European health care systems have embarked programmes of radical reform intended both to contain costs, maintain quality and promote equity. In most countries, the instruments used and the declared objectives seem to be similar and derived from the American model. As a result, observers are tempted to infer that these health systems are converging towards a single liberal model.

In an attempt to qualify this view, the present article will seek to show that the reforms currently in progress must be evaluated not in terms of universal criteria but by reference to the historical contexts in which they are being implemented.

Thus, for example, the British and French reforms are running into difficulties that are often attributed to "resistance". It is shown here that these difficulties are due to the fact that the advocates of the reforms underestimated the influence of earlier dynamics and the importance of the implementation phases. To what extent lessons for Japan health care reform can be drawn from European experiences is an open issue.

The Ministry of Health and Welfare (MHW) is now investigating a drastic improvement of the evaluation on medical expenses in year 2000, such as a doctor's bill, a system of drug price and so on.

It will be important in dental care to make technology assessment on prosthodontic treatment as main dental technique from a new point of view.

We attempt to analyze dental care system from medical economic view using Survey of Dental Disease by MHW and Survey of National Medical Care Insurance Services in 1993 in order to find essence of technology assessment on prosthodontic treatment technique in Japan.

As a result, we found that many fixed and removal dentures were frequently made again as both type of denture were not maintained long term.

It is suggested that this fact causes the increment of national expense.

Then, it thought that the evaluation much regarding long term maintenance and management, which have been a blind spot of evaluation on dental skill, becomes important when the health insurance system of fee is drastically reformed.

Of the DRG alternatives examined, we have found that the AP-DRGs are the preferred alternative. The data in Japan are not sufficiently complete to support the APR-DRGS, and we believe that the HCFA-DRGs are not as clinically sophisticated as the AP-DRGs and may not be as well accepted by the medical community. As there is a clear intention in Japan to develop Japanese specific DRGs, the AP-DRGs represent a sound starting point for this effort. In addition, beginning with the AP-DRGs saves time and money since one does not need to duplicate efforts, while allowing Japanese clinicians to focus on the clinical differences between Japan and the United States.

Though the provision of extended care in acute care hospitals was a problem in calculating DRG weights, we were able to compute reasonable weights based on topdown costing methods. However, these weights should be based on more cases and data from more hospitals to be certain that they will be accepted nationwide. A stratified random sample of about 300 hospitals would be ideal for this purpose. In addition, any weights will need to be carefully reviewed by a small group of physicians before they are considered for use in Japan.