A declining birthrate and aging population have brought about a declining working-age population in Japan. As the working population declines, work style reforms to meet diversifying needs of workers such as redressing long working hours and improving productivity, balancing between childcare / long-term care and work, engaging women and elderly in work, redressing disparities between permanent and non-permanent staff, become more important. These formed the background for the legislation of the Act on the Arrangement of Related Acts to Promote Work Style Reform in 2018. Under this law, a new system that places an upper limit on working hours and the advanced professional system was established in 2019. However, for physicians, labor regulations are needed that pay particular attention to their special requirements such as the obligation to attend to patients as well as other special circumstances; the regulation of the upper limit on working hours was to be postponed enacted in 2024. In the meantime, specific regulations and efforts to shorten working hours, with the aim of realizing new high-quality medical care and working styles in the medical field, were discussed with the participation of the relevant medical community. In this article, I would like to outline the discussions of the national panel on Promote Work Style Reform of Physician, summarize the proposed regulation under current discussion, and examine remaining issues to be considered.

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According to the 2020 annual publication “Current State of First-Aid and Rescue”, the survival rate of patients with Out-of-Hospital cardiac arrest (OHCA) who were rescued by Automated External Defibrillators (AED) was 4.5 times higher than those who were not treated appropriately. On the other hand, the report indicated that the rate of AED implementation by witness (bystanders) for OHCA was only 5.1％ . Meanwhile, drones have been evaluated as the means of delivering medical equipment and goods. Therefore, the purpose of this study is to evaluate the cost-effectiveness of developing AED drone network by a model analysis. Assumed that the fire stations in Ibaraki Prefecture the drone bases, a decision tree model using Utstein data from 2008 to 2012 was conducted. jSTAT MAP with the national census data was used for the model analysis. The costs included in this study were the drone network infrastructure initial and maintenance fees, the drone purchase and maintenance fees, the mobile network fees, and the pilot labor cost. The discount rate was set as 2.0％ per year. As the base case from this model analysis, by considering the weather conditions and the population coverage, 254.05 QALYs were additionally obtained in the environment where the drone network would be available. The total cost was calculated as 1,632,527,863 JPY, and therefore ICER resulted in 6,425,928 JPY per 1 QLAY. The sensitivity analysis showed that when one-month survival rates with AED were set to 0.350, 0.411, and 0.550 and drone-delivered AED defibrillation rates by bystanders were set from 0.20 to 0.90, ICERs were 18,432,545 to 4,096,121 JPY, 15,004,541 to 3,334,342 JPY, and 10,538,521 to 2,341,893 JPY, respectively. The result does not demonstrate that the drone network to deliver AED can be cost-effective for exceeding 5 million JPY as ICER, which is categorized as no price adjustment is required, set by Central Social Insurance Medical Council. However, it might be worthy enough to consider the deployment of AED drone network by carefully looking at the increase of AED defibrillation rate by bystander, the reduction of the initial cost and the possibility of the flight under the rain condition by the technological advances, the reduced number of the existing AEDs, and the non-dedicated pilot assignments. In the future, as the effectiveness and the safety of AED delivery by drones are developed, discussions on legislation about AED drone network are expected to be facilitated accordingly

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This paper points out the importance of two perspectives on preventive measures against COVID-19 as contributions of economics: (1) clarifying the trade-off between health and economy and implementing cost effective measures, and (2) understanding people's behavior. Policy makers will choose among the trade-offs, which are drawn by economists. If a measure is not on the efficiency frontier, economics can suggest an improvement. Restraints on individual behavior and on business operations led to the trade-off between health and freedom. In order to succeed in restricting activities based on requests without legal enforcement, we need to consider two questions: why do people comply with requests for restraints (it is not selfish behavior), and why did people no longer comply with the requests (why was the effect of emergency declarations weakened)? Then, the economic perspective that “if the altruistic behavior becomes expensive, altruistic behavior will not be taken” becomes important. Actual countermeasures against COVID-19 may create problems because of the lack of understanding of people's behavior behind these two questions. They raised the cost of cooperating with the countermeasures, and some people became reluctant to do so. By introducing penalties in the amendment of the law, the government gave the selfish incentive and tried to secure the cooperation that was once lost, but this may crowd out people's altruistic behavior and undermine the social order.

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