This paper uses two nationally representative sets of medical claims data from medical assistance and universal public health insurance systems to examine how medical assistance system assignment affects short-term inpatient health care provision. In Japan, the medical assistance system, which is part of a public assistance system, provides medical care services for its beneficiaries without imposing any financial burdens, such as copayments or advance premium payments. These circumstances can lead to inpatient costs, as physicians may provide more treatments because there is a financial incentive. Because the assignment of public assistance in Japan is not random but is subject to means testing by the local government, I employ the instrumental variable model to control the potential correlation. I find that medical expenditure is significantly higher for medical assistance patients than for universal public health insurance patients, with an arc elasticity of approximately 0.20. This elasticity is slightly greater than that found for inpatient care in the randomized RAND Health Insurance Experiment and recent empirical studies on low-income populations. In addition, the elasticities for patients who receive medication, treatment and surgery are greater.
ObjectiveAs in many other countries, the ratio of caesarean section (c-section) delivery to total births in Japan is rising steadily, while the total number of deliveries is decreasing. Although c-sections can effectively prevent maternal and perinatal mortality and morbidity when medically justified, it is uncertain how medically unnecessary c-sections affect the short-, middle-, and long-term postnatal effects on the mother and child. As there are no empirical studies on c-section choice for Japan, this study uses individual medical facility panel data from 1999 to 2014 to comprehensively examine the effects of recent public and social environment changes on c-section delivery choice.ResultsThe empirical results from our fixed effect model show that c-section delivery and its ratio are higher in public hospitals, in relatively large clinics, and in clinics opening on holidays. In addition, increases in the lump-sum birth allowance and the number of medical malpractice lawsuits also increase the number of c-section delivery.
Informal care is increasingly important in countries undergoing population aging. Previous research has discussed how the long-term care system may affect the behaviors of informal caregivers but has paid not much attention to how changes in caregivers' circumstances, particularly their health, affect those receiving their care. Using the Japanese Study of Aging and Retirement, we empirically examine how caregivers' health condition may affect the elderly parents receiving their care. We find empirical evidence that declining caregivers' health adversely affects care recipients' health. We see such links between informal caregivers and their in-laws, demonstrating that these effects go beyond genetic influences.
This article comprehensively examines the impact of recent smoking control policies in Japan, increases in cigarette taxes and the enforcement of the Health Promotion Law, on individual smoking choice by using multi-year and nationwide individual survey data to overcome the analytical problems of previous Japanese studies. In the econometric analyses, I specify a simple binary choice model based on a random utility model to examine the effects of smoking control policies on individual smoking choice by employing the instrumental variable probit model to control for the endogeneity of cigarette prices. The empirical results show that an increase in cigarette prices statistically significantly reduces the smoking probability of males by 1.0 percent and that of females by 1.4 to 2.0 percent. The enforcement of the Health Promotion Law has a statistically significant effect on reducing the smoking probability of males by 15.2 percent and of females by 11.9 percent. Furthermore, an increase in cigarette prices has a statistically significant negative effect on the smoking probability of office workers, non-workers, male manual workers, and female unemployed people, and the enforcement of the Health Promotion Law has a statistically significant effect on decreasing the smoking probabilities of office workers, female manual workers, and male non-workers.JEL classificationC25, C26, I18
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