Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study

Abstract

The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0–74 years) who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40–59-year-old men and 60–69-year-old women, and in duration of hospitalization among 40–59 and 60–69-year-olds of both sexes and 70–74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts.

The incidence of medically-attended norovirus gastro-enteritis in Japan: Modelling using a medical care insurance claims database

“…However, incidence rates of hospitalization-associated MA-AGE in Japan found in our analysis of the JMDC database (42/10,000 person-years) approached rates reported by these studies for the US (25/10,000 person-years) and England (56/10,000 person-years). A possible explanation for higher rates of MA-AGE outpatient consultations in Japan is a higher primary healthcare seeking behaviour of the Japanese population compared with the US and many other countries [ 37 , 38 ], combined with a auniversal health care system that provides affordable health care services to all persons. We are not aware of any similar assessment having been performed for Japan.…”

Work–family conflict and self-rated health among Japanese workers: How household income modifies associations

“…[ 30 ] In addition, despite a universal health care insurance system in Japan, people with low incomes are likely to have poorer access to outpatient care and more serious health conditions than people with high incomes. [ 31 ] Given Japan’s gendered social roles, there might be some possibility that Japanese women with low incomes prioritize needs of their families such as food and health issues. As a result, women perceived high work–family conflict in the low income group seem to have reported poorer health status.…”

Labor factor barriers to seeking medical services among metropolitan workers: a cross-sectional analysis by sex using the J-SHINE study

“…We employed three models for this analysis: (1) employment type, ( 2 ) company size, and ( 3 ) occupation type. As covariates, we used factors that have been mentioned in previous studies [7][8][9][10]12,14,15) and variables that were significantly associated with refraining from seeking medical services ( Table 2 ) ; including, marital status, number of household members, educational attainment, equivalent household income, self-rated health, physical activity, smoking status, alcoholic status, hours worked per week, job stress, and health literacy.…”

“…However, access to healthcare services is affected by coverage 3) and other factors including socioeconomic circumstances 1,4) , care-seeking behaviors 5) , and the behavior of healthcare providers 6) . There is abundant evidence that age, sex 7) , income 8,9) , cohabitation status 10) , ethnicity 11) ,and employment status 12) may affect accessibility of health care. However, little attention has been given, in Japan or in other countries, to the relationship between labor factors and refraining from seeking medical services 4,[13][14][15] .…”

“…Japan has three major forms of public health insurance, which together provide universal coverage 16) . Generally, except for individuals qualified to receive public assistance ( seikatsu-hogo ) a livelihood protection system that allows those below a certain standard of income to maintain a minimum standard of living and receive medical services at no cost everyone living in Japan must be covered by the public health insurance system 9) . Insured workers and their family members essentially pay 30% of the actual medical costs, with the monthly fees for health insurance depending on the type of insurance and the previous year's income.…”