The association between regional income inequality and individual health or self-rated health has been a key research issue in social epidemiology. A numerous number of multilevel analyses have been exploring it by explicitly considering both individual- and regional-level factors. In recent years, empirical studies on this topic have started to accumulate in Japan, where data availability is limited in general but income inequality has been widening remarkably.
This short essay presents a brief survey on previous studies in Japan and discusses issues to be addressed in terms of data and methodology. It also provides the key results from the author’s recent papers: Oshio and Kobayashi (2009a) (2009b), which indicate that regional income inequality adversely affects individual assessments of health in Japan.

Most empirical studies have neglected vertical equity in the distribution of health care services, focusing instead on horizontal equity. The present paper aims to investigate the relationships among the need for inpatient care, the amount of inpatient care services provided, and money transfers to Japanese municipal hospitals in the Kansai region from the viewpoint of vertical equity. The Standardized Mortality Ratio (SMR), which is a Bayes estimator, was used as an indicator of the need for inpatient care. Data from 89 municipal hospitals were collected from The Yearbook of Public Firms, Edition for Hospitals. Concentration index and Theil’s second measure were used to analyze the distribution of allotments to municipal hospitals.
The major findings can be summarized as follows. First, allotments per patient per day showed vertical equity in need for inpatient care, and inpatient cost per inpatient per day almost reached vertical equity throughout the Kansai region. However, allotments showed vertical inequity in the number of inpatients per day after taking into account the overall social welfare regarding the distribution of allotments. Second, inequality in allotment per inpatient was the largest with regard to allotment per patient per day. Inequality in the number of outpatients per physician increased in 2005 compared to previous years. This was caused by the movement of physicians following the introduction of a new in-service training system. Third, disparities in physician visits are underestimated when we do not take into account the flow of inpatients and overestimate the extent of inequality in allotments per patient per day.

Objectives: The benefits of health care services can be divided into two main groups. The first comprises substantial medical benefits derived from the provision of actual care. The second is an external effect that manifests as a sense of relief or peace of mind for residents living near medical facilities. The present study focuses on this second benefit and aims to estimate it statistically using regional data.
Methods/Design: As the data available are limited, the present study focused on the city of Yokohama in Kanagawa Prefecture. Open data from public land price announcements（Chika-Koji）were used to collect regional land price data, and geographical information systems（GIS）were used to collect data such as the characteristics of social infrastructure and accessibility of traffic. In addition, information on the regional medical system was collected from public data managed by the Office for the Promotion of Cooperation among Medical Institutions in Yokohama City. A total of 300 samples were included in the analysis. Based on the hedonic approach, a model was constructed to estimate land price with regard to various land characteristics as well as criteria such as the convenience of nearby social infrastructures, accessibility of public transportation and the current supply of regional medical services.
Results: A strong positive correlation between land price and the number of medical facilities within 1 km of any given point（p<0.01）and a negative correlation between land price and the distance of the nearest medical facility from any given point（p<0.01）were observed. The results also suggested that land price was raised marginally by increasing the number of nearby health care facilities. In contrast, land price tended to decrease when the distance to the nearest healthcare facility increased. The coefficients of external effect, which reflect residents’ sense of relief derived from the accessibility of health services, were greater than those for other important characteristics such as infrastructure or daily convenience.
Conclusion: In summary, health care facilities contribute to regional society not only by supplying health care services but also by providing peace of mind to neighborhood residents. This latter aspect of the benefits of health care facilities should be examined in more detail in the future.

The present study examined the relationship between prior knowledge and information search behavior in the health care market. First, based on prior knowledge about health care issues faced by consumers, consumers were divided into groups reflecting the three stages of the product life cycle: “Extensive Problem Solving”, “Limited Problem Solving”, and “Routine Problem Solving”.
Tests of experimental hypotheses revealed a positive relationship between the three problem solving stages and prior knowledge. These findings suggest that product solving stages can be used to examine the relationship between the amount of prior knowledge and information acquisition behavior. In addition, significant differences were observed among the three problem solving stages in the number of external searches and information sources, showing an inverted U-shaped relationship.
Thus, in the health care market, prior knowledge was shown to influence information acquisition behavior.

The National Institute for Health and Clinical Excellence （NICE）, established in the UK in 1999, marks its 10th anniversary this year. NICE, which publishes guidances on technology appraisals, has attracted widespread international attention for its evaluations of medications and interventions based on safety and efficacy information and cost-effectiveness. We surveyed the current climate of NICE and changes in its technology appraisal policies over the past 10 years using literature reviews and interviews with regulatory agencies and pharmaceutical companies in the UK. In addition, we analyzed 169 technology appraisal guidances published by NICE between 2000 and the end of March 2009 to examine changes in the organization’s decision making over time.
In this paper, we describe changes in NICE’s technology appraisal guidances over the past 10 years and discuss several controversies that have emerged from these guidances. NICE has used economic evaluations to determine whether a technology is recommended to the National Health Service （NHS）. However, as a result of the 2009 Pharmaceutical Price Regulation Scheme （PPRS）reform, NICE will soon begin to use such evaluations to adjust drug reimbursement prices as well. We demonstrate that economic evaluations have been more influential in recent NICE guidances. Although PPRS in the UK is based primarily on the free pricing system, it has been criticized for not reflecting the actual value of medications in drug prices （i.e., PPRS is not a “value-based” pricing system）. Economic evaluation is a method used to assess the relationship between the value of a medication and its price, and the UK is currently attempting to utilize economic evaluation to achieve the goal of “value-based pricing.” As of September 2009, the new drug pricing system in Japan is deliberated by the Central Social Insurance Medical Council to reflect the value of innovative medications. We believe that the application of health technology assessment, including economic evaluation, should be discussed more seriously in order to shift the drug pricing system in Japan to a more “valuebased” system.