In this paper, we evaluated the inclusive payment system based on the DPC (Diagnosis Procedure Combination) for cataract surgeries (DPC Category Code: 020110). We utilized the data pertaining to 1,225 patients hospitalized for cataracts and underwent lens operations from July 2004 to September 2005. The data were collected by the DPC Hospital Conference. We found large differences in the length of stay and payment based on the DPC among hospitals despite eliminating the influence of characteristics of patients, names of main diseases, presences of secondary diseases and treatments. The highest average payment based on the DPC was 3.5 times as high as the lowest payment. On the other hand, differences in payments based on the fee-for-service among hospitals were relatively small. The largest deviation from the average of all hospitals was about 10%. As the results, the major differences of medical payments by hospitals were payments based on the DPC, which accounted for only one-third of the total medical payments for this disease. The results of the study strongly suggest that the characteristics of the disease must be considered for efficient use of medical resources in the future revision of the payment system.

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Authorization systems for use of unlicensed medicines in European countries were reviewed. The situations in the UK, France and Switzerland were mainly surveyed by close examination of the guidelines provided by the regulatory agency of each country. In addition, interviews were conducted with persons in charge of regulatory agencies, manufactures, importers and academic researchers in said countries. Comparison was made between European countries and Japan.
In the three European countries, the use of unlicensed medicines was clearly positioned as an exemption from licensing of medicines. Use of unlicensed medicines must be considered on a last-resort basis and on a named patient basis. Prescription by doctors and reporting of adverse events were mandatory. On the other hand, in Japan, there is no specific requirement for the conditions for use of unlicensed medicines. It must be addressed that patients can import unlicensed medicines and the quality of medicines is not assured. While not many unlicensed medicines are in development in Japan, there are various needs for unlicensed medicines.
Japan-specific system for use of unlicensed medicines should be established in consideration of the following; (1) Importation by patients should be restricted. (2) Importers must be given a license. (3) Reporting of adverse events by doctors should be mandated. The system should not depend much on pharmaceutical companies, in order to achieve a good balance between new drug development and aid of patients.

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Industrial reorganization has progressed on a worldwide scale in the pharmaceutical industry with the recent intensified competition in new drug development. Mergers and acquisitions (M&A), business integrations and strategic alliances have occurred recently in the Japanese pharmaceutical industry, as well.
This paper analyzes the impact of these changes in firms' boundaries on appropriability of the returns from innovation and technological opportunities, which are the determinants of innovation. We took a case of the strategic alliance between Chugai Pharmaceutical Co., Ltd. and F. Hoffman-La Roche Ltd. and considered the impact of the alliance on appropriability and technological opportunities. We mainly analyzed the changes in the sales composition of drugs and the changes in development pipelines. The results suggest that the appropriability of returns from the innovation increased in Chugai Pharmaceutical after the alliance. On the other hand, technological opportunities from outside of the Roche group have been restricted in Chugai Pharmaceutical after the alliance.

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In this study we investigated the effect of corporate merger and acquisition (M&A) on the uptake and diffusion of innovation in pharmaceutical research and development (R&D) from the viewpoint of corporate organization management. Here we selected a case of Astellas Pharma and observed its post-merger management (PMM) effects on the size of R&D, research efficiency and licensing efficiency for two years after the establishment. Through a series of in-depth internal interviews and analyses we found a significant diversification of technological opportunities created by the complementary effects of the M&A which may lead to inconsistent gains in research and licensing efficiencies. We also observed a considerable fit between these effects and the corporate vision and strategy that the management had initially intended. Precedent studies indicated that the positive effect of M&A tends to be limited to short-term impacts such as fulfillment of pipeline candidates. Our study suggests the significance of PMM and monitoring approaches from the economy of scope rather than the economy of scale for long-lasting effects on pharmaceutical R&D.

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Trust hospitals have aimed to offer medical services due to dissatisfaction arising from the fact that there were many cases of medical malpractice around the year 2000 in UK, and have applied the concept of 'corporate governance', which is popular in private enterprises through out the world. It is remarkable that hospitals, which are a symbol of non-profit organizations, have practiced the reforms of corporate governance. I consider that management involvement is an extremely important clue to apply corporate governance to hospital management.
This paper clarifies how foundation trusts have approached for patient-centered management involvement, based on results from interviews in the Basingstoke and North Hampshire NHS Foundation Trust (BNHFT) of the South Central Strategic Health Authority in November 2007. I examined what kind of people are involved in hospital management, what interests and views people such as patients had, and how the people contributed to the management system and corporate governance in BNHFT.
This study shows that BNHFT places special emphasis on consideration of the minority community such as young people, older people, and disabled people and board of governors' selections of one chair in board of directors. BNHFT also have constructed flexible and precise management systems in setting on management involvement and committees in board of governors.

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