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Out-of-pocket payments and community-wide health outcomes: an examination of influenza vaccination subsidies in Japan

Published online by Cambridge University Press:  19 February 2016

Yoko Ibuka  and
Shun-ichiro Bessho
Yoko Ibuka*
Affiliation:
Graduate School of Economics and Management, Tohoku University, Miyagi, Japan
Shun-ichiro Bessho
Affiliation:
Faculty of Economics, Keio University, Tokyo, Japan
*
*Correspondence to: Yoko Ibuka, Graduate School of Economics and Management, Tohoku University, 27-1 Kawauchi, Aoba, Sendai, Miyagi 980-8576, Japan. Email: ibuka@econ.tohoku.ac.jp
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Abstract

While studies have shown that reductions in out-of-pocket payments for vaccination generally encourages vaccination uptake, research on the impact on health outcomes has rarely been examined. Thus, the present study, using municipal-level survey data on a subsidy programme for influenza vaccination in Japan that covers the entire country, examines how reductions in out-of-pocket payments for vaccination among non-elderly individuals through a subsidy programme affected regional-level influenza activity. We find that payment reductions are negatively correlated with the number of weeks with a high influenza alert in that region, although the correlation varied across years. At the same time, we find no significant correlation between payment reductions and the total duration of influenza outbreaks (i.e. periods with a moderate or high alert). Given that a greater number of weeks with a high alert indicates a severer epidemic, our findings suggest that reductions in out-of-pocket payments for influenza vaccination among the non-elderly had a positive impact on community-wide health outcomes, indicating that reduced out-of-pocket payments contributes to the effective control of severe influenza epidemics. This suggests that payment reductions could benefit not only individuals by providing them with better access to preventive care, as has been shown previously, but also communities as a whole by shortening the duration of epidemics.

Type
Articles
Information
Health Economics, Policy and Law , Volume 11 , Issue 3 , July 2016 , pp. 275 - 302
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Copyright
© Cambridge University Press 2016 

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References

Bolin, K., Lindgren, A., Lindgren, B. and Lundborg, P. (2009), ‘Utilization of physician services in the 50+population: the relative importance of individual versus institutional factors in 10 European countries’, International Journal of Health Care Finance and Economics, 9: 83–112.Google Scholar
Boulier, B. L., Datta, T. S. and Goldfarb, R. S. (2007), ‘Vaccination externalities’, The B.E. Journal of Economic Analysis & Policy, 7(1): 1–25. Article 23.Google Scholar
Currie, J. and Gruber, J. (1996), ‘Health insurance eligibility, utilization of medical care, and child health’, The Quarterly Journal of Economics, 111(2): 431–466.Google Scholar
Franks, P., Clancy, C. M. and Gold, M. R. (1993), ‘Health insurance and mortality. Evidence from a national cohort’, Journal of the American Medical Association, 270(6): 737–741.Google Scholar
Gruber, J. (2006), ‘The role of consumer copayments for health care: lessons from the RAND health insurance experiment and beyond’. Kaiser Foundation Report 7566.Google Scholar
Hirota, Y. and Kaji, M. (2008), ‘History of influenza vaccination programs in Japan’, Vaccine, 26(50): 6451–6454.Google Scholar
Ibuka, Y. and Bessho, S. (2015), ‘Subsidies for influenza vaccination, vaccination rates, and health outcomes among the elderly in Japan’, Japan and the World Economy, 36: 56–66.Google Scholar
Ibuka, Y., Paltiel, A. D. and Galvani, A. P. (2012), ‘Impact of program scale and indirect effects on the cost – effectiveness of vaccination programs’, Medical Decision Making, 32(3): 442–446.Google Scholar
Institute of Medicine (U.S.). Committee on the Evaluation of Vaccine Purchase Financing in the United States (2004), Financing Vaccines in the 21st Century: Assuring Access and Availability, Washington, DC: National Academies Press.Google Scholar
Jordan, R., Connock, M., Albon, E., Fry–Smith, A., Olowokure, B., Hawker, J. and Burls, A. (2006), ‘Universal vaccination of children against influenza: are there indirect benefits to the community? A systematic review of the evidence’, Vaccine, 24(8): 1047–1062.Google Scholar
Kane, R. L., Johnson, P. E., Town, R. J. and Butler, M. (2004), ‘A structured review of the effect of economic incentives on consumers' preventive behavior’, American Journal of Preventive Medicine, 27(4): 327–352.Google Scholar
Kondo, M., Hoshi, S. L. and Okubo, I. (2009), ‘Does subsidy work? Price elasticity of demand for influenza vaccination among the elderly in Japan’, Health Policy, 91(3): 269–276.Google Scholar
Kuwabara, N. and Ching, M. S. L. (2014), ‘A review of factors affecting vaccine preventable disease in Japan’, Hawai`i Journal of Medicine & Public Health, 73(12): 376–381.Google ScholarPubMed
Loeb, M., Russell, M. L., Moss, L., Fonseca, K., Fox, J., Earn, D. J., Aoki, F., Horsman, G., Van Caeseele, P., Chokani, K., Vooght, M., Babiuk, L., Webby, R. and Walter, S. D. (2010), ‘Effect of influenza vaccination of children on infection rates in Hutterite communities: a randomized trial’, Journal of the American Medical Association, 303(10): 943–950.Google Scholar
Manning, W. G., Newhouse, J. P., Duan, N. and Keeler, E. B. (1987), ‘Health insurance and the demand for medical care: evidence from a randomized experiment’, The American Economic Review, 77(3): 251–277.Google Scholar
Ministry of Health, Labour and Welfare (2013), The Preventive Vaccination Law. http://law.e–gov.go.jp/htmldata/S23/S23HO068.html (in Japanese). [30 September 2015]Google Scholar
Ministry of Internal Affairs and Communications (2014), Changes in the number of municipalities and mergers in Meiji and Showa period. http://www.soumu.go.jp/gapei/gapei2.html (in Japanese) [30 September 2015].Google Scholar
Monto, A. S., Davenport, F. M., Napier, J. A. and Francis, T. Jr (1970), ‘Modification of an outbreak of influenza in Tecumseh, Michigan by vaccination of schoolchildren’, Journal of Infectious Diseases, 122(1): 16–25.Google Scholar
Murakami, Y., Hashimoto, S., Taniguchi, K., Osaka, K., Fuchigami, H. and Nagai, M. (2004), ‘Evaluation of a method for issuing warnings pre-epidemics and epidemics in Japan by infectious diseases surveillance’, Journal of Epidemiology, 14(2): 33–40.Google Scholar
Nexoe, J., Kragstrup, J. and Ronne, T. (1997), ‘Impact of postal invitations and user fee on influenza vaccination rates among the elderly. A randomized controlled trial in general practice’, Scandinavian Journal of Primary Health Care, 15(2): 109–112.Google Scholar
Ohkusa, Y. (2005), ‘Policy evaluation for the subsidy for influenza vaccination in elderly’, Vaccine, 23(17–18): 2256–2260.Google Scholar
Ohkusa, Y. (2011), Forecast for the demand of influenza vaccination in FY2010. Submitted to a study group for the demand of influenza vaccination in Ministry of Health, Labour and Welfare on July 12, 2010.Google Scholar
Ohmit, S. E., Furumoto–Dawson, A., Monto, A. S. and Fasano, N. (1995), ‘Influenza vaccine use among an elderly population in a community intervention’, American Journal of Preventive Medicine, 11(4): 271–276.Google Scholar
Reichert, T. A., Sugaya, N., Fedson, D. S., Glezen, W. P., Simonsen, L. and Tashiro, M. (2001), ‘The Japanese experience with vaccinating schoolchildren against influenza’, The New England Journal of Medicine, 344: 889–896.Google Scholar
Rodewald, L. E., Szilagyi, P. G., Holl, J., Shone, L. R., Zwanziger, J. and Raubertas, R. F. (1997), ‘Health insurance for low-income working families. Effect on the provision of immunizations to preschool-age children’, Archives of Pediatrics and Adolescent Medicine, 151(8): 798–803.Google Scholar
Russell, L. B. (2007), ‘Prevention’s potential for slowing the growth of medical spending’. National Coalition on Health Care. http://www.ihhcpar.rutgers.edu/downloads/RussellNCHC2007.pdf. [30 September 2015.Google Scholar
Shibuya, K., Hashimoto, H., Ikegami, N., Nishi, A., Tanimoto, T., Miyata, H., Takemi, K. and Reich, M. R. (2011), ‘Future of Japan’s system of good health at low cost with equity: beyond universal coverage’, Lancet, 378(9798): 1265–1273.Google Scholar
Shigeoka, H. (2014), ‘The effect of patient cost sharing on utilization, health, and risk protection’, The American Economic Review, 104(7): 2152–2184.Google Scholar
Solanki, G. and Schauffler, H. H. (1999), ‘Cost-sharing and the utilization of clinical preventive services’, American Journal of Preventive Medicine, 17(2): 127–133.Google Scholar
Statistics Bureau of Japan (2014), ‘Statistical observations of Shi, Ku, Machi, Mura’. http://www.stat.go.jp/data/s–sugata/index.htm (in Japanese). [30 September 2015].Google Scholar
Stone, E. G., Morton, S. C., Hulscher, M. E., Maglione, M. A., Roth, E. A., Grimshow, J. M., Mittman, B. S., Rubenstein, L. V., Rubenstein, L. Z. and Shekelle, P. G. (2002), ‘Interventions that increase use of adult immunization and cancer screeming services: a meta-analysis’, Annals of Internal Medicine, 136(9): 641–651.Google Scholar
Trivedi, A. N., Rakowski, W. and Ayanian, J. Z. (2008), ‘Effect of cost sharing on screening mammography in medicare health plans’, The New England Journal of Medicine, 357: 375–383.Google Scholar
Wong, M. D., Andersen, R., Sherbourne, C. D., Hays, R. D. and Shapiro, M. F. (2001), ‘Effects of cost sharing on care seeking and health status: results from the medical outcomes study’, American Journal of Public Health, 91(11): 1889–1894.Google Scholar
World Health Organization (2002), Funding Health Care: Options for Europe, Buckingham: Open University Press.Google Scholar
Yoo, B. K., Berry, A., Kasajima, M. and Szilagyi, P. G. (2010), ‘Association between Medicaid reimbursement and child influenza vaccination rates’, Pediatrics, 126(5): e 998–1010.Google Scholar