ニホン ゼイセイ ノ トクシツ ト ゲンカイ 20セイキ マツ カラ 21セイキ ハジメ イチノセ アツシ キョウジュ タイニン キネンゴウ

I (After the oil crisis in 1970s, the economic structures of industrially advanced nations have changed. High economic growth came to an end, and structural unemployment problem and so on have occurred. Under such conditions, each state has enormous public debts. Owing to the fiscal crisis, many states have come to grips with fiscal reforms.) In 1970s and 1980s, Japanese tax burden rate and social security contributions rate went up. Naturally the national burden rate (tax burden rate + social security contributions rate) went up also. Japanese state introduced consumption tax in 1889. This tax is a Japanese version of a value-added tax. Between 1989～1990, the Cold War structure between the East and the West was melted down, and globalization of the world economy has been born. In addition to that, The bubble burst. For the reasons, Japanese state spent much money for public works projects, and carried out tax cuts in 1990s. Japanese economy was stimulated by public finance. But the economy has not gotten better. As a natural consequence, tax revenues went down. And the function of income redistribution declined. II OECD countries or USA, United kingdom, Germany, France and Sweden evolved tax increase policy 1990s. As the result of such tax policies, Japanese position of tax burden rate has become much lower than other OECD countries. OECD countries raised their social security contribution rates in 1990s. However Japan raised it higher than other countries. As the consequence of such social security burden policies, Japanese position of it went up. On the contrary of tax burden rate, Japanese social security contribution rate is never low. The balance of Japanese public debts (to GDP) is larger than other countries. That is to say, Japanese procurement base of tax revenue is poorer than OECD countries. And Japanese function of income redistribution is inferior to other countries. The doctrine of Japanese tax policy is based on neoliberalism. But Japanese government is not relied on by people. So tax reform in post welfare state era cannot be put into practice

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era