his article investigates how to design optimal cost-sharing schemes for health insurance contracts which include appropriate payment systems for providers. The asymmetric information amongst insurers (payers), consumers, and providers crucially influences the mechanism design of the optimal insurance. In particular, the insurer should take into consideration the possibility that providers might have both incentives to excessively provide services to consumers of low treatment cost, and to avoid consumers of high treatment cost. The insurer should also elicit cost reducing efforts from providers as well.
We demonstrate that the optimal contract specifies the payment promising the larger rent on the treatment of the lower cost consumers without making a loss on treatment for excessively costly consumers. This is achieved by adjusting prospective fixed price per case. However, since there are incentives for providers to induce demand for low-cost consumers, the insurer inevitably confronts an apparent tradeoff between eliciting cost reducing efforts, and constraining inefficient demand inducement. Considering such a tradeoff, the second best solu tion leads to mixed payment systems in which providers are paid a prospective fixed price for treatment of low-cost consumers and reimbursed for the cost of high-cost consumers. Moreover, the optimal insurance should charge the higher copay to consumers of the lower cost treatment, because the possibility of demand inducement cannot be completely wiped out by contriving payment systems for providers.

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Some studies applied the search model to the market for expert services; the model showed that an equilibrium exists where experts convey factual information to customers. However, we demonstrate that such a desirable equilibrium vanishes by replacing the original assumptions with more plausible assumptions. This shows the limitation of using customer search as a mechanism of disciplining experts' fraudulent behavior.

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The purpose of this paper is to investigate demand for health checks, which provide health information. Health information is valuable for consumers who face health uncertainty. Health checks eliminate such health uncertainty. Consumers can decide whether to visit doctors or not after receiving a health check. If the expected utility with a health check is higher than without a health check, consumers choose to receive a health check. Opportunity cost of a health check, age, income, and past illnesses all affect the demand for health checks. Aging extends health risks, health checks are expected to be more valuable for older people. But, older people who confront high health risks do not always wait for regular health checks. Consumers with past illnesses who have certain information on their health condition, decrease the probability of receiving a health check. Those results are also confirmed in analysis of 3 year panel data of male employees in a large corporation.

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Mental diseases have certain weight in health care expenditure in Japan, however, there are few articles regarding the health economics analysis of those diseases in Japan. We used the medical claim data from patients belonging to association-managed health insurance. Patients grouped into two subgroups: those who suffer from mental diseases, and those who suffer from other diseases.
We compared the demand structures for physician visits for individuals in these two groups, especially focusing on the effect of medical checks. We employed the probit-model for the panel data wi t h about 500,000 samples. The variables of gender, age, income and difference of the association of health insurance have effects on the number of physician visits. After removing the effects of these variables, we found that patients who had received a health checkup, made more physician-visits if they suffered from the non-mental diseases. Patients suffering from mental diseases would not make more visits to physicians even if they have a chance of early detection through the health check-up.
The results we obtained show that there are different d e m and structures between the mental disease treatments and the other diseases treatments. This implies that health check-ups gives us a chance of early detection of diseases other than mental diseases. Early detection is said to be effective for treatment of some mental diseases, so we need to reconsider the role of the health check-up system on mental health treatment.

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The purpose of this paper is to clarify the feature of prefectural variations in inpatient medical expenses for the elderly over the period 1983-1999 in Japan, and to examine whether the major determinants proposed by Chino and Sugino (2002)are appropriate or not. As Japan is faced with a rapidly aging population, the problem of regional differences is one of the serious issues in terms of medical resource allocation as well as income distribution. This issue becomes more complicated after the introduction of the long-term care insurance system, i. e. the year 2000, but will be made clear through the empirical results of this study.
The results of the paper are as follows. First, prefectural differe n ces in inpatient medical expenses per elderly person were still large over the period 19831999, and stability in terms of prefectural ranking was also found through the period. This also holds to hospitalization rates for the elderly, which is one of composition elements for inpatient medical expenses. Next, with regard to independent variables, we examine which variables are the major determinants of inpatient medical expenditure for the elderly by using 1999 data. In this estimation, we employ as a dependent variable not only inpatient medical expenses per elderly person but also two alternative variables, the numbers of inpatient medical bills per elderly person and the rates of elderly inpatient numbers to the population by prefecture, to investigate the appropriateness of independent variables adopted in the former paper. The empirical results show that these variables are appropriate as the major determinants of inpatient medical expenditure per elderly person at the prefectural level.

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The purpose of this paper is to measure technical efficiency in Japanese public hospitals and to compare the results obtained from the two models of estimating multi-output distance functions. Namely, data envelopment analysis (DEA) and corrected ordinary least squares (COLS). Output-orientated and input-orientated distance functions are estimated and compared. The mean efficiencies obtained from output-orientated DEA, input-orientated DEA, output-orientated model of COLS, and input-orientated model of COLS are 60.2%,72.1%,88.4%, and 88.9%respectively. The results indicate a strong degree of correlation between the outputand input-orientated results for each of the two estimation methods. The degree of correlation observed between the results obtained using alternative estimation methods is weaker than the degree of correlation between the output- and input-orientated results for each of the two estimation mothods.

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In Japan, there are two main issues of health economics. The first is many patients want to go to big hospitals to take a consultation. Many patients believe big hospitals have good doctors, co-medicals, instrument and care, and so, they tend to choose big hospitals if they have a light illness like a cold. The second issues of health economics in Japan is medical service delivery system and medical invenstment. In Japan, high functioning hospitals still supply longterm care after introducing long-term care insurance and small hospitals get some expensive instrument like a liniac which is a radi-instrument against cancer. In other words, Patient's rushing into big hospitals and unspecialized medical service supply system are Japanese health field issues.
Since 1992, MHLW has changed this situation. In 1992, MHLW appoints some hospitals as high functioning hospital by 4 conditions which include 30%introduction rate and 500 beds more etc. and patient must get a refer paper to take consultation at high functioning hospitals without additional cost. In 1996, if patients directly go to hospital 200 beds over, they must pay additional fee. Now, patients seldom go to big hospitals without refer paper, which we con firm by our data and some hospitals take a motive to reduce average in-patient days less than 14 days for getting more consultation fee from 2000.
In this paper, we analyze patient behavior and extent of hospital specialization using MHLW micro data. As a result of MHLW actions from 1992, most of patients (about 96% patient in 2000) use clinic or small hospital as a house doctor and take refer paper before going to big hospitals. However, immature of longterm care facilities and imperfection of medical fee system make some Japanese, hospital unspecialized as ever.

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This study surveyed providers of home care for the elderly under long-term care social insurance for the elderly in the whole of Japan, and collected information concerning their provision of home visit care, home help service, combined home-visit care-home help, and home-visit bathing service, when their fee for service are reformed. Using this information, own price elasticity and cro ss price elasticity among the services were estimated. In all four services, own price elasticity are significantly positive, i. e. these are 0.03,0.05,0.13, and 0.02 respectively. Thus, these service are price inelastic. From the estimation result of cross price elasticity, pair of home visit care and home help service, and pair of combined home-visit care-home help and home help service have a complementary relationship. Concerning about ownership, public sector like shakyou and local government tend to be more inelastic. Conversely, for-profit organization is more elastic in the service of combined home-visit care-home help and home help service. Concerning about service providing hours, it is more elastic if they provid more time in combined home-visit care-home help or home bathing service, but less elastic if they provide more times in home help service.

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