Cost containment of health care costs is an issue in Japan. If a prospective payment system such as DRG/PPS is introduced, hospitals will have to make efforts to increase clinical and administrative efficiency of providing health care while maintaining quality. To achieve this, measuring efficiency of the operating room is essential. In this study, a university hospital in the Tokyo municipal area was used as the study field and surgical operations performed between April of 1997 and March of 1999 were retrospectively investigated. Operating room utilization was analyzed and cost analysis was conducted on 10 diseases, which were frequently treated surgically at the hospital. Operating room utilization was 77.49% and average sales/cost ratio of the 10 diseases was 48.59%. The results obtained from our method of analysis may be lower than the actual cost but should be sufficient for practical administrative purposes.

Among the developed countries, it is a common problem how to control the medical expenditures. In order to harmonize such cost containment programs with the improvement of medical services, we need an appropriate information system that reflects both clinical and economic aspects. The DRG is such an information tool that was originally developed in the USA, and is widely used among other developed countries. Since 1999, the Japanese Ministry of Health, Labor and Welfare has been conducting a social experiment of DRG. Although the usefulness of DRG as a tool for effective hospital administration has been established, further consideration is required in order to decide how to apply the DRG to the existed health system of each country. In this article, the author summarizes the findings of our research on the DRG in Europe held by IHEP (1999-2000), and intends to summarize the requirements for introduction of the DRG based system into Japan. According to my personal opinion, in the case of Japan where a social insurance scheme is generalized based on the fee-for-services, it is more appropriate to introduce the European type of DRG based system such as the combination of DRG and global budgeting in France, instead of the American DRG/PPS system that is combined with the managed care.

Achieving the cost efficiency of health care while assuring its quality has been one of the most important issues in industrialized countries. "Managed Care System (MCS)" in the US, which aims to achieve the above objective by giving the financial risks and economic incentives to health care providers, has drawn a broad attention as a viable policy option and spread quickly all over the US Concern for MCS has also been growing rapidly throughout the world in recent years.

Reflecting the above situation, there are thousands of articles about the MCS, whose quality vary from a mere description to a multivariate analysis of its impacts on health care quality and costs. Also, as the MCS has spread as a health care system, the MCS itself produced its variations, absorbing the traditional health care providing and insuring mechanisms. As a result, the definition and evaluation of the MCS became very elusive and confusing.

The aim of this thesis is to (1) explore the concept of the Managed Care System, and (2) examine the impact of the MCS on the US health care system with a focus on health care costs, by systematically and thoroughly reviewing the past academic studies on the MCS, hereby providing policy makers and interested parties with a baseline for meaningful discussion.