This study defines "career identity" as the structure or network of meanings that each individual builds to link one's personal values, competencies and personality to career role. The purpose of this study was to investigate the feasibility of using career identity as an effective indicator and source of suggestions for nursing management, by measuring career identity of nursing and care personnel at long-term care hospitals. From October 2003 through February 2004, survey questionnaires were administered to 196 nursing and care personnel at three long-term care hospitals in Japan. There was a positive correlation between career identity score and the degree of effort invested in work (work effort). Moreover, staff who had previously experienced career identity crises had higher current career identity and work effort scores, when controlling for current crisis score. There is evidence that career identity would be an effective indicator to help with such matters as performance management and personnel career development support. It was also evident that career identity score varied according to occupational category and position: the career identity score for nurses was generally low and care workers felt that their field was less empowered than nursing. The career identity score for nurse managers was generally high, but there was no association between a sense of meaningfulness of nursing and meaningfulness of current work and between a sense of identification with nursing and identification with current work. These findings show that different support for career development will be required according to occupational category or position.

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Rapid expansion of medical care expenses has become a major problem in Japan, and shortening the average length of stay (ALOS) by reducing longterm hospitalization has become an important political issue. The ALOS requirement for acute care hospitals was shortened by the Medical Care Payments Revision in April 2002. It is important to evaluate the influences of the Medical Care Payments Revision on ALOS and effects of medical treatment for considering future medical policies such as medical care payments.
In this paper, length of stay and effects of medical treatment were analyzed using the data of patients hospitalized due to transcervical fractures and for artificial head replacement or oseteosynthesis operations. The influences of the Medical Care Payments Revision in 2002 were evaluated, and factors which might influence the length of stay and medical treatment effects (walking ability at the time of ending hospitalization) were also analyzed. The length of stay was analyzed by the discrete-type proportional hazard model, and the effects of medical treatment were analyzed by the ordered probit models. The findings were: i) although the length of stay was not significantly shortened by the Medical Care Payments Revision in 2002, walking abilitiy became worse after the Revision, ii) cement usage at the operation, infections and complications were important factors affecting the length of stay, and iii) in addition to walking ability at the time of hospitalization, dementia, infections, complications, residential conditions and place of return were all important factors affecting the walking ability at the time of ending hospitalization.

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We developed a stochastic model, Proportional Distribution Method (PDM) to estimate disease-specific costs in health insurance claims with multiple diagnoses in 1996. PDM assumes a common magnitude for each diagnostic category and distribute the cost of a claim in proportion to the magnitude for each category. We demonstrated previously that, by using arithmetic means of per diem costs of claims containing a certain diagnosis with proper correction as magnitudes, PDM was able to estimate disease-specific costs in computer-generated simulation data which mimics health insurance claims with multiple diagnoses. In this article we proposed a yet another method of magnitude estimation using Excel® Solver function for optimization and refined the established method of arithmetic means with correction by introducing a correction formula for automatic correction. A Monte Carlo simulation using 100 datasets each consisting of 1000 cases with 100 diagnostic categories, which bears little resemblance to actual claims, demonstrated that PDM had achieved near-perfect accuracy by the method using Excel® Solver function and less-perfect but acceptable accuracy by the method of arithmetic means with correction. PDM is also effective in estimating disease-specific days (in and out patient) in health insurance claims but only costs are dealt with in this article.

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(Purpose)
To analyze the demand of smoking cessation programs for smokers who want to cease smoking.
(Methods)
We surveyed the smokers through the WEB site in February 2003. We asked them the Conjoint analysis about four types of smoking cessation programs, in addition to their demographic and socioeconomic characteristics, history of smoking and experience of smoking cessation. We selected eight thousand subjects and distribute the questionnaires. Conjoint analysis consists of four types of smoking cessation programs are those at the following sites: 1) Pubic Heath Center that provides group instructions, 2) Medical Institution that provides consultation by doctors and nicotine patch, 3) Pharmacy that provides OTC nicotine gum, 4) Pharmacy that provides OTC nicotine patches. Since nicotine patch has not been switched to OTC yet, the fourth program is hypothetical. Attributions in the hypothetical questions are place (program), time-of-the-day, travel time and cost. The levels were selected such that they were orthgonalized to each other and we set five patterns of the hypothetical questions and randomly allocated the responders. We estimate their choice of each program in conjoint analysis using probit estimation with random effects.
(Results and Discussions)
We collected 3166 responses, in which 907 (28.6%) of them were from smokers. The estimation results showed the decline in cost significantly encourages the choice probability of any program. Moreover, the reduction in travel time significantly enforces to choice probability of the program provided by Public Health Centers or by Medical Institutions. In the program provided by Public Health Centers, they can raise the number of participants if they open the program in holidays. The time-of-the-day in the program of Medical Institutions did not affect their choice probability.

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Since August 1992, materials on pharmacoeconomic evaluations (PEs) have been accepted by the government during new drug price negotiations in Japan. The aim of this study was to investigate the current status of use of PEs by pharmaceutical companies during price negotiations. A questionnaire was sent to all pharmaceutical companies that had entered new drug price negotiations with the government between December 2000 to December 2002. Eighty-two price negotiations were made during this period. Ninety-one questionnaires, which covered all 82 negotiations, were returned. PEs were submitted for 19 products (23%). When analyzed according to the method of the price decision, PEs were submitted for 18% of the negotiations in cases where the drug price was set by comparison with an existing drug, and for 40% of the negotiations where the drug price was determined by calculating the cost of development. Examination of the relationship between submission of the PE data and premiums showed that a premium was given in 27% of the negotiations in which PEs were presented, and for 33% of the negotiations for which PEs were not, suggesting that the submission of PEs did not necessarily affect the awarding of premiums. Only one company stated that submission of the PE had resulted in a better pricing decision. The potential usefulness of PEs as one of the approaches to determining the appropriate price-for-value of drugs is suggested by the status of its use in several developed countries. A system for ensuring that the PEs submitted correctly reflect drug prices, such as by the development of PE guidelines to standardize research methods and the establishment of rules for assessing PEs during price negotiations is necessary to promote active utilization of PEs for new-drug pricing decisions.

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