The financial performance of health insurance societies in Japan has worsened because of increasing elderly health care cost and the economic recession. This study is to quantify the characteristics of societies to determine the indicators for the cost burden of elderly health care. The indicators were inpatient，outpatient and medical cost per enrolled elderly person and the cost share for elderly health care per insured person in the societies. The subjects were 1816 societies that were member of the Health Insurance Society Association in 1996. The related characteristics of societies and the magnitude of the effect were different among the indicators. The dependent rate was strongly related to the cost share for the elderly health care per insured person and the standardized regression coefficient was 0.598 by the multiple regression analysis. The cost share for elderly health care per insured person is proportionate to each insurerer's health care cost per the enrolled elderly and the dependent rate. No society can decrease its cost if it insures a disproportionate number of sick and older people or dependents. The current cost-sharing redistributes elderly health care cost unequally.

I have analyzed the three cases of policy process of the Regional Health Service Plan. The first case was the amendment to the Health Service Act in 1962, which introduced control over the number of the public hospital beds. The second case was the Health Service Fundamental Act, which was rejected in 1972 but resulted later as the experimental implementation of the Regional Health Service Plan. The third case was the amendment to the Health Service Act in 1985, which introduced the Regional Health Service Plan and the control over the number of hospital beds. In the second case the policy process of the health service policy had metamorphosed by the rise of the medical officers and the formation of the medical professionals' policy community.

Health Policy can be divided into health service policy and health insurance policy. As for health service policy, the policy community composed of the medical officers and Japan Medical Association was formed in the 1970s, and the Chief Medical Officer had implemented the Model Plan of Regional Health Service after the bill was rejected. In the background there was the idea held by the opposition parties to socialize the health service system. The significance of the amendment to the Health Service Act in 1985 was merely to confirm the prearranged policy prepared by the policy community.

The objective of this study was to detect whether there was any multidimensional relationships between nurse's job satisfaction and customer satisfaction with home nursing care. The sample for this study was drawn from customers and home care nursing staffs within a public health center area in K prefecture. The relationship between each customer satisfaction (dependent variables) and nurse's job satisfaction (independent variables), based on its content validity in previous researches, was explored by stepwise multiple regression analysis. Customer's "Overall satisfaction" was associated positively significantly with "Relationship with customers" among nurse's job satisfaction dimensions. It was suggested that customer satisfaction with home care nursing depended potentially on the relationship between customer (caregiver) and home care nurse.

Objective.

To verify the possibility if medical payments can be determined by RBRVS(Resource－Base Relative Value Scales) viewpoint.

Study Design.

1) Ask physicians to evaluate their medical practices from the view of time and work (load) by a questionnaire survey.

2) To investigate the effect of attributes associated with the respondents upon the answers.

3) To analyze the relationship between time and work.

4) To consider if there are more efficient methods to evaluate medical service from RBRVS perspectives other than the questionnaire survey.

Conclusions..

1) The difference in the disciplinary and years of experience of the participated physicians had less influences on answers to the questionnaire.

2) The correlation coefficient between work and time was high in the answers to the questionnaire.

3) The results of the evaluation by mutual consent of a small number of medical specialists resulted in the similar values with those obtained by the questionnaire survey, suggesting that the assessment even by a small number of authorities retains enough representativeness.

These results indicated that medical and technical service payment could be determined from RBRVS perspectives.

The data analysis also revealed the followings:

1) Even the same medical service resulted in huge differences in time and work required, depending on the disease characteristics of the subjects.

2) The current medical fee payment system includes both economically overestimated and underestimated medical services.

These facts would have substantial significances in the future improvement of the medical fee payment system.