This paper examines pharmaceutical distribution systems in isolated islands based on a case study on the Goto Islands of Nagasaki Prefecture, and focuses in particular on the function of pharmaceutical wholesalers. As pharmaceuticals are directly connected to life and wellbeing, a certain level of equity is required to ensure their uniform, regular delivery. The absolute level of demand is small in the Goto Islands, and there are limitations to the level of delivery efficiency improvement that can be achieved with economies of scale. At the same time, these isolated islands experience high delivery costs due to their remoteness and relative smallness in comparison with the mainland. However, NHI (National Health Insurance) drug prices are determined uniformly throughout the country, meaning that these remote locations account for a high percentage of the delivery costs built into NHI drug prices.
Pharmaceutical wholesalers focus on delivering essential drugs while ensuring a profit, and must also pay attention to the structural problems of the distribution system in the isolated island group. They set high wholesale prices for medical institutions and pharmacies, and also minimize unprofitable services such as urgent delivery as much as possible.
The results of a questionnaire survey involving pharmacies located in the Goto Islands indicate that their inventory management is problematic and that wholesalers' level of service is insufficient. On the other hand, the business environment of wholesalers is deteriorating rapidly. Accordingly, pharmaceutical wholesalers may close branch offices or reduce their frequency of delivery in relation to the speedy dispatch of essential pharmaceuticals.

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Membership within a residential group was not stable in hunter-gatherer societies, such as those of the San (Bushman), Mbuti Pygmy, Hadza, Hare Indian, Inuit, Orochon, and Ainu. So far the differences of the degree of fluid residential groupings among hunter-gatherers have not been revealed well. The purpose of this study was to measure the degree of fluid residential groupings of settlement dwellers between the Ainu and Orochon by making use of a co-residing ratio (U), and to consider the backgrounds of their differences.
The numerical value of the co-residing ratio (U_i) of the household i was calculated as follows:
U_i=m_i / M_i
Mi:the number of households that resided with household i at the same settlement in one year and also resided at any settlement after a given number of years. M_i≥1.
m_i:the number of households that resided with household i at the same settlement in one year and also resided with household i at any settlement after a given number of years, including household i.
The numerical value of the degree of the co-residing ratio (U) per household was within the range of 0 to 1. When the degree of the co-residing ratio (U) increases from 0 to 1, the fluidity of residential groupings of settlement becomes lower.
When we focused on the 74 Ainu households that resided at any settlements in 1856, 1862, and 1868 in the Monbetsu district, a given number of years of the co-residing ratio（U） was six years for each time frame 1856-1862 and 1862-1868. The co-residing ratio （U） was 0.9～1.0 in about 73% of 144 households. Samely when we focused on the 46 Ainu households that resided at any settlements in 1856, 1858, 1864, 1865, 1868, and 1869 in the Mitsuishi district, a given number of years of the co-residing ratio （U） was two years, six years, one year, three years, and one year for each time frame. The co-residing ratio （U） was 0.9～1.0 in about 43% of 230 households. On the other hand, when we focused on one Orochon household in 1910, 1925, 1928, 1932, 1935, 1938, 1945, 1947, and 1957, one Orochon household in 1900, 1920, 1921, and 1931, and one Orochon household in 1908 and 1913, the co-residing ratio （U） was 0.9～1.0 in only about 25% of 12 households. In the Orochon households 33.3% of 12 households showed 0.1～0.2 degree of the co-residing ratio （U）.
Next, when we focused on the 46 Ainu households that resided at any settlements in all time frames 1856, 1858, 1864, 1865, 1868, and 1869 in the Mitsuishi district, and one Orochon household that resided at any settlement in all time frames 1925, 1928, 1932, 1935, and 1938, the numerical value of the co-residing ratio （U） of Orochon was lower than that of the Ainu in the Mitsuishi district during almost all thirteen years.
Therefore it is postulated that the degree of fluid residential groupings of settlement dwellers was higher in the Orochon than in the Ainu, and was higher in the Mitsuishi district than in the Monbetsu district. And also it is estimated that the Orochon settlement was formed mainly by moved households and the Ainu settlements in the Mitsuishi district were formed by moved households and stayed households, and the Ainu settlements in the Monbetsu district were formed mainly by stayed households.

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