This study attempts to illustrate the corporate governance system of two large family-controlled firms engaged in the healthcare-related business, Merck KGaA and Fresenius SE. Significant proportion of family-controlled firms provides the background of the German corporate governance system. The availability of legal forms of firm suited for family businesses sets the cause and effect relationships of this ownership structure. The goal of corporate governance for both firms is to assure permanent family control while tapping financial resources from the capital market.
E. Merck KG does this as the partner with unlimited liabilities by resorting to the legal form of partnership limited by shares.
Fresenius uses the pyramidal structure by using public interest foundation as the holding company for the secondary holding as well as for the four operating companies. The company has issued half of its capital as non-voting preferential shares in the market as a source of additional capital, while protecting the firm against possible hostile takeover attempts. As of December 2010 Fresenius is in the process of transforming its legal form into SE&Co.KGaA, partnership limited by shares with the existing Fresenius SE as the partner of unlimited liabilities. Explanations on the new structure are provided. The move is expected to increase autonomy of the foundation. The company is also converting its non-voting preferential shares into common stock with voting rights for improved monitoring by shareholders. Ramifications of these changes are discussed.
Corporate governance of both firms is evaluated for effectiveness and implications for Japanese healthcare companies are suggested.

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The Pharmaceutical Distribution in Japan are characterized by many unreasonable trade practices; lump-sum bulk buying, delivery without price agreement between wholesalers and medical institutions/pharmacies, and obscure rebate/allowance system. Over 20 years, Health Labor & Welfare Ministry and Japan Pharmaceutical Wholesalers Association (JPWA) have been trying to improve these unreasonable trade practices through some formal meetings; Committee for Distribution Modernization (RYUKINKYO) in 1990s and Commission for Improvement on Pharmaceutical Distribution Transaction (RYUKAIKON) in 2000s with the members of Pharmaceutical Manufacturers Association, Private Hospitals Association and Pharmacies Association, etc.. In September 2009, the RYUKAIKON members agreed to publish a message that distribution transaction improvement was very critical. This message had some positive effects. But wholesalers realized that some drastic changes in pharmaceutical distribution such as growing pharmacy channel and generic drugs complicated distribution problems.
Since early 2000s, the public pricing policy for drugs has been reexamined from the industrial point of view. A new pricing scheme (Premium Pricing Scheme for Promotion of New Drug Creation and Resolution of Unapproved Drugs/Indications) has been implemented on a trial basis since April 2010. The prospect of this pricing scheme is now unknown, but it is sure that these reform trials would finally change the pharmaceutical distribution system, wholesalers' functions and trade practices. Wholesalers should challenge to reform their management and empower their sales forth.

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Health Technology Assessment (HTA) is a multidisciplinary field that addresses the health, economic and social impacts of health technologies. In many countries, public or private institutions for HTA were established. HTA plays an essential role in supporting policy decision-making such as reimbursement decisions on pharmaceuticals and medical devices, and clinical decisions such as clinical guidelines development.
In this paper (part 1 of 2) , we reviewed emerging HTA activities in Asia, focusing on Korea and Thailand. The Korean Health Insurance Review Agency (HIRA) was originally established to review claims submitted by medical institutions and to assess the quality of health care. In 2007, the HIRA started HTA for the reimbursement decisions on pharmaceuticals. The National Evidence-based Healthcare Collaborating Agency (NECA) was established in 2008 as a HTA agency to conduct systematic reviews and economic evaluations. In Thailand, the Health Intervention and Technology Assessment Program (HITAP) , was established in 2007 in order to take responsibility for appraising a wide range of health technologies and programs, including pharmaceuticals, medical devices, interventions, individual and community health promotion and disease prevention as well as social health policy. To support reimbursement decisions, the HITAP conduct economic evaluations for the selected new pharmaceuticals with highest priorities.

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As life expectancy among the elderly has improved, increases in health care spending and care methods have become issues in many developed countries. The present study examined health care costs for disabled elderly with a focus on care location.
A total of 226 inhabitants (age, over 65 years) of a town in Hokkaido, whose Care Needs Levels were classified by Long-Term Care Insurance and who were covered by National Health Insurance, participated in this study.
We considered three care locations for disabled elderly : home, LTC facilities and chronic hospitals. We performed generalized liner model (GLM) with log link for the subjects of home and LTC facilities, in order to determine which factor affected health care costs. The dependent variable was health care cost, and independent variables were age, gender, Care Needs Level, and hospital length of stay. Age and hospital length of stay were treated as continuous variables, and the other variables were treated as dummy variables. We described health care cost for the subjects in chronic hospitals by Care Needs Level and length of hospital stay, because the number of those was too small to conduct multivariate analysis.
Institutional costs accounted for 74% of health care costs. Care Needs Level and hospital length of stay were factors significantly associated with health care costs, particularly with respect to home and LTC facilities.
It has been suggested that preventing Care Needs Level becoming more severe and prolonging home care could be effective for reducing health care cost. But it may be said that we should consider the family status of the disabled elderly at the selection of care location.

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Prescription drugs are characterized by the fact that doctors make decisions regarding prescription drugs to be purchased, using their professional expertise on patients' behalf. This decision-making process is different from that of general consumer products. In the product selection of prescription drugs, other than the manufacturers (pharmaceutical companies) who develop and produce products and the consumers (patients) who use and consume the products, doctors are involved as the persons who actually select them. Then, given the relationships among these three groups of people, do pharmaceutical companies' CSR (corporate social responsibility) activities lead to an increase in sales of prescription drugs in either the short or long term?
In this study, we analyze the impact of pharmaceutical companies' CSR activities on doctors' decisions regarding prescription drugs in an exploratory approach. We conducted qualitative research by interviewing with six breast cancer specialists. To clarify what kinds of CSR activities are preferred, we also conducted interviews with six breast cancer patients and their advocates, and compared patients' views on pharmaceutical companies' CSR activities with doctors' views.
The main finding from this study is that pharmaceutical companies' CSR activities rarely affect doctors' decisions regarding prescription drugs directly. It is also shown that usefulness is considered most important for prescription drugs in specialized medical fields while the reputations of the pharmaceutical companies are regarded most important for those in non-specialized fields, and that pharmaceutical companies' CSR activities contribute to enhancing their reputations. Furthermore, it is found that patients' views on pharmaceutical companies' CSR activities are different from doctors' views.

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The purpose of this paper is to propose an analytical method of outsourcing and strategic alliance. Our method starts by calculating a sales-based introduction rate and a product-quantity-based introduction rate. We analyzed a sample of major Japanese pharmaceutical companies from 1977 to 2002.
In using our method and indexes, we can realize the effectiveness of an introduction of the technology in firms and inter-firm relations.

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