The pharmaceutical wholesalers in Japan are still in the dynamic process of merger and acquisition. In the late 1990s, this process seemed to have been accelerated and some large-scale mergers among big wholesalers caused more turbulence and uncertainty. The wholesale consolidation in Japan is rather moderate, but if this process continues, there would be two or three big wholesalers which would dominate over the distribution. Shrinking demand, severe competition and consolidation of manufactures and customers could stimulate wholesale consolidation. In pharmaceutical distribution, one critical factor, changing public health care policy (cutting public drug prices and reducing R-zone), should not be dismissed. Annoyed by reduced wholesale margin and squeezed profit, wholesalers seem to choose the way of merger and acquisition on the premise that the scale could strengthen their power to negotiate with manufactures and hospitals. However, it should be emphasized that their relational strings with manufactures and hospitals have been weakened through wholesale consolidation. Another underlying factor of the structural changes in distribution is integrated supply. Supply chain management, the know-how to optimize the total inventory in the value chain by synchronizing sales activity and logistics, is now catching eyes. In pharmaceutical distribution, logistics has been underestimated because hospitals buy drugs in large quantities and keep their own stocks. But the increasing of pharmaciesing which need frequent deliveries of drugs in small quantities, generates new problems for wholesalers. The question is whether or not existing supply chain management could solve the problems in pharmaceutical distribution. I assume wholesalers need to develop a new marketing system model and customer-based demand chain management, which would integrate logistics, marketing, sales force and customer service to satisfy their customers.

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This article examines the factors affecting hospitalization by using survival analysis. Most of the annual surveys collecting each patient's information on medical resource consumption are executed in a short-term range (for the most part only one month). Therefore, these kinds of large micro level data sets include lots of“censored” samples that don't have whole episode information from the moment of entering hospital to leaving the hospital. Omitting these censored data from the data set is very likely to bring down the sampling bias because long-term samples are largely excluded from the analysis.
As a trial case to cope with this problem, intervertebral disk disease samples are extracted from the large micro level data (H7-9“Iryo kyufu jyukyusha jyoukyo chosa” ) and the Kaplan-Meier method and Cox proportional hazard model are applied to this data set.
From the results of these empirical analysis, some factors, such as the gap of patient co-payment rates (jikofutan ritsu), the difference between hospitals and clinics, the number of diagnoses printed on the receipt and so on are statistically significant as factors affecting inpatient's rate of hospital discharge (taiin ritsu). And that application of survival analysis to this kind of data set may be useful is suggested.

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Some researches have been made on the medical service price indexes. We are going to clarify what problems those researches have, especially on the causes of increasing price indexes. First, we newly worked out price indexes that reflect price and technological changes. Second, using them, we classified the increase rates of scores on diagnostic tests by on-screen projection into several factors. The results have shown that half of the increase comes from the widespread-use of expensive high technologies and that the rising number of the aged is not a principal factor.

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The development of life science has prompted us to use the genetic tests clinically. Strohmenger and Wambach (2000) said that'from the insurance point of view, these diagnostic methods have to be considered as new possibilities for more exact risk classification of insured persons, and also as a possible source of new asymmetry in the distribution of information between insurer and insureds'.
We examine the effects of genetic tests on the health insurance market using the Rothchild-Stiglitz (RS) model. Our focus is on the problems after genetic tests. The information of the genetic test results is different from the information of usual risk of diseases of patients. It seems that insurers can get the genetic test information more easily than that of risk of diseases. Therefore, genetic discrimination is an important issue, and hence the authorities have considered the regulations on insurers' behavior of collecting and using the information of the genetic test results.
We consider five regulations following Doherty and Thistle (1996). Regulation 1 is to permit insurers to know the test results and use them for underwriting and premium rating. Regulation 2 allows insurers to ask applicants about their test results but applicants have no need to answer the question. Regulation 3 is a consent law. Regulation 4 prohibits insurers from inquiring about the test results of applicants. Under Regulation 5, insurers must treat all applicants equally on top of Regulation 4.
Our results are as follows. If insurers know that individuals take genetic testing, under Regulations 1,2 and3, it respects the rights of low risk individuals, the private insurers have complete information ex post and hence we have an efficient outcome in the RS model. On the other hand, under Regulations 4 and 5, the rights of high risk individuals are respected and there is an inefficient outcome because of incomplete information. Furthermore, Regulation 5 may cause the adverse selection problem. As for which regulation we should choose, some social agreement is needed.

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Although the Health Service has been an object of study for a long time in such fields as Health Economics, Medical Sociology, Politics, Social Welfare, a clear definition concerning the Health Service by those fields appears to be lacking.
The difficulty in defining the health service comes from the uncertainty of the meaning of health. A possible cause of the uncertainty of its definition is the change of meaning attached by society to the pursuit of health.
First, the features of service industries are examined as well as the peculiarities of the Health Service, as the Health Service is an industry which combines both Health and Service.
Next, the different definitions of the Health Service given by researchers are presented in tabular form and their different scopes discussed.
After examining the existing studies of the Health Service, the author presents some issues which have not been resolved because the consumer's viewpoint has not been taken into consideration. In order to establish interdisciplinary study of the Health Service and resolve those issues, the author proposes introducing distribution theory and M. Porter's concept of the Value Chain into health service research.

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