Wholesalers in the pharmaceutical industry has been growing up and expanding drastically through tie-ups and mergers. This tendency seems to be accelerated in 1990's and some cases of merger among the large-scale wholesalers show how rapidly the structure of wholesaling in this industry is changing now.
However, the tie-ups and mergers which had occurred by 1970's and those which occurred in 1980's and 1990's are quite different in their purposes and directions. Cutting the official prices of medicine has surely a strong impact on their tie-ups and mergers. But it seems some peculiarity in the management of the wholesalers, homogeneity in their management style and cost structure regardless of their size, is accelerating this process. Public policy for the pharmaceutical industry and big manufacturers' keiretu (soft vertical integration) could guarantee the growth and existence of the wholesalers. But, as a matter of fact, most wholesalers are now so dependent on the public health care policies and manufactures' marketing policies that they are excessively responsive to these policy changes. Because wholesalers' functions and assortment of merchandise are limited, they are likely to be unprofitable in spite of their sales size.
This research, focussing on the wholesalers in Kantou region, shows clearly the changing power balance and the consolidating process among super-regional, regional, and local wholesalers. However, there are some possibilities of converting conventional wholesaler functions to marketing functions and creating the new type of wholesaling business which is trying to find their customers' needs and present the new kinds of service to support their customers.

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The Pharmaceutical industry has been undergoing fundamental changes. In the developed countries such as North America, Europe and Japan, healthcare costs have been the major targets for containment in the past several years. There are a large number of new entrants into this industry, such as managed care companies which provide healthcare to the changing market in new, innovative ways. In addition, biotechnology ventures specialized in genomic research and other types of research and development, using the latest information technology, have changed the way in which the value chain is set in this industry.
The big pharmaceutical companies have used cross-border mergers, acquisitions and alliances, to cope with and/or pre-empt the globalization of the industry.
This research analyses the level of globalization of the pharmaceutical industry, and the strategic options for big pharmaceutical companies. First, the industry is analyzed by its globalization drivers-market, cost, government and competition. Next, the importance of mergers/acquisitions as means to attain sustainable global competitive advantage is reviewed. Particularly, the emphasis is placed upon the fit of value chain activities when companies expand their operations on global basis by mergers and acquisitions. The case of SmithKline Beecham is analyzed in depth from its birth in 1989 through its recent merger attempt with Glaxo Wellcome. The fit of merger activities with strategic positioning, coordination/integration of value chain activities at different levels and the need for continuous effort to align, not only organizational structure, but also management processes, evaluation systems and culture is identified to be significant for the success of merger / acquisition activities. Implications for Japanese companies are discussed.

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The empirical study on the diffusion rate of MRI was conducted in this paper. The diffusion rate of MRI varies in nijiiryo-ken, and we applied the error correction model to it.
The results were the followings. Firstly, CT and MRI were complements, the more CTs were diffused, the more MRIs were diffused. The diffusion rate of MRI increased by 0.06% when that of CT increased by 1%. Secondly, the larger was the scale of hospitals measured by the number of inpatients and outpatients, the more MRIs were diffused.1% increase in number of inpatients increased the number of MRIs by 0.255% while that in number of outpatients increased MRIs by 0.08%. The third result is that the younger average age of doctors employed in the hospital contributes the diffusion of MRIs. When the average age of doctors employed in the hospitals increased by 1%, the diffusion rate of MRI decreased by 0.311%.

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This report investigates gynecological decision making in cases of hysterectomy in ROC, Japan, England, and the US. Hysterectomy imposes a huge economic impact, especially in the US. Many believe that the increasing trends in hysterectomy rates result from an expansion of the accepted indications for hysterectomy. However, defining clear indications for hysterectomy is difficult, as more reasons are listed for removal of the uterus than any other organ. The indications range from life threatening cancer of the genital tract to menstrual pain. With so many possible indications for hysterectomy, the actual decision to perform hysterectomy may be a great contributing factor to the different rates between countries.
This study is based on a questionnaire survey that presents six fictional case histories to physicians. The cases are related to some typical indications for hysterectomy and the doctors are asked if they would perform hysterectomy for each case, and if they would perform it within one month. The questionnaire also included space for personal comments and demographic data (age, sex, length of experience, etc. ). The surveys were conducted in ROC in 1997, in Japan in 1996, both in England and the US in 1990.
The effective response rate varied in the four countries: ROC (19.8%), Japan (21.1%), England (70.7%), US (69.7%). In general, Asian doctors (ROC and Japan) are less likely to perform hysterectomy than Western doctors. In particular, Asian doctors are less likely to perform hysterectomy in non-life threatening conditions, such as dysmenorrhoea and monthly pain. The only case that Asian doctors were more likely to perform hysterectomy than Western doctors revolved around the condition of potential pre-cancer. In fact, Japanese doctors were more likely to perform hysterectomy in the condition of potential precancer than pre-cancer. To further examine these findings, a more intensive study with personal interviews, should be conducted to find the rationale behind these clinical judgments.

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Although the final purpose of this research is to analyze the benefit of interaction between the market principle and the planning principle in the health care sector, this article, as the first step of this study, focuses on these three aspects,1) the transactions between physicians and insurers,2) an underwriting of medical insurance,3) the relationship between hospital ownership and opportunistic behaviors.
The below contents are summary of this article.
1) The planning principle (e. g. managed care) seems to be more effective than the market principle (e. g. traditional indemnity health plan) to control the moral hazard of physicians because of the saving monitoring costs. However the planning principle is not always better for the patients (or the insured). Whether the planning principle is better for the patients or not depends on whether insurers are faithful agents for them or not.
2) We can find some countries, the health care systems of which are based on mainly the market principle (or the planning principle), introduce the counterpart principle in order to increase the efficiency of their performance. The rapid growth of managed care in the U. S. can be seen as the penetration of the planning principle into the market principle. The introduction of the concept “quasi-markets”into the NHS can be seen as the injection of the market principle into the planning principle.
3) There is no advanced country without public security of medical care for the reason that private insurance might incur inequality and inefficiency due to its characteristics (risk selection, adverse selection, high transactions costs). The combination patterns of public security and private insurance vary equality and efficiency in the health care system.
4) It is possible that health care providers will take an opportunistic behavior under the conditions in which the information asymmetry and the third party payers exist. Our careful survey of the studies about the relationship between hospital ownership and its behavior on the hypothesis that profit seeking motive will induce an opportunistic behavior, makes it clear that for-profit hospitals take more cream-skimming manners than non-profits.

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