Hysterectomy is the most common non-pregnancy-related major surgery performed on women in the United States. Close to 600,000 women in the United States undergo the procedure each year, with annual costs exceeding $5 billion. By age 60, more than one-third of women in the United States have had a hysterectomy.

Many believe that the high U.S. hysterectomy rate is a result of an expansion of the accepted indications for hysterectomy. More reasons are listed for removal of the uterus than for any other organ, with indications ranging from life-threatening cancer of the genital tract to menstrual pain. In the United States, hysterectomy is widely accepted by medical professionals and by the public as an appropriate treatment for uterine cancer and for various common non-cancerous uterine conditions that produce disabling levels of pain, discomfort, uterine bleeding, emotional distress, and related symptoms.

With so many possible indications for hysterectomy, the decision as to when to perform the procedure may be a great contributing factor in the different rates of hysterectomy between countries. This study poses the question, "Does individual physician decision-making affect hysterectomy rates in different countries?"

Zouping offers important general lessons for the study of China's rural transformation. The authors in this volume, all participants in a unique field research project undertaken from 1988 to 1992, address questions that are far from simple and about which there is some controversy.

The questions are grouped around two issues. The first is the role of local governments as economic actors. What is this role, how have they played it, and how can we explain their behavior? Have they dominated rural economies through public ownership of industry and local planning, or has the role of local governments diminished with the rise of market transactions and private ownership? The second issue is market reform and inequality. Have rural cadres enjoyed income advantages in the new market environment? Has the provision of such collective services as education and health care declined, leading to new forms of inequality?

The chapters on the role of local government all point to a single conclusion: one cannot explain the rapid development of Zouping without reference to the role of local governments and of local government officials as economic actors. Scholarly writings about the "transitional economies" have often ignored or distorted this aspect of China's reform experience. On the second issue, changes in inequality owing to market reform, the authors present mixed findings but contribute rich new data to the research on this issue.

By almost any criterion of success—be it cost-effectiveness, risk-reward ratio, multiplier
effects, or sheer longevity, the Japan America Security Alliance (JASA) stands out as one of
the most successful alliances in twentieth century history. For the United States, chief
architect of a global network of military relationships, JASA is arguably the most important
of its many bilateral alliances. In terms of historic impact, JASA is comparable to the North
Atlantic Treaty Organization (NATO), a multilateral alliance that restructured the European
security landscape in 1949. For nearly a half-century, JASA and NATO have functioned
as the bedrock on which the Cold War security systems of Asia and Europe have been
constructed.

Published as part of the "America's Alliances with Japan and Korea in a Changing Northeast Asia" Research Project.

One of the most persistent and important questions in international comparisons of health systems pertains to the wide divergence in costs between countries. Japan has significantly lower per capita health care costs than does the United States, despite having a fee-for-service reimbursement system and universal coverage, and aggressively purchasing and utilizing equipment-embodied medical technologies. 1 One important factor in the increase in American health care costs over time has been the substitution of surgical intervention for medical treatment. 2 This leads us to consider differential rates of surgery as a potential explanation for divergent cost performances. Indeed, although Japan has one-half the inpatient admission rate of the United States, it has only one-quarter the surgery rate per capita

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.