In the past few decades, new vaccines were developed and introduced into a national immunization program of many countries in the world, including Asian, African and Latin American countries, through international initiatives to promote immunization programs. In Japan, the disease burden from vaccine-preventable diseases (VPD) is substantial, when compared with other high-income countries, while its immunization program has made only limited progress in the past decades. Unlike in the US or UK, the program in Japan has been planned and implemented based, not on scientific evidences, but on court orders or mass media reports, which sensationalized the vaccine adverse events (VAE) and downplayed its benefits. Even though the management of VAE is essential for the success of the national immunization program, multidisciplinary discussion is currently not undertaken in Japan, and most of health professionals are not interested or well-informed on VAE. These challenges contributed to the stagnation of the program in the past decades. What we need for the advancement of the immunization program in Japan should include 1) formulation of a long-term national strategy to reduce disease burden from VPD, 2) promotion of cooperation between vaccine-professionals and local/central governments, 3) promotion of well-balanced understanding on the program among general public, mass media, jurist and clinicians, and 4) amendment of the immunization laws and other related laws and ordinances to materialize the aforementioned tasks.

Under the health guidance program implemented in April 2008, physicians should consider starting drug treatment only when health guidance for diet, exercise and smoking cessation do not show sufficient effects on their patients. Making such drug available over the counter for consumers, however, may actually contribute to the reduction of healthcare costs. We estimated the reduction in healthcare costs obtained through self-medication of a hypothetical OTC antihyperlipidemic drug. The drug will be equivalent to pravastatin 10 mg and, and it will be offered to patients for whom hyperlipidemia control was judged to be necessary at a health examination.
Patients aged 40 who use the OTC antihyperlipidemic drug would live 0.17 years longer than those who do not use the drug, and would achieve an overall reduction in healthcare costs of 436,000 yen. The savings will translate to the reduction of 137.7 billion yen in national healthcare expenditures over the next 10 years and to 605.6 billion yen over the next 20 years. Since these savings are achieved by shifting the costs of drugs from insurers to consumers, ultimately leading to increases in individual patient’s financial burden. An additional analysis was therefore performed to estimate the increase in the insurer’s burden that could be used to reduce a part of the individual patient payments for the OTC drug. As a result, the healthcare cost reduction is offset when insurance payers bear 35,432 yen. This annual burden would bring about a patient payment reduction of approximately 79% when the price of an over-the-counter antihyperlipidemic drug is equivalent to that of Mevalotin （2008 revision price）.

In this study, through a non-linear estimation of system of equations, we examine the effects of various factors that promote health-related activities in individuals, and how these activities affect their health. In particular, we pay special attention to time preference and risk aversion of individuals in health-promotion activities (eating balanced meals, regular physical activities, moderate use of tobacco, and adequate sleep). In addition, as individuals can perform several health-promotion activities simultaneously, we took account of the correlation among these activities. Furthermore we accounted for the effect of unobserved factors that simultaneously influence both an individual’s health-promotion decisions and his/her health status in individual’s health equation.
The data used in this study comes from an original survey we have conducted in Japan. Our empirical investigation shows that the error terms of health-promotion equations have a significantly positive correlation between themselves, and hence it is important to take into account the correlation among health-promotion decisions simultaneously. Even after controlling for this correlation, we have found that health-promotion activities, particularly getting adequate amount of sleep or rest, have a positive impact on health status.

Purpose of the Study
The present study aims to identify the factors that predict the future increases in health expenditures and discusses the implication for the Focused Health Checkup/Consultation (FHC) system currently in place to control future health expenditures. In particular, we focus on the instruments of cardiovascular risks adopted by the FHC, and estimated their effects on future health expenditures.
Methodology
Study subjects were insured individuals of National Health Insurance (NHI) of a municipality in Kumamoto Prefecture in Kyushu, Japan. We investigated the associations between annual health expenditures per capita from May 2006 to April 2007 on one hand, and the levels of cardiovascular risk factors, including hypertension, hyperglycemia, dyslipidemia, and overweight/obese, in the three health checkups conducted in 2005, 2001, and 1996 (i.e., 1, 5, and 10 years prior to the actual health expenditures), on the other. Checkup data were linked with the NHI claims data for each individual. For health expenditures, medical and pharmacy expenditures were integrated for each individual from the claims data.
Results
Of 608 subjects, 194 (32%) were men and 414 (68%) were women, with mean ages of 72.6 and 70.8 years, respectively. Among cardiovascular risk factors, we have found that hypertension in 1996 and hyperglycemia in 2005 for men were associated with higher health expenditures, and hypertension in 2001, hyperglycemia in 1996, and overweight/obese in 1996 and in 2001 for women, compared to those without such risks. Men with multiple risk factors without obesity are not currently eligible for support under the FHC system, but they had higher expenditures than those without risks. Further improvement in the healthcare information system is necessary to facilitate the utilization of claims data and health checkup data.

Recently, in order to improve the efficiency, functional division among medical facilities has become very common in medical services of Japan. So far, however, not only this phenomenon has escaped the attention economists’ scrutiny, but also its welfare implication has not been fully discussed yet. This paper addressed these two points.
First it analyzes the functional division among medical facilities using the framework classical Ricardian specialization model. Secondly, it analyzes the impact of functional division on social welfare using Rawlsian criterion. Thirdly, we examine the social optimal medical service delivery.
Our main results are as follows: (a) To achieve functional division appropriately, gaps in publicly regulated prices among health services must be within an allowable range; (b) If there are sufficient gaps in labor resources among medical facilities, functional division cannot realize socially optimal equilibrium, even if appropriately implemented; (c) To achieve socially optimal equilibrium, the mixed delivery system—characterized by collaboration between private medical facilities aiming to maximize their own profits and public medical facilities acting with public interests in mind—is essential.

Purpose of the Study
The present study aims to clarify the actual situation of utilization of both contributions and benefits of our social security system, focusing on what we call as the pitfall households. We define “pitfall households” as low-income households who do not pay social insurance premiums, but not low enough to qualify for welfare benefits. When a member of the household is sick, they cannot rely on public medical service coverage. If the proportion of pitfall households has increased in recent years, possible countermeasures for this problem should be discussed.
Methodology
To determine the number of such “pitfall households”, we had access to the micro data of the Survey of Redistribution of Income by the Ministry of Health, Labor and Welfare of Japan. Specifically, we identified the pitfall households in the sample in two steps; first we identified the households that had not paid public health insurance premiums, and then identified those that were not receiving welfare benefits. We then compared basic statistics of the pitfall households with the other households. We also conducted probit analysis to identify factors contributing to a household becoming a pitfall household.
Results
According to the results, 12.7% of the sample households were classified as pitfall households. We considered this proportion to be reasonable compared with the results of previous studies. The results of the probit analysis confirmed our hypothesis that liquidity constraint is a factor influencing non-coverage of medical services. We also found that unstable employment increased the probability of a household becoming a pitfall household. Conversely, larger households and households led by single mothers had a lower probability of becoming pitfall households. In a sub-sample that included only households below the poverty line, the probability of being a pitfall household showed an inverse correlation with the age of the head of the household.

Introduction and Objective : Although the Ministry of Health, Labor and Welfare of Japan has encouraged the use of generic drugs, the promotion of generic drugs has met considerable difficulty in the field of anticancer medicine. We conducted a questionnaire study to identify the nature of this difficulty from the viewpoint of pharmaceutical companies and from the medical personnel, respectively.
Method : A survey was conducted among generic pharmaceutical companies (members of the Japanese Society of Generic Medicines) from October to December in 2008, and another survey among doctors (hospitals, clinics), pharmacists (hospitals, pharmacies), and pharmacy students from August to December in 2008. Participants were questioned about current awareness, perceived problems and the necessity, of generic anticancer drugs.
Results : Eighteen of 28 companies (response rate, 64%) answered the questionnaire. Answers from medical personnel were collected from 49 doctors (response rate, 34%), 29 pharmacists (response rate, 29%) and 54 pharmacy students (response rate, 100%).
Although all 18 companies indicated that generic anticancer drugs were desirable, many companies expressed hesitation to develop generic drugs due to various obstacles in sales and manufacturing. Furthermore, while medical personnel were well aware of the necessity of generic anticancer drugs, they expressed a negative attitude toward increasing the use of such drugs at present.
Conclusion : In general, there is a consensus that anticancer agents are extremely cytotoxic medicine that must be used with special care, and hence it is inadvisable to use generic anticancer drugs in the same manner as the rest of the generic drugs. However, switching to generic drugs is almost inevitable under the current the present government’s health care system. Tri-lateral cooperation among medical personnel, industry and academia is essential in order to generate the evidence necessary to eliminate apprehensions surrounding generic anticancer drugs.