The ideal of Independent Living (IL) has been widely supported in many advanced industrial societies since the international disability movement of the 1970s. While the effectiveness of the IL ideal is recognized in Japan, almost no research has been done to understand the processes by which individuals first become familiar with the ideal of IL and subsequently pursue a lifestyle reflective of it. This study, based on interviews with thirty-eight people living with physical disabilities in urban Tokyo and the provincial San'in region, describes when and how the IL movement spread in these two areas and the ways in which people encountered the ideal of IL. Although rates of development differed, similar patterns of development were evident in the two areas. In the early stages in both areas, a very limited number of individuals undertook experimental efforts at IL. As this group of pioneers began to form a center for independent living (CIL), former classmates and other acquaintances were recruited to join the movement. Finally, as the CIL began to provide services to the community, a growing number of individuals encountered the IL ideal through the CIL's outreach efforts. Unique to the Tokyo area were two kinds of case, one in which individuals made use of a Tokyo CIL to relocate to Tokyo and another in which a person who had no special awareness of the IL movement applied for a job at a CIL.

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We propose a simple model describing supply and demand for dental services by patients and by physicians based on assumptions that they maximize their utilities. We consider how the change of the copayment rate affects the supply and demand with the model and also empirically examine the effects after the 1997 reform where the copayment rate of the head of the insured family was raised from 10% to 20%. The doctor visits of the head decreased after the reform, while those of dependents did not. The dental service fee per visit did not change significantly.

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This study tried to develop quality indicators (QI) intended for the inpatient care of acute myocardial infarction using a systematic review and a consensus method. The development of the selected indicators was performed in accordance with 4 steps: 1) depiction of initial index items based on a systematic review, 2) evaluation for appropriateness of the items by experts using a Delphi method, 3) qualitative evaluation through the consensus meeting by the expert panel, 4) revaluation after the expert panel meeting. We selected 9 members as the expert panel committee for developing the QI. On the initial step, we collected 41 quality evaluation items. Each indicator item was assessed and scored by every expert panel member, then the median and range of each item was calculated and informed to the member before the consensus meeting. Then the all members gathered and the 2 hour consensus meeting was conducted. The appropriateness of all nominated items as QI were discussed and estimated by the members. Some items were deleted and the contents of some items were modified. After the meeting, we sent the modified set of items which fulfills a standard as the QI to the expert panel members, and then we re-scored the evaluation items. The QI were finally arranged into 22 items in total. These procedures went well as an initial challenge for the development of an appropriate tool evaluating quality of the process of medical care.

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