The Ministry of Health and Welfare in May 1995 published a white paper on health and welfare. This year's white paper on health had a special reference to quality, information, choice and understanding. The paper is a comprehensive account on health care in Japan and in the very first chapter the paper analyzed the results of 2000 questionnaires concerning health status, health service, and health security systems. The result was that 50 percent expressed satisfaction,19 percent marginally satisfied, and 3 percent were very dissatisfied with overall health care services. Improving satisfaction is the first and foremost responsibility of health care providers. In order to achieve this goal, we must first improve professional standards and this needs objective evaluation. Like in other countries, Japan has been conducting this evaluation within three dimensions of health services, namely structure, process, and outcome. The establishment of an objective organization in 1995 to do this evaluation is a step in this direction.
But high professional standards do not guarantee the customers satisfaction. Special emphasis is necessary to foster the common perception about what constitutes high quality of health service between providers and customers.
General question on satisfaction tend to draw high scores from customers if the question was asked by health care providers. We should be specific about procedures which are regarded as optimal by both providers and customers and to ensure that these are actually provided. These procedures should be declared as a component of patient's rights. To discover specific problems of each patient based on the survey of satisfaction on agreed procedures and to correct these short comings is essential in continuing improvement of satisfaction which ultimately leads to a higher quality care.

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The aim of this paper is to demonstrate from the patient's perspective several issues of the health care system in Japan. The health care area consists of patients as consumers, doctors as suppliers, and the government in the function of a regulator. Similar to other goods and services, health care is primarily accompanied by asymmetric information. Efficiency is not necessarily reached, and regulations do not affect this situation in realizing efficient resource or service allocation. In this paper, we emphasize the following: dignity of patients, disclosure of information, and efficient allocation of health care resources. The first is to respect the dignity of patients. Because of the discrepancy of expertise on the diagnosis and treatment of diseases, patients are forced to make decisions with inadequate information, and doctors possibly invade the welfare of patients. Unfortunately, we do not have measures in place to prevent this invasion. The second is to disclose and share information. As noted above, under asymmetric information, patients must rely on the doctor's evaluation. If doctors do not provide sufficient explanation, patients will be unable to choose optimal health care services that they would choose under symmetric information. Doctors should also disclose information and share it with patients while simultaneously patients must also assume responsibility for their own choices. The third is the efficient allocation of health care resources. Asymmetric information and regulations distort the incentives of patients and doctors. We need a system which can efficiently allocate health care resources. For example, the existence of an impartial third party which can ameliorate asymmetric information will be of significant importance to the system.

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Seventy percent of the total expenditure of health care for the aged is financed by contributions by all sickness funds,20 percent by State grants, and 10 percent by local governments grants in Japan.
Aging is the main factor cau s ing financial crisis in sickness funds. Because the aging ratio caused by a changing industrial structure differs across sickness funds, from a national health care perspective sickness funds should share risk of aging to avoid the risk of bankruptcy for small funds.
To equalize the risk of aging across sic kness funds, each sickness fund should pay contributions to the accounts of health care for the aged according to a ratio that is universal for all funds.
In this paper we con c lude that the present risk sharing scheme does not give each fund a financial incentive to economize because they must share the total cost of health care for the aged of their members and not the average national cost.
According to the 1990 Personal Social Services Act, local municipalities must take responsibility in developing personal social services. However, each municipality does not have a financial incentive to provide personal social services because they have separate systems of finance and in-hospital care is cheaper than home help for the municipality. In the future, Japan must integrate the health care for the elderly into personal social services.

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The main focus of health care policy in industrialized countries is shifting from an access guarantee to an efficiency and quality improvement of health care. This is also the case with Japan. What is presently needed is not excessive cost containment due to austere fiscal policy, nor the no-change-please reaction in order to protect vested political interests. An effort to evaluate scientifically and continuously the quality of health care from the standpoints of consumers and patients, and to reflect the ensuing evaluation on the management and policy of health care is urgently required in today's environment. To achieve this objective, it is first necessary to reevaluate and reformulate the government's regulations on health care from the perspectives of health care technology assessment. Secondly, an improvement of the quality of health care by continuously evaluating the government's health policy program through modern analytical methods is required, and finally a new policy designed to encourage competition and additional efforts at improving the quality of health care in the private sector should be devised.
Some argue that measuring the quality of health care is difficult. However, such obstacles should not preclude the introduction of modern methods of analysis even if they are currently in the infancy stages of development. We should remember the argument in the United States forty years ago and in Japan ten years ago that economics could not be applied to health care. Nothing is perfect in the beginning. Because medicine as a practice combines both art and science, the potentiality for error always exists and the primary reason for improving the quality of health care is to prevent impermissible human errors. Any attempt to reduce or slow the introduction of global progress standards will ultimately be meaningless because consumers and patients in the age of virtual information will demand universal standards of treatment and quality.

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Each U. S. patent cites“U. S. Patent Documents”and“Other Publications”as part of the reference. Utilizing these recitations one can construct measures to evaluate the quality of the individual patent as well as overall firms. A proprietary U. S. patent data base“TECH-LINE”constructs measures such as“Current Impact Index (CII)”,“Science Linkage”, and“Technology Cycle Time. ”“CII”is an index to measure how frequently patents of a certain company are cited by other U. S. patents. “Science Linkage”is the average number of“Other Publication”in the patent.“Technology Cycle Time”is the median age of the earlier U. S. patents cited by patent documents of an individual company in a given year.
Principally using TECH-LINE this study investigates r esearch productivity of large scale pharmaceutical firms. First this study ranks 150 global pharmaceutical firms by“Total Technological Strength”which is a product of the number of patents of a firm in a given year, and“CII.”Second, this study conducts international comparison using patent related indices. Third, this study investigates what kind of information is conveyed by these patent related indices.
Several interesting results were discovered. First, the share of Japanese pharmaceutical firms in“Total Technological Strength”is 10 percent, which is far less than their R&D expenditure. Japanese pharmaceutical firms are much smaller than their U. S. and European large scale counterparts. Second, CII of Japanese firms is around unity, which represents the industry average. Although this is much is much smaller than some U. S. firms, it is comparable to most European firms. Thus, we conclude that the question of Japanese pharmaceutical firms is more related to the“number of patent”rather than“CII”. Third,“Science Linkage”of U. S. firms is much higher than Japanese firms. Fourth,“Technology Cycle Time”of Japanese firm is comparable to U. S. and European firms. Fifth, a number of U. S. research institutes as well as small firms exhibit higher“CII”and“ScienceL inkage.”These entities are virtually non-existent in Japan.
This study indicates that the cita t ion based patent data is useful in studies on pharmaceutical research productivity.

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Though many countries in the world adopt“Primary Care System”in their Health Care Systems, there is little common agreement about its merits and demerits. In this paper, focusing upon characteristics of information of health care services, I investigate merits and demerits of“Primary Care System”and its function. In section 2, I will look into characteristics of information of health care services and problems which they bring into market of health care services. In section 3, referring to standard definition of“Primary Care System”, I make clear essentials of“Primary Care System”and show how they solve those problems which characteristics of information of health care services bring into health care market. Furthermore, problems which are left to be unresolved are considered. In section 4, conclusion is stated.

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Wes eekt o clarifyt he influenceo f the mass mediao n job satisfactiona nd job choicea mong 133 nursesi n two generalh ospitalsi n the Kanto area by utilizinga self-ratingq uestionnaireo, r iginallyd evelopebdy Stamps, e t. al.
The followingre sultsw ereo btained:
1) Thes atisfactionr ates associatedw ith task requirementp, ay, administration, doctorn urse relationship, a utonomyi n daily work activities, interactiona mong nursesa nd professionasl tatus were2 1%,2 6%,3 1%,3 3%,5 0%a nd6 0%, r espectively; all the rates werel ower than those amongA mericann ursese xaminedb y another researcher.
2) Job satisfactiond iffereda mongt hree age s pecificg roupso f thesen urses: the nursesa ged3 0-44y ears, s howedth e lowests atisfactionr ates on interaction, a dmi nistration and doctor nurse relationship, a nd those aged4 5 and over showedt he highestr ates on pay, professionasl tatus, and doctorn urser elationship.
3) Ther esults of multivariatel ogistica nalysiss howedth at professionals tatus and autonomyw eres ignificantlyre latedt o job satisfactioni n the nursesw hilec on trollingf or the effectso f age, w orkingd uration, a ndt hep resence/absenocfe c hildren or night work; and that professional status and doctor nurse relationship were significantlyre lated to intentiono f continuingto work.
4) Mosto f the nursesa nsweredth at the presentj obh adb eenc hosenb y themselves. Andl ess than 2 0% of the nursesr eportedt hat mass media, e speciallyte levision, had affectedj ob choice; w hile, i ts rate amongt hosea ged2 0-29y earsw as 43%.

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