There is an increasing and rapid global tendencies toward community care in contrast to traditional institutional care especially for the elderly. There are many interesting economic problems associated with community care. In this paper I have selected three particular problems for analysis.
First I try to explain that informal caregivers decide which type of care to provide for elderly relatives and these decisions are based on both the marginal benefit and marginal cost for the caregivers. In this case both the opportunity cost and altruism of the informal caregiver are very important elements. Second, in spite of these tendencies toward community care, the need for traditional institutional and hospital care still exists and its use depends on the individual case. The ultimate choice of care type depends on the allocation of care and the different stages of social benefit and cost. Finally, I apply theoretical explanations to the present situations of community care in the UK and Japan. Our policy proposal to promoting and improving Japanese community care, may include a governmental compensation system for the opportunity costs of informal caregivers.

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Many developed countries began to rebuild health systems or to introduce health insurance schemes soon after the Second World War. They continued to expand these systems snd schemes, based on prosperous economy up until the first half of the 1970' s, Accordingly the total cost of health services has gradually increased during this period. But the change of economic conditions through oil crises and the prospect for further ageing into the 21st century compelled these countries to determine containing or rationalizing the costs of health services. Especially they had to fight with the large share of and the large increase of hospital expenditures partly caused by a number of elderly population.
Their cost containment policies st a r ted with those immediately effective but only effective in short-run, and then moved gradually to those with mid-term and long-term effect, namely the reform of health sevice supply system. As a result, the grwoth of health expenditures of these contries in general has come to slow down in the 1980' s and after.
Under these circumstanc es, these countries now try to reform their current health systems, aiming at maintaining an equal access to health sevices for every citizen, improving the quality of services, and also at accomplishing macro-econom ic and micro-economic efficiency. Here macro-economic efficiency mea ns an adequate proportion of resources used for health purposes to the total amount of national output. And the micro-economic efficiency means the increase of patients'and their relatives' satisfaction, the attainment of desirable results with smaller costs, and the reduction of time and transportation costs for patients and their relatives.

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Drug revolving fund(DRF), a program to finace essential drug supply at district level of developing countries, has been drawn attention since 1980s, the economical depression period when developing countries faced finacial difficulty to provide drug.
DRF is primarily a cost recovering program, utilizing user charge for supplementation of public expenditure of drug. This is also financial independent program described in detail as follows. Initial fund is externally introduced to purchase intial stock of drug. The drug is sold in communities and the revenue is utilized for fulling up consumed stock of drug. This process is theoretically simple, but the implementation is hard. For long-term success of this program, planning, organization and managial skills are neccesary, identifing local background.
In this study, DRF theory was examined and implementation studies were done in the case of Laos, Thailand and Nepal.

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The United States performs twice as many hysterectomies per capita as England. Why?
This paper investigates how decisions made by gynecologists may influence on hysterectomy rates. If U. S. and English gynecologists differ substantially in their propensity to operate, then their decision making would contribute to the rate differences.
To expose judgment differences, we used hypothetical care vignettes based on the most commom indications for hysterectomy (e. g. endometriosis, uterine cancer). Economics, ethics, and other social factors were excluded. English and American physicians were presented with six identical cases and were asked two questions:“Would you operate on this patient?”and“If so, would you operate within on e month?”
Our r esults indicate that differences do exist between American and English gynecologists regarding the decision to operate. However, there is no clear trend. In vignette three, a case involving endometriosis and prolapse, U. S. respondents were significantly more likely to operate. In vignette four, a case involving cancer, English respondents opted for surgery much more often than American ones. In the other four vignettes, no significant difference surfaced.
At the same time, clinical judgement regard i ng the timing and urgency of hysterectomy was marked in all six cases. Once they elected to operate, American physicians were far more anxious to do so within one month than their English counterparts.

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Newhouse in 1977 showed that the international differences in health expenditures is mainly explained by the difference of GDP. He also showed that GDP elasticity in health expenditures is larger than 1 by the coefficient of GDP. His findings demonstrated that medical services are not normal goods, but luxury goods. After Newhouse's study many specialists researched whether the GDP elasticity of health expenditures was greater than 1.
The studies investigating the Newhouse hypothe s is can be classified into three types. The first type attempts to show that the varying results are obtained due to the differences in conversion factors such as PPP (purchasing power parity), PPP of health expenditures. The second type studies use not only GDP per capita, but also other explanatory variables. Finally, the third type of studies utilizes not simply cross sections of the OECD data, but also data pooling across sections and time series data. The results of these numerous studies demonstrate that GDP elasticity of health expenditures is larger than 1.
This study concentrates on using the pooling of data of cross sections and time series data of the OECD and estimates equations. Therefore, panel analysis is used in this study. Using pooling data offers several advantages such as the ability to control the differences among countries while simultaneously increasing the data quantity.
The estimated equations consist of two types. The first type estimated equation includes only GDP per capita as an explanatory variable. The second type estimated equation includes GDP per capita and aging ratios. The equations do not include other explanatory variables other than GDP and the aging ratio. The result of this study demonstrates that GDP elasticity of health expenditures is less than 1 and that it is statistically significant regardless of conversion factor and the aging ratio. Consequently, the results of this study stand in contrast to the results of many previous studies.

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The purposes of this study are to review raisons d'etre and roles of ethics committees in the development of bioethical policy in the UK and Japan.
Ethics committees can be classified into three categories with regard to history and function; Hospital Ethics Committees (HEC), Institutional Review Boards (IRB) and National Ethics Committees. In the UK, Local Research Ethics Committees (LRECs) were established as IRBs in the 1970s to regulate research programs involving human subjects. When regulating reproductive technologies and gene therapy, the UK government established the Committee Inquiry into Human Fertilisation and Embryology in 1982 and the Committee on the Ethics of Gene Therapy in 1989. According to the recommendations of these committees, two new independent regulating bodies were established. Human Fertilisation and Embryology Authority (HFEA) and Gene Therapy Advisory Committee (GTAC). HFEA is a statutory authority and GTAC will be in the near future.
The UK follows a definite pattern on bioethical policy. Once they call specific bioethical issues into question, National Ad Hoc Research Committee surveys ethical, social, and legal implications. According to its recommendations, government establishes an independent licensing body which should be the main authority to help LRECs and to license each research/treatment project. Such a body also plays a role as a National Ethics Committee of each field.
In Japan policy-making on bioethics has not been significantly addressed or settled. First, medical professions should take initiative in policy-making processes to avoid the unquestioning obedience prevalent in American style policy. Second, it is necessary to define the roles and functions of Japanese ethics committees. Especially, we have to be careful on the appointment of members from various backgrounds. One single National Ethics Committee which advises those ethics committees would be helpful for making coherent and comprehensive policy. Finally, sociologists and anthropologists have to contribute to improving the situation through comparative studies on policy-making in biomedicine.

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In this paper I discuss and critically analyze contemporary research which has been conducted on medical malpractice. The primary focus of the paper is on Simon (1981) and Simon (1982). Simon (1982) makes a comparative analysis on the“negligence system”and the“strict liability system”. The negligence system punishes the defendant if he is negligent. The strict liability system punishes the defendant whether he is negligent or not. Simon concludes that the negligence system is superior to the strict liability system in the Paretian sense.
Simon (1981) analyse the quality of the treatm e nt in cases where the costs of litigation are prohibitive for the plaintaiff. Simon derives the natural conclusion that the quality will be relatively worse in markets composed of low incomes. This result implies that the court system has its limits in upholding the incentive system. Therefore, it is natural to consider the economic effect of the government's intervention.
The last section in the paper provides comments of the above analyses and the future direction of such research.

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