In Japan, for essential information to promote strategies to assure patient safety, we need to estimate the frequency of patient injuries caused by health care. A development of the methodology is urgently needed. The objective of this study was to establish a methodology of a chart review to detect adverse events. We revised the chart review manual and two review forms for "The Quality in Australian Health Care Study" considering the Japanese culture of medical care. As the first step, registered nurses (RNs) screened for one or more of 18 explicit criteria indicating a potential adverse event. Based on the results of the RN screening, as the second step, physicians determined whether an adverse event had occurred. As a result, we confirmed that the adequacy of the methodology consisted of the two-step chart review in order to estimate the frequency of adverse events. We concluded that it would be possible to apply this methodology to a large national survey.

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A pharmacoeconomic study was conducted for the treatment of severe internal hemorrhoids comparing hemorrhoidectomy and OC-108 that was newly developed as a local injected drug in Japan. The study used a decision analytic model and Markov model based on the results of clinical trials of OC-108 and hemorrhoidectomy, and the results of examinations for relapses performed in Japan. The perspective of the analysis adopted was that of the payer, and data on medical fees compiled from a survey of medical claims at hemorrhoid specialist medical institutions. The length of hospitalization according to data from clinical trials was used as an indicator of health status, with the two-year period for revision of medical fees adopted as the time horizon. The analysis showed a switch to OC-108 treatment to result in a cost reduction of ¥51,000 in the two-year period in comparison with hemorrhoidectomy. As OC-108 has been shown not only to reduce the length of hospitalization but also to lower the incidence of pain during initial treatment and eliminate symptoms more rapidly, there is an important need for future research to identify the economic benefits of OC-108 and incorporate an evaluation of QOL.

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In Japan, the factors which affect the opening of clinics are investigated. The results are that:
1) The factors of women, the occupations of their fathers to be independent physicians and entering medical schools to get high incomes make medical students want to be independent physicians.
2) When they are in their 40s, 50s, and 60s, the factors of women and entering medical schools to save lives and not to be stable cause medical students to want to work for the medical universities.
3) When they are in their 40s, 50s, and 60s, the factors of men and the occupations of their fathers to be independent physicians cause medical students to want to open clinics. The results are reverse for the intension to work for hospitals.

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Social insurance for long-term care in Japan, enforced in April 2000, has become a prevalent feature of people's lives and is progressing favorably. However, the cost is increasing, and in addition, regarding the contents of service, false claims for insurance reimbursement and over-utilization are being reported. Therefore, the Ministry of Health, Labor and Welfare set out concrete programs for the "Rationa-lization of care provision" as a special feature of the budget in fiscal 2003, outlining its stance on tackling this problem.
This paper adopts the supplier-induced demand hypothesis approach long engaged in energetic debates in the fields of health economics and examines the possibility of the existence of moral hazard. Data used for the verification is panel data by month and prefecture derived from "The state of long-term benefit payment," "The state of certified persons and beneficiaries" according to the All-Japan Federation of National Health Insurance Organizations and "The information of care providers" reported by the Welfare And Medical Service Agency (WAM). The estimation period is 22 months from June 2001 to March 2003.
This paper focuses on "home-visit long-term care" from among the many varieties of care services available, and it sets out to correct bias through the opportunity cost for access. Estimation results show that when the degree of competition in the home-visit long-term care market is heightened, service utilization is induced and care cost increases, and the induction is caused by the increase of frequency.

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The termination of a policy is considered an important step for correcting existing policies and allocating resources efficiently. Health policy change/termination can not always proceed automatically and smoothly, in accordance with science. Its obstacles come from the properties and social contexts of scientific knowledge, from the political factors affecting policy process, and from the failure of the mechanisms linking between them. The paper addresses these factors, along with possible remedies.

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