As medical care becomes an increasingly large share of Gross Domestic Product, understanding the mechanisms for how and why medical care spending is rising becomes increasingly important. Such an evaluation should consider the productivity relationship between medical care and health. An evaluation of medical productivity involves the measurement of medical care input prices, disease treatment output prices, and the productive relationship between medical care inputs and disease treatment health outcomes. Medical care price measurement is complicated by the heterogeneity of services, the role of insurance in negotiating prices, rapid technological advancements in medical care and limited availability of transaction price data. Health outcome prices are difficult to construct because of the difficulty in measuring health outcomes, the heterogeneity of health outcomes, and the messy relationship between consumption goods and health. Finally, in addition to accurate input and output price measurement, a productivity assessment requires a measurable causal relationship between medical care services and health outcomes. To date, all of these requirements have been insurmountable hurdles to assessing the productivity of medical care for the entire United States economy. This dissertation uses the Medical care Expenditure Panel Survey to address the necessary requirements for evaluating the productivity of medical care. The second chapter constructs regional medical care price indices using transaction prices that control for service type heterogeneity. The data employed in the analysis associates the observed medical care spending with the diseases the spending is used to treat. This association is exploited in the third chapter, which constructs medical care treatment prices for twelve of the major health conditions in the United States. The fourth chapter compares the productivity of medical care services used to produce disease treatment health outcomes across insurance types. / text

PHRサービス「ポケットカルテ」に集積された個々の住民の生涯の健康医療福祉介護履歴情報は、当該個人のLife-Logといえることが判明し、従来の医療費に加えて、健康維持や「未病」対応のための消費の総和を新たな指標「健康費」と定義した。現在の医療経済施策基盤である国民医療費の上位概念となる「健康費」を最適化することは、医療の質を向上しつつ、国民医療費を適正化し、国民皆保険の維持に寄与すると思われる。 / The big data of the life-long history information in health care and welfare care of an individual resident stored in the PHR service "Pocket Karte", has been found to be the Life-Log of the resident. So, I have defined a new index "Health Care Fee" as the sum of consumptions for health maintenance and the "pre-disease" care in addition to the conventional medical costs. It is believed that to optimize the "Health Care Fee", the broader concept of the Estimates of National Medical Care Expenditure as the basis for medical economic policy currently, is to contribute to improve the quality of medical care, and to optimize the Estimates of National Medical Care Expenditure, and to maintain of universal health insurance system in Japan. / 博士(政策科学) / Doctor of Philosophy in Policy and Management / 同志社大学 / Doshisha University