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Does income influence demand for medical services despite Japan's “Health Care for All” policy?

Published online by Cambridge University Press:  24 January 2008

Akira Babazono ,
Kazuaki Kuwabara ,
Akito Hagihara ,
Eiji Yamamoto  and
Alan Hillman
Akira Babazono
Affiliation:
Kyushu University
Kazuaki Kuwabara
Affiliation:
Kyushu University
Akito Hagihara
Affiliation:
Kyushu University
Eiji Yamamoto
Affiliation:
Okayama University of Science
Alan Hillman
Affiliation:
University of Pennsylvania
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Abstract

Objectives: We examined the impact of household income on the use of medical services in Japan, where there is a “health care for all” policy, with important, centralized influence by the national government designed to ensure universal access.

Methods and Subjects: All healthcare societies operating in 2003 were included in the study, representing 14,776,193 insured adults and 15,496,752 insured dependents. The mean case rate (the average number of monthly bills per patient), the mean number of service days per person, and the mean medical cost per person served as indicators of medical service use. Multiple regression analysis was performed by the forced entry method using case rate, the number of service days, and medical cost as outcome variables, and average monthly salary, dependent ratio, average age, and premium rate as the explanatory variables.

Results: In the multiple regression analyses, average monthly salary showed a high positive correlation of outpatient and dental indicators, including case rate, the number of service days, and medical cost. If the average monthly salary were reduced 20 percent lower than the mean, the estimated changes (95 percent CI) in case rate for the insured were −7.49 (−8.14 ∼ −6.84) percent for outpatient visits and −8.16 (−8.77 ∼ −7.56) percent for dental services.

Conclusions: Average monthly salary intensifies the effects of copayments on the case rate, the number of service days, and medical cost in the “Employees Health Insurance” in Japan. Thus, a low salary appears to discourage patients from seeking medical and dental services.

Keywords

Health policyHealth insuranceIncome effectUniversal accessJapanese healthcare system
Type
RESEARCH REPORTS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 1 , January 2008 , pp. 125 - 130
Copyright
Copyright © Cambridge University Press 2008

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