A discrete choice experiment studying students' preferences for scholarships to private medical schools in Japan.

BACKGROUND: The shortage of physicians in rural areas and in some specialties is a societal problem in Japan. Expensive tuition in private medical schools limits access to them particularly for students from middle- and low-income families. One way to reduce this barrier and lessen maldistribution is to offer conditional scholarships to private medical schools. METHODS: A discrete choice experiment is carried out on a total of 374 students considering application to medical schools. The willingness to receive a conditional scholarship program to private medical schools is analyzed. RESULTS: The probability of attending private medical schools significantly decreased because of high tuition, a postgraduate obligation to provide a service in specific specialty areas, and the length of time of this obligation. An obligation to provide a service in rural regions had no significant effect on this probability. To motivate non-applicants to private medical schools to enroll in such schools, a decrease in tuition to around 1.2 million yen (US$ 12,000) or less, which is twice that of public schools, was found to be necessary. Further, it was found that non-applicants to private medical schools choose to apply to such schools even with restrictions if they have tuition support at the public school level. CONCLUSIONS: Conditional scholarships for private medical schools may widen access to medical education and simultaneously provide incentives to work in insufficiently served areas.

[Pharmacoeconomic evaluation of combination therapy with dutasteride and α1 blocker for treatment of benign prostatic hyperplasia in Japan].

The cost-effectiveness of combination therapy with an α1 blocker and dutasteride in benign prostatic hyperplasia (BPH) was analyzed in comparison with α1 blocker monotherapy. A Markov model with seven health states related to BPH was constructed with 4-year and 10-year time horizons and from the entire payers perspective. The transition probabilities among different health states input into the model were mainly derived from CombAT Study data, while cost parameters were estimated from a clinical database including DPC claims. Effectiveness was defined as quality adjusted life year (QALY). The cost-effectiveness of combination therapy was assessed by the incremental cost-effectiveness ratio (ICER) threshold (6 to 7 million Japanese yen (JPY)/QALY gained). For a base-case analysis, combination therapy produced an incremental effectiveness versus monotherapy of 0.050 and 0.097 QALYs at 4 years and 10 years, respectively, while the concomitant incremental costs were estimated to be 257,172 and 579,908 JPY, respectively. The ICERs for combination therapy versus monotherapy calculated at 4 years and 10 years were 5,119,007 and 5,974,495 JPY/QALY gained, respectively, both below the acceptable ICER threshold. Sensitivity analyses revealed that the ICER tended to decrease with greater BPH severity. These findings suggest that combination therapy with an α1 blocker and dutasteride would be more cost-effective in BPH than α1 blocker monotherapy and more efficient in moderate-to-severe BPH.

[A future image of clinical inspection from health economics].

Do you let medical costs increase in proportion to the growth rate of GDP? A way of thinking of the Council on Economic and Fiscal Policy. Should we exclude public medical insurance? It is not a problem, it is an absolute sum if you are effective. If there is no insurance, and individuals pay the total amount, there is no problem, but it is impossible. Economic development will cease if there is no insurance. As medical personnel, to offer good medical care with an appropriate cost. An appeal to the nation is necessary. Economic technical evaluation to identify a cheap method for each clinical inspection. Does medical insurance have a deficit? I. Japanese Health insurance system. (1) Health insurance union. When you look at the contribution money, it is originally 2,479,800,000,000 yen, with premium income and a profit of 45%. (2) Government management health insurance. When you look at the contribution money, it is originally 2,163,300,000,000 yen, with premium income and a profit of 36%. (1) + (2) Employed insurance meter. (3) Mutual aid. (4) National Health Insurance. II. A clinical economic method. III. Expense of medical care and its effect. A. Expense. B. A medical economic technical evaluation method. 1. Cost-effectiveness analysis CEA. 2. Cost utility analysis CUA. 3. Cost-benefit analysis CBA. 4. Expense minimization analysis.