We use newly released data on Japanese hospitals to explore patients’ perceptions of hospital quality, the implications of these assessments for the structure of demand for hospital care, and the role of the availability and quality of hospital care in influencing access. We find that the primary influences on hospital choice for Japanese patients are interpersonal aspects of care, that Japanese hospital markets are not segmented, and that availability has no influence on access. These results are interpreted in light of institutional differences between the Japanese and American health care systems.

In today's competitive health care markets, market forces are motivating large innovations in cost reduction and customer service improvement. Government programs, on the other hand, are often associated with waste, complexity, rigidity, and coercion. Thus, there are important advantages to be gained by leaving resource allocation to the private market. But market forces in health care if left unchecked can produce undesirable results. Therefore, collective action at some level is often needed to correct these problems. In some cases, there is no alternative to government intervention; in others, with appropriate rules and incentives, collective action in the private sector may produce the desired results.

Market forces will not produce universal coverage, because some people cannot reasonably afford coverage, and others are motivated to take a free ride (by the cost of coverage, the availability of the safety net, and the easy access to coverage if there is guaranteed issue without exclusion of coverage for preexisting conditions or waiting periods), Thus, to produce universal coverage, the market needs to be supported by a system of incentives, subsidies, or possibly compulsion (mandates or taxes).

Rapid Response Project prepared for the Management Decision Research Center, Department of Veterans Affairs

Japanese and American economists assess the present economic status of the elderly in the United States and Japan, and consider the impact of an aging population on the economies of the two countries.

With essays on labor force participation and retirement, housing equity and the economic status of the elderly, budget implications of an aging population, and financing social security and health care in the 1990s, this volume covers a broad spectrum of issues related to the economics of aging. Among the book's findings are that workers are retiring at an increasingly earlier age in both countries and that, as the populations age, baby boomers in the United States will face diminishing financial resources as the ratio of retirees to workers sharply increases.

Because medical technology is the most important controllable component of health spending growth, the success of strategies for limiting spending growth depends upon their impact on technology dissemination. Technology assessment is fundamental to any strategy for controlling the adoption of medical technologies. Cost-effectiveness analysis holds particular promise as a method for evaluating alternative health care technologies because it explicitly incorporates costs. This paper describes how the widespread adoption of health insurance promoted the dissemination of medical technologies and how technology dissemination fueled spending growth. It then describes approaches to technology assessment and the ways in which technology assessment, in the form of cost-effectiveness analysis, can be applied to help control spending growth.