The medical assistance system and inpatient health care provision: Empirical evidence from short-term hospitalizations in Japan

Yuda, Michio

doi:10.1371/journal.pone.0204798

Cited by 6 publications

(10 citation statements)

References 44 publications

(37 reference statements)

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“…Theoretically, exemption from copayment increases healthcare utilization by PA beneficiaries. This income effect is broadly confirmed in aggregated outpatient services (22), hospitalizations (23), public long-term care services (24), and dental services (25). One interpretation is that low-income people generally have a low socioeconomic status (SES), which is strongly correlated with low health conditions and increased healthcare use.…”

Section: Policy Backgroundsmentioning

confidence: 83%

“…In addition, SID has little impact on healthcare expenditure because the costs of medical treatments are reimbursed to a medical institution only after they have been doubly reviewed by the public third-party payer and the insurer ( 32 ). In the extant empirical analyses, it is very difficult to identify each effect on inherently poor health, moral hazard, and SID, while the results of Yuda ( 23 ) provide useful evidence for an SID effect in the Japanese PA system. Yuda ( 23 ) focuses on short-term hospitalization that medical suppliers have broad discretion over healthcare provision and finds that its arc price elasticity is inelastic, only 0.2, which suggests that there is little effect of SID on healthcare expenditure in the Japanese PA system.…”

Section: Discussionmentioning

confidence: 99%

“…In the extant empirical analyses, it is very difficult to identify each effect on inherently poor health, moral hazard, and SID, while the results of Yuda ( 23 ) provide useful evidence for an SID effect in the Japanese PA system. Yuda ( 23 ) focuses on short-term hospitalization that medical suppliers have broad discretion over healthcare provision and finds that its arc price elasticity is inelastic, only 0.2, which suggests that there is little effect of SID on healthcare expenditure in the Japanese PA system. Second limitation is that our claim data only include the intensive margin in healthcare utilization.…”

Section: Discussionmentioning

confidence: 99%

“…This means that the estimation results from an equation without local characteristics are positively biased because PA ijt and error term u ijt are correlated. To address this problem, Yuda (23) uses instrumental variable (IV) estimation, but these results may not be consistent because this identification relies on the non-linear specification in the first-stage regression. In this analysis, I add several local (prefectural) characteristics, z jt , as confounding factors to Equation [1].…”

Section: Statistical Modelmentioning

confidence: 99%

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Healthcare Utilization Under a Comprehensive Public Welfare Program: Evidence From Japan

Yuda

2022

Front. Public Health

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The public assistance system in Japan provides detailed and comprehensive livelihood support for low-income families with various needs. As one example, and the beneficiaries of the public welfare program in Japan can receive the same medical treatments as those insured of the universal public health insurance without any financial burdens. This system has greatly contributed to maintaining and improving the health of public assistance beneficiaries but may cause excessive healthcare utilization: moral hazard. This study uses a large sample taken from two nationally representative claim data for public assistance and public health insurance patients to estimate the magnitude of moral hazard effect in basic outpatient utilization. The results of the fixed-effect regression analysis utilizing the concept of pseudo panel data analysis and those of propensity score matching show that the average treatment effect of public assistance assignment on healthcare utilization is significantly positive. Specifically, public assistance assignment increases monthly healthcare expenditure by 17.5 to 22.9 percent and the monthly number of doctor visits by 23.1 to 27.8 percent, respectively. In addition, the average treatment effects on the treated are also significantly positive, suggesting that monthly healthcare expenditure significantly decreases by 22.7 to 25.0 percent and the number of visits by 27.6 to 29.7 percent, respectively, when imposing a copayment on public assistance beneficiaries. However, the estimated price elasticity based on these results is very small, approximately −0.02, indicating that the level of copayment rate has little effect on the intensive margin of outpatient healthcare utilization.

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Section: Policy Backgroundsmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Statistical Modelmentioning

confidence: 99%

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Healthcare Utilization Under a Comprehensive Public Welfare Program: Evidence From Japan

Yuda

2022

Front. Public Health

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“…In Japan, the majority of public assistance recipients are older people (55.5%) (3), and medical assistance occupies the largest portion of the public assistance budget (48.6%) (14). Furthermore, medical expenditure is signi cantly higher among the recipients of public assistance compared to the patients using universal public health insurance (15), and the recipients of public assistance have a higher risk of frequent outpatient attendance (16). These studies indicate that other negative factors might be contributing to public assistance recipient's unhealthy behaviors or health conditions.…”

Section: Introductionmentioning

confidence: 99%

Public assistance program and depressive symptoms of the recipient: A cross-sectional Japan Gerontological Evaluation Study

Kino

Nishioka

Ueno

et al. 2021

Preprint

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Background Health inequality between public assistance recipients and non-recipients has been reported. However, it is not clear whether this is due to the participants’ income inequality or because of other socioeconomic and psychosocial factors. We aimed to examine whether older recipients of public assistance were more likely to have depressive symptoms compared to non-recipients. Methods Data were obtained from the Japan Gerontological Evaluation Study, a 2016 community-based study of older adults. Poisson regression analyses with a robust error variance using fixed effects were conducted to examine the relationship between receiving public assistance and depressive symptoms controlling for sociodemographic factors. Depressive symptoms were assessed by the Geriatric Depression Scale 15. Results We found that the recipients of public assistance were 1.57 times (95%CI: 1.47, 1.67) more likely to have depressive symptoms compared to non-recipients. When additionally adjusting for indicators of social participation, this relationship was slightly attenuated; however, the recipients still had worse mental health (Incidence rate ratio: 1.33; 95%CI: 1.25, 1.42). Conclusions Even after controlling for sociodemographic factors, older recipients of public assistance were more likely to have depressive symptoms than non-recipients. However, social participation could slightly attenuate the negative relationship between receiving public assistance and depressive symptoms. Therefore, the public assistance program needs to consider inclusion of other healthcare supports in addition to financial support.

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Duration of untreated illness of patients with obsessive–compulsive disorder in Japan

Matsumoto

Nakamae

Abe

et al. 2020

Early Intervention Psych

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Aim Obsessive–compulsive disorder (OCD) is a common and severe disease; however, the duration of untreated illness (DUI) of OCD is approximately 7 years, which is longer than that of other psychiatric disorders. Differences in medical environments have been reported to affect the DUI. Therefore, we surveyed the DUI of OCD in Japan and the reason for delayed treatment. Methods The study participants were outpatients who visited the OCD specialty outpatient clinic for the first time between June 1, 2017 and May 31, 2019. Obsessive–compulsive disorder was diagnosed using the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, and semistructured clinical interviews, which included asking the reason for the delay in seeking treatment and treatment drop‐out history. Results Seventy‐one patients met the inclusion criteria for the study. The mean period between OCD and the first visit to the hospital was 2.8 years and the mean DUI of OCD was 4.7 years. There was a significant difference in the history of tic disorders and treatment drop out between patients with a DUI of >2 years and those with a DUI of ≤2 years. The most common reason for delaying treatment was that the patient did not consider the symptoms of OCD to be those of an illness, and the most common reason for dropping out of treatment was lack of improvement. Conclusions This was the first study on the DUI of OCD in Japan. The DUI was relatively shorter than that found by studies in other countries. Stopping treatment lengthened the duration of the illness. Preventing the patient from dropping out of treatment could further shorten the duration of the illness.

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The medical assistance system and inpatient health care provision: Empirical evidence from short-term hospitalizations in Japan

Cited by 6 publications

References 44 publications

Healthcare Utilization Under a Comprehensive Public Welfare Program: Evidence From Japan

Healthcare Utilization Under a Comprehensive Public Welfare Program: Evidence From Japan

Public assistance program and depressive symptoms of the recipient: A cross-sectional Japan Gerontological Evaluation Study

Duration of untreated illness of patients with obsessive–compulsive disorder in Japan

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