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The purpose of this paper is to propose a sensor system and its measuring strategy. The proposed system is regarded as a total system of a robot and a sensor. It can make full use of a robot's degrees of freedom (DOF) for not only locomotion but also sensing.

The sensor system is composed of a connected crawler robot and a simple sensor unit. The connected crawler robot consists of five connected flat crawler stages; each stage has motor‐driven crawlers on its left and right side. The left and right crawlers are driven by motors independently. The five stages are connected by motor‐driven joints, which can be arbitrarily controlled. The sensor unit is made up of a position sensitive detector and two active joints. Generally, all sensors have a measurable range limit. If the object is bigger than the measurable range, it is impossible to recognize the object's shape. However, this sensor system compensates for this problem due to a combination of sensor unit's motion and robot's motion. The robot's DOF are ordinarily used for going forward. In this moving, if the sensor detects a bigger object than its measurable range, the robot's DOF are used for lifting up sensor unit. Therefore, the robot's DOF are exploited for both locomotion and scanning.

The experiment was done by using proposed measurement strategies. Through this experiment, the maximum distance error was 0.037 m, that fulfils the required sensor's accuracy. This experiment confirmed that the measurable range was expanded by making full use of the robot's DOF and sensor's DOF. The robot's DOF which is ordinarily used for moving is applicable to expand measurable range. Therefore, it was possible to expand measurable range by making full use of the robot's DOF without mounting extra equipments or mechanism on the robot. Hence, it was enable to exert enough sensing function even if the sensor's structures and robot's structure are also simple, by using both the robot and the sensor's functions effectively and simultaneously.

General existing mobile robot systems have both mobile function and sensing function, they are completely separate. However, this sensor system is regarded as a total system of robot and sensor. It can make full use of a robot's DOF for not only locomotion but also sensing. This sensor system makes full use of a robot's DOF. Hence, it is enable to exert enough sensing function even if the sensor's structure and robot's structure are also simple. There is originality on this point.

Significant regional variations by prefecture level exist for the family and the elderly in Japan. This suggests that the Japanese family, and aging society as well, must be studied carefully with close attention to the socio‐cultural characteristics specific to each region and community (Kumagai, 1997a, 1997b). Therefore, it is essential to move the unit of analysis down to the community level rather than the national or even prefecture (regional) level. Social practices and cultural characteristics specific to each region and community are difficult to measure and quantify. Upon careful examination of Japanese married women in the traditional extended family, the theoretical hypothesis was postulated: Whether in urban or rural regions, regardless of the place of residence, married women living with their mother‐in‐law are likely to seek work outside the home. A national random sample of 3,662 Japanese women was analyzed. In conducting Chi‐square significance tests, this hypothesis is proved to be valid. The most striking finding of this study is that working outside the home seems to be one of the effective alternatives adopted by married women in the traditional generational family household. When son’s wives are in the labor force, it is most likely to reduce intergenerational conflict, a negative aspect of co‐residence living arrangements. In other words, working outside the home helps to minimize intergenerational conflict with in‐laws ‐mothers‐in‐law, in particular). Thus, the qualitative analysis of the family can provide effective indicators for the in‐depth analysis of Japanese families. It is, therefore, necessary to propose welfare policies for the elderly in the same manner, rather than simply looking at national average statistics.

Tsuda Hiromichi is a most representative shishi (noble‐minded patriot) of the Meiji Restoration Era. He came from a middle class warrior family of Okayama han. Trained first in Confucianism and later in Western technologies, he was appointed to new high positions in the military and civil services for the Han to cope with changing situations. He was selected as one of the 18 to be despatched by the Meiji Restoration Government for the first round‐the‐world observation tour for one year from 1871 to 1872. On his return, he repaid the balance of travel expenses, which became the foundation of the Ikeda Scholarship. Before long, he was installed as a high official of the Meiji Restoration Government. After the services there, he came back to hometown Okayama to develop enterprises for employing ex‐samurai. An examination of Tsuda’s career will reveal the following as most significant roles played by middle class warriors; work ethics and the tradition of thrift maintained firmly by samurai élites; the feudal system’s flexibility in the later half of the 19th century which allowed their foresight and claims to be satisfied.

The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016.

The authors collected data from surgical records in the Teikyo University electronic medical record system from April 1 till September 30, 2016. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated each surgeon’s efficiency score using output-oriented Charnes–Cooper–Rhodes model of data envelopment analysis. The authors compared the efficiency scores of each surgical specialty using the Kruskal–Wallis and the Steel method.

The authors analyzed 2,558 surgical procedures performed by 109 surgeons. The difference in efficiency scores was significant (p = 0.000). The efficiency score of neurosurgery was significantly greater than obstetrics and gynecology, general surgery, orthopedics, emergency surgery, urology, otolaryngology and plastic surgery (p<0.05).

The authors demonstrated that the surgeons’ efficiency was significantly different among their specialties. This suggests that the Japanese surgical reimbursement scales fail to reflect resource utilization despite the revision in 2016.

This paper discusses how corruption, in its various manifestations, has had — and continues to have — a very serious impact on the economic and political stability of the Asia‐Pacific region.

The purpose of this paper is to determine the characteristics of healthcare facilities that produce the most efficient inpatient orthopedic surgery using a large-scale medical claims database in Japan.

Reimbursement claims data were obtained from April 1 through September 30, 2014. Input-oriented Banker-Charnes-Cooper model of data envelopment analysis (DEA) was employed. The decision-making unit was defined as a healthcare facility where orthopedic surgery was performed. Inputs were defined as the length of stay, the number of beds, and the total costs of expensive surgical devices. Output was defined as total surgical fees for each surgery. Efficiency scores of healthcare facilities were compared among different categories of healthcare facilities.

The efficiency scores of healthcare facilities with a diagnosis-procedure combination (DPC) reimbursement were significantly lower than those without DPC (p=0.0000). All the efficiency scores of clinics with beds were 1. Their efficiency scores were significantly higher than those of university hospitals, public hospitals, and other hospitals (p=0.0000).

This is the first research that applied DEA for orthopedic surgery in Japan. The healthcare facilities with DPC reimbursement were less efficient than those without DPC. The clinics with beds were the most efficient among all types of management bodies of healthcare facilities.

‘It must be remembered there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than the creation of a new system. For the initiator has the enmity of all who will profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new one.’ Machiavelli.

The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014.

The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30, 2014. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated surgeons’ efficiency scores using data envelopment analysis.

The efficiency scores of each surgical specialty were significantly different (p=0.000).

This result demonstrates that the Japanese surgical reimbursement scales still fail to reflect resource utilization despite the revision of surgical fee schedule.

The sustainability of the Japanese healthcare system is in question because the government has had a huge fiscal debt. Despite an enormous effort to cut the deficit, our healthcare expenditure is increasing every year because of the rapidly aging population. One of the solutions for this problem is to improve the productivity of healthcare. The purpose of this paper is to determine the factors that change surgeons’ productivity in one year.

The authors collected data of all surgical procedures performed at Teikyo University Hospital from April 1 through September 30 in 2014 and 2015, and computed the surgeons’ Malmquist index (MI), efficiency change (EC) and technical change (TC) using non-radial and non-oriented Malmquist model under the constant returns-to-scale assumptions. The authors then divided the surgeons into two groups; one whose productivity progressed and the other whose productivity regressed. These two groups were compared to identify factors that may influence their MI.

The only significant difference between the two groups was ECs (p < 0.0001). The other factors, such as TC, experience, surgical volume, emergency cases, surgical specialty, academic ranks, medical schools and gender, were not significantly different between the two groups.

EC is a major determinant of surgeons’ productivity change. The best way to improve surgeons’ productivity may be to enhance their efficiency regardless of their surgical volume and personal backgrounds.

This study seeks to investigate doctors' desire to change the hospital where they work to sustain higher quality care.

Self‐administered questionnaires were sent to doctors in Aichi Prefecture, Japan. Data were analyzed using univariate and logistic regression analysis and recursive partitioning.

Factors related to doctors' desire to change hospitals, according to logistic regression, were interaction between working hours and satisfaction with the hospital, evaluation, local government hospitals versus private ones, small vs large hospitals, ophthalmology versus internal medicine, desire to continue working as a hospital doctor and age. Additionally, working hours were also found to be related, based on recursive partitioning.

The response rate was low and sampling bias was observed – therefore results need careful interpretation. Also, because this was a cross‐sectional study, causal relationships could not be identified. Desire to change hospitals, but not actual behavior, was measured.

Efforts to prevent doctors from changing hospitals should include considering job satisfaction and workload, doctor evaluation methods, support for career progression and organizational management.

As the hospital doctor shortage in rural areas becomes more serious, exploring doctors' desire to leave their current hospital is meaningful for Japanese hospital managers and hospitals worldwide aiming to provide sustainable and higher quality care.