Objective : This study aims to qualitatively explore aspects regarded as insufficient by community residents, for their residential areas and themselves, to create communities where people with mental illness can live in harmony with other residents.
Methods : Twenty survey areas were selected from among the administrative cities/municipalities of Tokyo. In each area, a random sample of 100 community residents aged 20 or older was selected, and a total of 2,000 residents were surveyed using a mailed cross-sectional questionnaire from September to November 2009. The questionnaire included two open-ended questions such as “What would it take for your residential area to create a harmonious community for people with mental illness and other community residents?”, “What would it take for yourself to create a harmonious community for people with mental illness and other community residents?”, as well as demographic variables including sex and age. Valid data from 274 respondents (mean age 48.6 years, males 44.2%), who answered at least one open-ended question appropriately, were analyzed using Berelson's content analysis technique.
Results and Discussion : The analysis of the responses revealed various aspects such as knowledge and understanding of mental illness, communication with people with mental illness, and communication among the community residents. To promote social inclusion of people with mental illness, it is important to examine how the approaches such as offering educational opportunities which meet the needs of the community residents to improve their knowledge and understanding of mental illness, providing them with opportunities of interaction with people with mental illness, and intervention to promote interaction and alignment among the community residents affect the stigma community residents attach to people with mental illness.

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The recent financial condition of medical expenses in Japan is becoming unhealthy due to the aging society with less youngsters to support the elders. In the past, several attempts to increase copayment of Medical care expenses were made with less effective solutions. However in the recent years, self-medication is gaining more popularity in parallel with the generalization of switch-OTC medicines. The popularization of self-medication activities will bring price elasticity to medical service, hence it may be expected to bring down incremental demand of medical services.
This thesis scopes allergic rhinitis as target symptom, and the author has conducted a web-based survey. Estimations for the functional probit analysis of medical service demand and self-medication demand were made, and also chi-square tests and t tests were performed between factors when copayment ratio is 28% (current practice) and copayment rate being inflated to 60%.
As the result of the analysis, cross price elasticity became 0.90 from 0.54, hence proving that inflating copayment rate is a valid solution to suppress demand for medical services. But when copayment ratio is 60%, the selective rate of spontaneous cure has risen. It is concerned about decline in the healthy standard and increase copayment of Medical care expenses.
Also, the author examined other qualitative factors such as “sex”, “age”, “acceptable copayment rate”, “household income”, “medical knowledge” and “symptom” to clarify which factor has the most impact on copayment rate inflation acceptance. The result show “medical knowledge” and “symptom” to be most influential.

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There had been a policy debate to improve administrative efficiency of public hospitals in rural areas through reform under the “Public Hospital Reform Guidelines,” when the Great East Japan Earthquake struck rural Iwate on March 11, 2011. This report summarized the financial and sociopolitical situations that public hospitals in rural Iwate, local major providers of healthcare, have been facing in the revival course since the Earthquake, in order to identify policy challenges toward improving the financial sustainability of public hospitals in agricultural rural medical districts. Four lessons were mainly extracted, as follows :
(1) Public providers have been playing a significant role in providing healthcare services in agricultural districts in Iwate since before the disaster, and the revival of their capacity is indispensable for recovery of the local community.
(2) Even before the disaster, however, these public providers had already faced financial difficulties and were forced to downsize their services. The situation has not changed and the challenge remains.
(3) Case studies suggested several conditions were required for the revival of public hospitals : trust between the prefectural and municipal governments, public providers, and local residents ; flexible functional division between hospitals and clinics ; and integration of medical, nursing, and welfare programs. The significance of these conditions was brought to light in a more intense manner after the earthquake.
(4) Meeting these conditions is expected to improve the financial sustainability of public hospitals in rural agricultural districts.

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