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Health technology assessment (HTA) is a critical part of healthcare decision making in many countries. Changes in Methods and Processes (M&P) of HTA agencies can affect the time and degree of patient access to treatments. Published literature focuses on the different M&P adopted by HTA agencies, rather than on how these have come about over time. Our study investigates key HTA reforms and explores their drivers and interdependencies in a set of HTA agencies in Europe, Asia-Pacific, and North America.
Methods
We conducted a targeted literature review on M&P guidelines and subsequent changes to those, for 14 HTA agencies. We supplemented and validated initial findings with 29 semi-structured interviews with country-specific experts. We used analytical tools to create process maps, proactivity and influence networks, and clusters of HTA agencies.
Results
We found that processes leading to M&P reforms follow similar steps across HTA agencies. The three most important drivers to reforms were HTA practice and guidelines in other countries; the healthcare policy, legal, and political context within the agency’s country; and experience of challenges in the assessment by the HTA body itself. International collaborations have the potential to accelerate the evolution of HTA systems and the implementation of reforms.
Conclusion
We identified PBAC (Australia), CDA-AMC (Canada), NICE (England), IQWiG (Germany), and ZIN (the Netherlands) as HTA agencies that are catalysts of HTA reforms as well as internationally influential. International collaborations may represent a useful route to accelerate changes as long as they ensure wide stakeholder engagement at an early stage.
It is a remarkable thing to behold, the extent to which the issue of “comfort women” galvanizes the Japanese right more than two decades after the first Korean survivor appeared in public. The hopeful moments of the Kono Statement (1993) and the Murayama Statement (1995) seem to belong to a remote past. Circumscribed though they were, those official statements by the then chief cabinet secretary (Kono Yohei) and prime minister (Murayama Tomiichi) squarely acknowledged the grievous consequences of imperial Japan's acts of aggression not only on the Japanese people but their Asian neighbors, and most pertinently with respect to “comfort women,” the involvement of the Japanese military.
Speak, Okinawa is a book I needed to write for a long time, long before I knew I needed to write it. The book is essentially about healing the relationship between me and my mother, me and my heritage. Both felt very strange and foreign to me, distant from me, for most of my life.
My mother was born and raised in Okinawa. She was born in 1948, three years after the Battle of Okinawa, which destroyed and devastated the entire island, killing one third of the population and leaving those who survived to wander and scavenge amidst the ash and wreckage. My mother was born into poverty and chaos and grief. As she grew up, she witnessed the militarization of the island, the countless crimes that were committed, the injustice. She became a waitress at a nightclub where soldiers, marines, and sailors came from nearby bases to drink, flirt, and forget about the war. She met and married my father, who was a U.S. soldier stationed on the island after fighting in Vietnam.
Most common pool resource (CPR) dilemmas share two features: they evolve over time and they are managed under environmental uncertainties. We propose a stylized dynamic model that integrates these two dimensions. A distinguishing feature of our model is that the duration of the game is determined endogenously by the users’ collective decisions. In the proposed model, if the resource stock level below which the irreversible event occurs is known in advance, then the optimal resource use coincides with a unique symmetric equilibrium that guarantees survival of the resource. As the uncertainty about the threshold level increases, resource use increases if users adopt decision strategies that quickly deplete the resource stock, but decreases if they adopt path strategies guaranteeing that the unknown threshold level is never exceeded. We show that under relatively high uncertainty about resource size, CPR users frequently implement decision strategies that terminate the game immediately. When this uncertainty is reduced, they maintain a positive resource level for longer durations.
Pedro Iacobelli's essay also elucidates some of the less immediately obvious consequences of the U.S.'s administration of Okinawa, in his case focusing on Okinawa's international legal status during the American occupation. As he details, under the terms of the 1951 San Francisco Peace Treaty, Japan in theory retained “residual sovereignty” over Okinawa's population. Iacobelli, after discussing in some detail the historical circumstances that gave rise to this status, traces its practical consequences for a Ryukyu Government-sponsored emigration program to South America.
We devise an experiment to explore the effect of different degrees of bargaining power on the design and the selection of contracts in a hidden-information context. In our benchmark case, each principal is matched with one agent of unknown type. In our second treatment, a principal can select one of three agents, while in a third treatment an agent may choose between the contract menus offered by two principals. We first show theoretically how different ratios of principals and agents affect outcomes and efficiency. Informational asymmetries generate inefficiency. In an environment where principals compete against each other to hire agents, these inefficiencies may disappear, but they are insensitive to the number of principals. In contrast, when agents compete to be hired, efficiency improves dramatically, and it increases in the relative number of agents because competition reduces the agents’ informational monopoly power. However, this environment also generates a high inequality level and is characterized by multiple equilibria. In general, there is a fairly high degree of correspondence between the theoretical predictions and the contract menus actually chosen in each treatment. There is, however, a tendency to choose more ‘generous’ (and more efficient) contract menus over time. We find that competition leads to a substantially higher probability of trade, and that, overall, competition between agents generates the most efficient outcomes.
My life as a scholar and writer has been dedicated to unknotting the tangle of forces that created my mother’s mental illness, which became apparent to me in 1986, when I was fifteen. The biomedical paradigm of mental illness was dominant in the 1980s, and it said that her condition - a set of perceptions that Western psychiatry calls “schizophrenia” - was nothing more than genetic bad luck, her voices nothing more than symptoms of a broken brain. Her illness might have been cured, I was told, had we noticed it earlier. Schizophrenia was (mis)understood to be only a young person’s disease and not an ailment that could befall a middle-aged woman like my mother, and so the counselor at the community mental health center where I sought help for my mother said that it was “too late.” That year was when the seeds of my future work were planted.
In an effort to combat abuse of police powers by the world's most repressive regimes, the United Nations General Assembly adopted a “Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment” at a plenary meeting on December 9, 1988. Among other things, these rules declare that “A detained or imprisoned person shall have the right to be visited by and to correspond with, in particular, members of his family and shall be given adequate opportunity to communicate with the outside world, subject to reasonable conditions and restrictions as specified by law or lawful regulations.” Three years later the UN Commisssion on Human Rights created a five member “Working Group” charged with investigating “cases of detention imposed arbitrarily or otherwise inconsistently with the relevant international standards set forth in the Universal Declaration of Human Rights” or in treaties or other international agreements.
This paper examines exhibits at the Shanghai Expo and the urban improvement schemes undertaken for the Shanghai Expo for what they reveal about the ideals for and experiences of urban modernity in contemporary China. Rather than focus on the experiences and perceptions of a global audience, this paper examines how the Expo sought to speak to a domestic audience about state legitimacy through its messaging about urban citizenship and urban modernity. It argues that the manner in which the Expo promoted certain forms of sustainability and the domestic audience's experiences with Shanghai urban improvements revealed tensions in the nation's development model and excluded sectors of the population from participation.
The Tokyo Games have had mixed success on the compactness and sustainability fronts. The financial news, however, has been uniformly disappointing. Interest groups play a clear role in prompting governments to pursue the Olympics. While the population as a whole experiences little or no net benefit, specific groups, such as the local hospitality industry and construction unions, stand to gain a great deal. These groups spend heavily to elect politicians who support their pursuit of the Olympics.
1. Gavan McCormack, Introduction: The Experts Report and the Future of Okinawa
2. The Okinawa Third Party (Experts) Committee, translated by Sandi Aritza,
Report of Okinawa Prefecture's “Third Party Investigation into the Reclamation of Oura Bay” (Main Points)
3. Sakurai Kunitoshi, translated by Gavan McCormack, “To Whom does the Sea Belong? Questions Posed by the Henoko Assessment”
Those who refer regularly to this journal will be familiar with the “Okinawa problem.” The “Okinawa problem” is best understood as the consequence of a post-war 70 years divided into 27 that were under direct US rule as a military colony and 43 that have been nominally under the constitution of Japan but in practice under a Japanese government embracing subservience towards the US and support for its various wars. That has entailed shifting the burden of the US military presence as much as possible away from densely populated areas in mainland Japan and as much as possible onto Okinawa prefecture. The well-known statistic of 74 per cent of US base presence concentrated on Okinawa's 0.6 per cent of the national land is the plainest expression of this.
The paper examines Japan's capital city of Tokyo's “Zero Emission Tokyo Strategy.” Our work shows that Tokyo's strategy is particularly important in light of the 2030 Agenda's emphasis on greenhouse-gas emissions reduction, equitable sustainability, and building holistic resilience against all hazards. The data indicate that Tokyo's ambitions are built on a track record of global leadership in resource efficient water systems, transit networks, and other critical infrastructure. Moreover, Tokyo is part of Japan's zero-emission communities, smart cities, all-hazard resilience, and other multilevel and silo-breaking collaborative platforms. Our analysis also makes recommendations for bolstering Tokyo's strategy, to enhance co-benefits from integrating climate change mitigation and adaptation, in addition to strengthening pandemic response.
August 15 remains an important day in Korean and Japanese cultures for the two peoples, the former commemorating their liberation from colonial rule and the latter lamenting the end of the tragedy that had befallen their nation. On this day in 1945, the emperor declared his country's intention to accept the Allied forces' surrender terms. This date, however, is a myth of sorts as the Koreans were soon after forced into division and further subjugation at the hands of the United States and the Soviet Union, who divided postwar occupation responsibilities. For the Japanese, the emperor's unprecedented broadcast may have ended the bombing of Japanese cities, but it did not bring about a general return of Japanese soldiers from Pacific War battlefields. These days, however, the day is marked for concluding two tragic periods of their histories, but with very different sentiments. In this article the author traces his observations on how the Japanese and Koreans observe August 15 in contemporary times.
This article examines the Japanese government's 2010 decision to exclude Chōsen schools (Chōsen gakkō) from its Tuition Waiver and Tuition Support Fund Program for high school education (Tuition Waiver Program). It introduces the perspectives of groups supporting the Chōsen schools as well as those seeking to exclude Chōsen schools from the Tuition Waiver Program. By tracing the historical background and trajectory of discrimination against ethnic Koreans in Japan, it shows that the exclusion of Chōsen schools reflects the continuation of Japan's intolerance toward the ethnic education of Korean residents, particularly Korean residents affiliated with North Korea, since the colonial period, which hinders the nation from becoming an ethnically inclusive society.
This study uses an experimental approach to examine whether markets are sensitive to the internal incentive structure of the competitors. Toward this goal, we modeled the competitors in a price competition duopoly game as three-player teams. Each player simultaneously declares a bid (price) and the team whose total bid was lower won the competition and was paid accordingly. The losing team was paid nothing, and in case of a tie, each team was paid half its price. This duopoly game was studied under two conditions; a cooperative treatment in which the team's profit was divided equally amongst its members and a non-cooperative one in which each individual member was paid her own bid. Whereas the Nash equilibrium is for each player in either treatment to demand the minimal price possible, we predicted that convergence to the competitive price would be much faster in the cooperative treatment than in the non-cooperative one. The experimental results firmly confirmed this prediction.
March 10 is the 70th anniversary of the Great Tokyo Air Raid. Although Tokyo was bombed more than 100 times from November 1944 to the end of the war, the firebombing centered on the Shitamachi district in the early hours of March 10, 1945, was by far the most devastating air raid on the capital. In less than three hours from just after midnight, 279 B-29 bombers dropped a total of 1,665 tons of incendiaries. By dawn, more than 100,000 people were dead, one million were homeless, and 16 square miles of Tokyo had been burned to the ground.
“If our sin as scientists was to make and use the atomic bomb,” Leo Szilard, famed physicist would admit, “then our punishment was to watch The Beginning or the End.” Szilard's exposure to the 1947 MGM movie, however, went far beyond merely enduring a viewing of the first Hollywood drama about the creation and use of the bomb. The previous year he had traveled from Chicago to Los Angeles to offer his input on key scenes, then signed a contract agreeing to be portrayed in the movie–and after much cajoling, convinced Albert Einstein to sign his own approval.
This article extends the reader's gaze beyond the Metropolitan Core (Tokyo-Osaka) that dominates the English language literature on Japan. It is important to understand rural, small town and smaller city Japan because most Japanese do not live in the Core and most of the land area of the Japanese archipelago lies outside the boundaries of Japan's urbanized confines. There is a very different dynamic in rural and small town Japan where there has been a dramatic level of depopulation and aging and economic stagnation. In contrast, the metropolitan core is still growing, and looks prosperous and modern even after two decades of economic stagnation. To bring out distinctive features of the “other” Japan, the one hidden behind the metropolitan core, consider changes in land use, demography, the rural and small town economy, transportation, communications and architecture. The relative neglect of this topic is striking because regional Japan is both idealized as a repository of “traditions” and values while also denigrated as backward. The declining “other” has been subjected to extensive government policy interventions, but as I argue here, these frequently have been misguided. Significantly, the “other” Japan remains an important arena of identity politics in a nation that has experienced massive socio-economic convulsions in the post-World War Two era.
A vivid close up view from the front lines of the protest by Okinawans and their supporters against construction of a new US Marine Base at Henoko, Okinawa.