1. What is the role of USF for the disability Isao NAKAJIMA, M.D., Ph.D. Professor, TOKAI University Vice Rapporteur for eHealth of ITU-D

2. What is the USF(Universal Service Fund) It is a funding mechanism to support the management cost of deficit circuit in rural area ( High Cost Area ) aiming to nationwide coverage to solve digital divide. In case of the U.S., applications(schools, libraries, low income, disability, healthcare )are included in the USF.

3. The obstacles against continuous self-sustainable operation 1. Economic factor ( running cost; tariff ) 2. Human factor (replacement of human resources) 3. Environmental factor ( Pressure of the group which doesn't admit operation itself and so on ) 4. Technical factor ( Problem of the virus infection, the trouble of the circuit, etc.) 5. Legal problem ( Regulation of the individual protection law, etc..)

4. Solutions for the tariff problem  Promote Universal Service Policy ( Management policy)  Promote IP-Telephony with multimedia ( Free market policy )  Use participatory group’s communication network (non-telecom operator’s network) ( Wi-Fi;Wireless Fidelity, Satellite;HealthSat)

5. Why we consider e-disability separately from other e-business? The business of the telecommunications is operated on the principle of market-economy which made free competition basis so far. While on the other hand, as for the healthcare, it takes the form of the managed-economy which is operated with an annual budget decided in advance in any country.

6. Purpose of this investigation When thinking of the healthcare as an application of telecommunication, some technique to relieve the poverty, the weak, and disability who left by the free competition, is indispensable. The USF(Universal Service Fund) is solving these gaps between market principle and management policy respectively describing the overview which was investigated in the viewpoint of telemedicine.

7. Ideas of create the budget of the USF Japanese USF only for High Cost Area, not for applications; telemedicine!! 1. Transfer the NST cost to Careers NST: Non-Traffic Sensitive Cost The first idea was reported by FCC in 1980s 2. Extra charge from each terminal to USF \7.35 yen/terminal/month estimated almost 200 Million U.S.D ( FY2007 ) that will pay to only NTT East/West

8. Transfer NST cost to Carrier

9. High cost area in Japan NTT-East and NTT-West

10. Revenue-Cost Methodology (Offset type )

11. Cost per line vs density

12. 4.9% comes from 2 x standard deviation

13. 4.9% loss over average cost will pay from the USF compensate for NTT East/West’s deficit

14. Future situation of fixed telephone in Japan Mobile and IP-telephony will increase more!

15. in case of U.S., USF for applications!! Sites of rural healthcare providers

16. Eligible public and non-profit rural health care providers in the U.S. These organizations are candidates of the USF Local health department or agency Not-for-profit hospital Rural health clinic Part-time HCPs (of above types). Emergency Room of For-Profit Hospitals Community mental health center Post-secondary educational institution offering health care instruction, teaching hospital, or medical school Community health center or health center providing health care to migrants Consortia of one or more of the above entities

17. Distribution of the USF in U.S.

19. Is free market policy for rural comm. suitable for your country? It might be meaningless to manage the rural communication with free market policy in developing nations. Because rural area might be much wider than developed nations, and profit from urban area has a limitation. If you allow the free market, you will suffer from venture company who perform the cream skimming.

20. Attention !! foreign company excluded in the U.S.  To adapt free competition business on telecommunication that the U.S. requested all nations.  The telemedicine service providers in the U.S. are operated absolutely by the policy of managed-economy. There is a unequal mechanism that the foreign company can’t join USF of the U.S..

21. The Population ratio in the U.S. & Japan

22. Life expectancy lack of human resource of healthcare

23. Population ratio in urban and rural areas by each country Source :World Bank “ World Development Indicators 2004 ”

24. In case of developing nations Shall consider your own mechanism! 1. Transfer NST cost to careers 2. Extra charge per call or per terminal 3. Others 4. National/State budget or objective tax

25. Thank you ! Vice-Rapporteur for ITU SG2 Telemedicine