore, we explore what is the economic rationale for this type of entry regulation.
One of the prominent features of health care markets is that health care facilities do not necessarily behave in profit-oriented way. We assume that health care facility's objective functions are defined over the number of treated patients and quality of services each patient receives. Health care facilities are supposed to maximize their objective functions subject to profitability constraints under a competitive environment. We construct a rigorous model of competition among nonprofit firms in the framework of spatial economy originated by Hotelling. A remarkable result is obtained. It is the counterpart of so-called excess entry theorem in industrial organization literature. An implication of our result is that entry regulation might be welfare-enhancing, although it should be cautiously interpreted in the context of the current Japanese system of health care provision.

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This paper examines the effects of regulation on the health insurer in Japan. In Japan, the Health Insurance Act allows the insured to choose freely health care providers. This regulation keeps the patients' freedom of access. But it implies that the insurers cannot but reimburse the providers which patients choose, even if they know the providers have less quality. Hence it can be thought to be a regulation to the insurer. This regulation may reduce the social welfare when the patients have little information on the providers.
This paper shows there is a theoretical possibility that the social welfare can be improved by allowing the insurers to contract the providers. The social welfare can be improved if the insurers observe the providers' quality and they contract with ‘high quality’ providers. If it takes the insured significant cost to switch the health care providers, then there is a exceptional case that social welfare cannot be necessarily improved.

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Under conditions of perfect information, all consumers and producers have complete information on all prices as well as the quality any goods or services available in the market. Consumers will also be as well informed concerning the product as the seller. However, in the case of the asymmetric information about quality of goods or services, suppliers have and use their superior knowledge to influence demand for their self-interests. The asymmetric information may be able to generate supplier-induced demand (SID). The increase of physicians generates over-utilization of medical care services under SID hypothesis. However, if there is not any asymmetric information, the increase in the number of physicians may reduce time cost of medical access, hence encourages demand for medical care. Under conditions disregarding the access cost of medical care, the empirical result of SID may be over-estimated.
We estimate the necessary input of medical services for the sake of maintaining the level of health status by estimation of the expenditure function of medical care. Since variations of medical access rate are controlled within estimation model, we measure the degree of waste of medical care use by the increase of physicians in our model. Our study finds that inducement elasticity of about 0.8 for inpatient care,0.4 for the outpatient care.

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The purpose of this paper is to estimate the technical efficiency of Japanese pharmaceutical firms and to analyze the relationship between the efficiency of pharmaceutical firms and NHI Drug Price revisions. This efficiency and relationship has not been effectively analyzed in the past.
First, stochastic production frontier of pharmaceutical firms is estimated, and technical efficiency is measured. Then the relationship between the efficiency of pharmaceutical firms and NHI Drug Price revisions is estimated.
The estimation results of stochastic production frontier of pharmaceutical firms are good. And the results show that technical efficiency is about 90 percent at each firm. The estimation result of the relationship between technical efficiency and the NHI Drug Price revisions shows that drug price of this period is significant. These results lead to the conclusion that the efficiency of pharmaceutical firms increases via NHI Drug Price revisions.

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The research and development of pharmaceutical firms depends in part on public financing. These include universities/research institutes, hospitals, regulators, and people as participants in clinical trials. Following the research of Uzawa (1990), this paper analyzes the role of the public sector as social overhead ca pital. Second using case study of Japan, this paper investigates the roles of public sector in basic research, clinical studies, and new drug approval. Compared with the U. S., social overhead capital in Japanese pharmaceutical R&D is insufficient, which in fact limits the accumulation of professional R&D services in public sector. Due to the containment of government spending, Japan will not be able to invest heavily in the public sector. A possible solution is to introduce private R&D service firms with profit motive.

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In this paper, firstly, I try to analyze the decision-making process selecting in home care or care in welfare facilities. The utilized data comes from the Survey of National Living Standard in 1995. Second, I analyze the labor supply of those who take care at home. The utilized data are the estimated results of the first step and the Survey of National Living Standard in 1986,1989,1992 and 1995.
As a result, with respect to the choice of the care in home, the higher the ability of care in the family is, the higher the probability of choosing care in home is. Furthermore, the greater the supply of welfare facilities is, the higher the probability of choosing welfare facility care. This results show that the supply restriction of welfare facilities and the local governments rationing of them according to the ability of care in family. Then, with respect to the labor supply of those who take care at home, the home-helper restrict the labor supply, and day-service, short-stay encourage a greater labor supply. The estimation results imply that if the policy of welfare for elders doubles, the labor supply of those who take care in home would increase by 16 percent.

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The Japanese version of WHOQOL-BREF has been used with different groups with various diseases and has demonstrated a high level of sensitivity to the variances among the comparative groups in each study as well as a high level of reliability and instrument validity. In order to provide a standard for QOL scores, a survey was conducted to obtain average WHOQOL-BREF QOL scores for a healthy Japanese population using stratification sampling methods in Tokyo, Osaka and Nagasaki in April 1998. The total number of participants in the study was 1,410 (male 679 / female 731), selected to be proportionally equivalent to the age and sex distributions of each site. The average QOL score was 3.29 (male 3.24 / female 3.34). The results indicated no differences in area or sex, but persons over 60 years old had higher QOL scores than those in their 30s.
The General Health Questionnaire (GHQ-12) score distributed simultaneously showed a higher correlation with WHOQOL-BREF indicating that the lower QOL score, the lower people's general health status.
Based on the results of this study of a healthy population, it should be possible to clarify the impact of various diseases and disabilities on people across different populations in order to improve their quality of life.

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