The Uruguary Round of Multilateral Trade Negotiations resulted in the establishment of the World Trade Organization (WTO) in January 1995. Several multilateral trade agreements, which are integral part of the WTO Agreements, have considerable health repercussions, particularly in food safety, pharmaceutical market and trade in health services . The WTO agreements thus have potential to profoundly influence health policies of the member governments and the level of public health and welfare acchieved thereby . The analysis of the new trade environment has revealed differential public health impacts on developing and industrialized countries. Whilst the actual effects of the WTO agreements on developing countries have not yet been fully understood, these countries will soon have to comply with the entire range of the duties under the agreements as the agreed initial delay period expires. The creation of transnational markets for foods and drugs and the deregulation process of health services may be one of the policy options for governments in search of increased efficiency and productivity in health and social services. In the 21st century where further liberalization of trade and investment is expected to take effect, each government will be obliged to maintain its economic advantages by offering a more competitive and efficacious social security system.
It is indispensable to incorporate variables concerning the relationships between caregivers and care recipients into the model which investigates the determining factors on dental care utilization of recipients. The objective of this study is to analyze the factors for dental care utilization of care recipients, using the expanded Andersen and Newman's Health Behavioral Model . The subjects were 30 pairs of caregivers and care recipients who routinely visited a day care center in a town of Yamanashi prefecture. All of the subject care recipients, who had one or more dental problems were encouraged to seek dental care after survey including oral examination and interview with them and their caregivers . The multiple logistic regression analysis revealed that the care recipients' perception of need of dental care was the most significant predictor and that the variables about cognition for the decision-making played significant roles in dental care utilization. It was also clarified that frequency of respondent's utilization of dental care was high in cases that not only the care recipients but also their caregivers recognized the former as a decision-maker of receiving dental care, demonstrating that this decision-making pattern is one of the regulating factors of the care recipients' dental care utilization in communities.
Regional population change reflects adaptation process of the people to their environment. In this study, to clarify the regional characterization of the administrative units in Yamanashi prefecture, which abounds in mountainous areas, their population changes from 1920 to 1995 were analyzed to relate with the landform and the industrial structure. Population change of Yamanashi prefecture as a whole is divided into three phases, rapid increase in 1940-47, decrease in 1947-65 and increase in 1970-95. Based on the patterns of population change in these three phases, the administrative units were categorized into six groups (A, B, C, D1, D2, and E). The administrative units of the group A, in which the secondary and tertiary industries were already dominant in 1920, constantly increased population, though the increase in 1940-47 was small. After a rapid increase of population in 1940-47, the group E also showed gradual increase of population with change in industrial structure from the early time. In contrast, the groups B (with stable population in 1940-47) and C (with rapid increase of population in 1940-47), which were characterized by narrow flatlands area, have decreased population since 1947 due to less development in any industries. The groups D1 (with a high proportion of flatlands) and D2 (with an intermediate proportion of flatlands) have also decreased population since 1947, though the former has shown a rapid population increase since 1965 in accordance with rapid change in industrial structure and the latter has gradually increased population since 1970, remaining relatively high dependence on the primary industry. In summary, the variation in change of regional population has been basically related to the local industrial structure. In addition, however, the proportion of flatlands has profoundly affected the regional difference in population change through change of industrial structure.