R&D expenditure is investment for uncertainty as is the case with equipment investment. But there exists asymmetry between R&D expenditure and equipment investment. The former is regarded as a flow each year and it can not be accumulated as knowledge capital stock according to the accounting rule whereas the latter is regarded as a piece of capital stock and treated as asset. This asymmetry may well give a bias for estimating profitability of investment. In this paper we estimated the stock of knowledge capital by using a neoclassical model. Based on this result we calculated and compared the accounting profit rate and the economic profit rate which integrated knowledge capital into the model. The empirical results revealed that the accounting profit rate is higher than the economic one and may give inaccurate information to the stockholders.

In this paper, I discussed the present and future role of health economics in performing health services research in japan by raising one of the policy issues:that is, how the concept of ‘equity’ should relates to the size of national health expenditures. Though realizing the limits of the way of economics to construct a model for the analysis, I asserted that only collecting data and showing their results would not attract economics.

We estimated the effect of medical activity in inducing production for each industry through interindustry transactions using Miyazawa’s interaction model of goods industries and service industries, after reorganizing the official input-output table in 1990 and producing a new input-output table which consists of 24 goods industries and 24 service industries. The main conclusions are as follows.

①The effect of medical activity in inducing production for all the industries through interindustry transactions is less than the average of 48 industries but, considering the effect of household consumption, the effect is more than that of the construction industry, depending on the magnitude of propensity to consume.

②The effect of medical activity in inducing production in service industries directly (the internal multiplier) is small but the effect of medical activity in inducing production for service industries indirectly through goods industries (the external multiplier) is greatest in service industries.

③Generally, the effect of service industries in inducing production for goods industries has been weaker over time and the effect of goods industries in inducing production for service industries has been stronger over time. But the effect of medical activity in inducing production for goods industries has been stronger over time.

Recently some people advocate for-profit hospitals which are not approval should be authorized in Japan. They emphasize the profit motive improves the economic performance of hospitals. Then I try to examine the differences in the efficiency between for-profit and nonprofit hospitals by survey of the comparative studies in the United States. Although there is a common belief that for-profit hospitals are more efficient or less costly than are nonprofit hospitals, these studies of hospitals provide no evidence to support it. Moreover many studies show for-profit hospitals are more likely to avoid unprofitable patients in cream-skimming way. These studies imply to support the hypothesis that for-profit status are more likely to take opportunistic behaviors in information asymmetry market. From the result of this survey and a careful observation about Japanese healthcare, I conclude that an approval of for-profit hospitals will not contribute to improve the efficiency in Japanese healthcare sector and may cause new problems; unfair competition, unstable supply for service etc.

In order to identify the social and administrative factors affecting the participation rate of health examinations in Japan, we conducted a postal survey on all local municipalities in Japan. The results indicated that the participation rate was significantly higher among the municipalities which are implementing the following policies; employing the higher number of public health nurses per population, miking a campaign for health examination via individual reminding system, mailing an examination ticket to the individuals, scheduling an examination results, utilizing the examination records for other community health services, and allocating more budget into health examinations. It is suggested that there still remains much room to increase the participation rate of health examinations by implementing these policies.

Cost-Utility Analysis (CUA) seems to have high potential in that through it we can compare different sets of health care programmes. Therefore，this study examines the methodological issues of CUA.

Through a survey of almost 170 nurses we studied utility assessment methods for quality adjusted life years(QALYs)，which is an important indication of the utility of CUA. Ther esults are follows;

1) When the subjects are health care staff，questionnaires are more useful than interview methods for utility assessment.

2) Among the three utility assessment methods of Standard Gamble，Time Trade-off and Person Trade-off, Person Trade-off seems to be the most prominent method for various reasons; for example，the context of Person Trade-off is quite similar to the resource allocation settings.

It has not been deeply examined whether the Japanese Fee Schedule (“Tensu-hyo”) is validly set against international standards. As a preparatory study for more thorough examination of validity of the Japanese Tensu, this paper makes, using a simple model, “direct” comparison of Tensu with RVUs (Relative Value Units), which is equivalent to Tensu, in the Medicare Fee Schedule. The author picks up Tensu set for Outpatient Visit (“Shoshin” and “Saishin”) of an Elderly Patient and for Medical Guidance (“Seikatsu-shido”) to an Elderly Patient with Chronic Disease(s), and RVUs set for Office or Other Outpatient Visit (equivalent to “Shoshin” and “Saishin”), which is part of Evaluation and Management (E/M). The simple model is composed of four patterns according to length of period in which visits are performed and to severity of disease. The result of this comparison suggests that total Tensu and total RVUs are comparable in each of the four patterns.

To solve the problems in constructing an ursing care insurance system for the elderly, it is essential to establish the method of evaluating personal needs for nursing care and the amount of care needed.

3,443 elderly people in hospitals dealing with intensive care services and special nursing homes were studied as subjects regarding the kinds of care they received and time span. 360 questions were asked of the residents to determine their attributes.

Analytical approaches showed that the collected data regarding the amount of provided care could be translated into the residents' attributes. Thus a method was developed to estimate the kinds and amount of care needed for the elderly by studying the personal information.

A survey on the actual conditions of persons 65 years of age and over who had been admitted to nursing homes, health care facilities for the elderly, geriatric hospitals, and convalescent wards, was conducted in order to evaluate their daily living conditions. The survey was conducted in October 1995, and the subjects were persons and facilities in Tochigi Prefecture. Data was gathered on a total of 4,316 persons in 68 institutions.

The content of the survey sheet centered mostly on the activities of daily living. Scoring was based on the “ADL20”, and the analysis was conducted according to the degree of care required. The “ADL20” and the degree of nursing care required were consistent with each other in terms of the activities of daily living of the elderly in the various institutions, and no marked differences were found between institutions. Thus, despite differences in the systems of the various institutions, the findings suggested that all of the institutions must have the same institutional functions in terms of the quality and quantity of nursing care.

The French health care system has long been characterized by its fee-for-service payment system, freedom of prescription and location by the doctor, and free choice of doctors by the patient under the quasi-universal medical insurance scheme. However, since 1980s the French government has been conducting a series of reforms of health care system, in order to stabilize the rapid increase in the national medical expenditures, some of which limit the generosity of the traditional French system; i.e., global budgeting for public hospital services, establishment of standardized medical practices and introduction of patients' medical information system managed by general practitioners. These reforms must be very suggestive for the future health care policy in Japan, therefore, it is strongly expected that some collaborative research projects between the two countries will be organized near future.

Economic evaluation of the health care sector is needed to distribute health care more efficiently. However, due to a variety of evaluation methods employed by researchers and policy makers, discussion on this topic is frequently confused.This research has selected 6 evaluation methods and has outlined the character or limit of each method in order to make clear under what conditions each particular method is appropriate.

These evaluation methods may be analyzed according to whether or not they consider externalities (that is, whether or not a social costs are taken into consideration) and the scale used in the analysis (that is, macro or micro).

The latest survey shows that the number of deaths from hepatocellular carcinoma totals 27,765, and that this figure represents an increase of 2.6 times over the number of deaths twenty years ago.This significant upsurge in the number of deaths is primarily due to an increase in the number of hepatocellular carcinoma cases related to hepatitis C virus. Recently, the number of deaths from cirrhosis related to hepatitis C virus has shown an increase as well.

To prevent cirrhosis and hepatocellular carcinoma, it is important to treat chronic hepatitis C, which causes these two diseases.Under the present circumstances, the administration of interferon is the only effective treatment for chronic hepatitis C.

In recent years, the medical care cost in Japan has increased significantly. As a result, there is growing public concern about reducing medical care cost, using limited resources effectively and efficiently. Accordingly, it is important to verify the cost efficiency of an expensive medical treatment, such as interferon for chronic hepatitis C.

The purpose of this study is to investigate the current status of pharmacoeconomic studies of the treatment for chronic hepatitis C with interferon, to establish the most suitable treatment strategy for chronic hepatitis C with interferon, and to measure the cost efficiency of the treatment for chronic hepatitis C with interferon based on the most suitable treatment strategy.

It is found that there are only four papers in Japan and overseas medical literature that deal with cost efficiency of the treatment for chronic hepatitis C with interferon.

And, it turned out that when the treatment is given to a million patients with chronic hepatitis C using the least expensive interferon α-2a under the most suitable treatment strategy, the total medical care cost is between ¥9.4 trillion and ¥11.3 trillion.

By contrast, when the former treatment, which did not rely on interferon, is given to a million patients with chronic hepatitis C, the total medical cost is approximately ¥14.2 trillion.

Consequently, it can be concluded that interferon treatment that is based on the most suitable treatment strategy would be effective in reducing the total medical care cost by from ¥2.9 trillion and ¥4.8 trillion.