Objective: The monetary evaluation of QALY gain is necessary and important for medical and public health policy decision-making. Even though one piece of empirical research has been conducted about this, the research used direct methods to estimate WTP and thus encountered a great deal of problems. This paper aims to study the same topic using conjoint analysis.
Material and Method: A survey was conducted in 2005 and questionnaires were distributed to and collected from 773 households. The response rate was 88%. The subjects were 1,297 adults over age 20. In addition to socio-economic characteristics, in this survey respondents were asked a hypothetical question for conjoint analysis purposes: whether they would agree to medical care under a hypothetical situation in regards to cost, duration, number of patients, and health status. We also performed a sensitivity analysis in regards to explanatory variables in the estimation equation, discount factors, and QOL evaluation for health status.
Results: In all the estimations, the estimated coefficients of total cost are significantly negative and those of QALY gain are significantly positive. The WTP per QALY gain is estimated to be 6.35 to 6.75 million yen. Income does not affect WTP per QALY significantly.
Discussion: The WTP per QALY obtained in this paper is slightly higher than in the previous one, but it is worth noting that the difference between them is minor. This finding suggests that there is strong evidence for WTP per QALY being around 6 to 7 million yen.

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This paper analyzes lengths of stay at the hospital using data from patients hospitalized for cataract ((IR-DRG (International Redefined Diagnosis Related Groups) 2041) in Japan. Unlike other countries, not only one-eye surgeries but also two-eye surgeries are done in a single period of hospitalization in Japan. It is an interesting question whether two-eye surgeries reduce the length of stay at the hospital or not. In this paper, the lengths of stay of one-eye and two-eye surgeries were analyzed by the discrete type proportional hazard model. The factors which might affect the decision to perform one-eye or two-eye surgeries were also analyzed by the discriminant and tobit analyses.
In one-eye surgeries, we found that child, place to return after hospitalization and types of additional operations were important factors making the length of stay longer. In two-eye surgeries, place to return after hospitalization and types of additional operations were found to be important factors making the length of stay longer. The lengths of stay for two-eye surgeries were shorter than doubles of those for one-eye surgeries except one hospital. The patients who had two-eye surgeries were found to be older with lower tendency of going to other facilities after hospitalization than those who had one-eye surgeries. We also found that as hospitals became larger and more profitable, the proportion of two-eye surgeries became larger.

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In this study we examined the effects of psychological preparation at home on emotional upset in young children aged 3-7 years scheduled to undergo inguinal hernia in hospital. Subjects were randomly assigned to one of two groups that both viewed a promotional video once as outpatients in a group of other patients prior to hospitalization ("standard of care"); the control group (n=31) later underwent surgery without any further preparation; the intervention group (n=28) watched the same promotional video again at least once at home with their parents prior to hospitalization and surgery.
The patients' emotional upset was measured once pre-intervention, twice perioperatively, once at discharge, and three times post-discharge, the last being 1 month after surgery. Patients' perioperative vital signs and parents' anxiety were also assessed.
We found that patients in the intervention group experienced significantly less upset at induction of anesthesia (p=0.04) and in the postoperative period (p=0.01) than patients in the control group and that such perioperative vital signs as body temperature (p=0.003) and heart rate (p=0.02) indicated lower physical stress in the intervention group than in the control group.
We also found evidence of post-hospitalization negative behaviors in both groups, suggesting that medical personnel should proactively follow up and assess the condition of such young patients and their parents.
We concluded that psychological preparation with parents at home significantly alleviates young patients' perioperative emotional upset and disturbances in vital signs; young patients' post-hospitalization mental state and parents' anxiety merit further investigation.

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[in Japanese]

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Based the Health and Social Care Act, foundation trusts became recognized as legally independent corporations called Public Benefit Corporations in the United Kingdom in 2004. They have been set free of central government control, manage their own budgets and are able to shape the healthcare services they provide to better reflect local needs and priorities. Thirty-two foundation trusts have applied the concept of 'corporate governance', which is popular in private enterprise through the world, to the top management of hospitals.
This paper clarifies how all foundation trusts in the UK practice the corporate governance reform based on the stakeholders' participation in management, applying corporate governance principles. First, I considered how state-operated hospitals have been privatized in the UK since 1991 and how the concept of corporate governance has been introduced to foundation trusts. Second, I examined how the development of the management structure is founded on the stakeholders' participation in the management under the leadership of patients, and how foundation trusts practice the management reforms. Third, I elucidated how foundation trusts execute the advancement in transparency and disclosure.
This analysis emphasizes that the foundation trusts' approach to corporate governance reform is useful for Japanese hospitals, although foundation trusts still face outstanding problems to be resolved as reflected in the independent auditors' reports on financial statements To implement such an approach, it is crucial that the corporate governance reform effectively permeates into places where the clinical treatment is conducted in order to realize improved medical treatment for patients.

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