On Geographic Inequality in Japanese Regional Health Insurance

In Japan, economic stagnation due to the lack of aggregate demand has hit the regional health insurance system and this affects most retired pensioners. The fiscal state of insurers in rural areas deteriorated. This paper aims to investigate whether the regional disparities in medical levies per household make a contribution to income-related geographic inequalities in health care financing. Data of the central two regions of the Japanese National Health Insurance in 2005 were extracted. Their share of population was about 41.5 percent. Retired employees and self-employed individuals are covered by this insurance system. We conducted the geographic decomposition using the concentration index. The within-area inequality in medical levies mainly accounted for geographic inequality in medical levies per household. The hypothesis that there was no between-area inequality in medical levies was not rejected. We revealed the differences in the within-area inequality in medical levies in the central Kanto. This means such proportionality was not built into the NHI system through near constant contribution rates across the distribution of living standards. It can be considered that the differences in the within-area inequality were caused by the inequality in income per household and the multiplier of income levies. We found that income per household, the standard land price of residential districts and the size of an insurer are major determinants of the multiplier of income levies. The higher land price tends to greater the multiplier of income levies. The expansion of insurer's size increases the multiplier of income levies in most of districts. The inequality in the multiplier of income levies will reduce if local governments raise per-household levy in proportion to the size of an insurer and lower the multiplier of income levy.Decomposition, Inequality, Japan, Medical Levies, National Health Insurance

On the Long-Run Equilibrium Relationship among Health Care Expenditures, Public Pension and Social Insurance Burden Rate in Japan

Despite a decrease in the number of working generations supporting Japan's social security system, the relationship between public pension benefits and health care expenditures since the inception of universal health insurance system has not been explored. We obtained one stable long-run equilibrium relationship among those three variables over the period from 1966 to 2002. We employed the forecast error variance decomposition to examine the determination of social insurance burden rate. It is found that health care shock was important for the long-run determination of social insurance burden rate. Because it appears that a free health service system for the elderly (health care shock) caused the increase in the doctor's consultation, we estimated the health care function to analyze price policy in the health care sector. We finally accepted the dynamic OLS model with lead lags as an aggregated health care function. The price elasticity of health care has declined in absolute value since the universal health insurance system started, and it has been around 0.6 since the early 1980s. The policy which eliminated health care fees for the elderly in the 1970s was a mistake since the elderly increased their health care expenditures. The out-of-pocket expenses for health care of the elderly should have been raised in the 1970s.cointegration, dynamic OLS, price elasticity of health care, variance decomposition, vector error correction model

The Effect of Cost Containment on the Outpatient in Japan: A VAR Approach

This paper examined the effects of restrictions on both the demand and supply sides of the health sector in Japan over a certain time period. Because the effect of supply side restrictions could not be taken into account in previous studies, we employed econometric time series techniques to develop a four-variable VAR model of the health sector over a sample period from November 1999 to March 2004. We used a first-difference series regarding the number of general beds to capture productivity shock. By using impulse response functions and a forecast error variance decomposition, we found that a price shock dominated the behavior of both patient and physician at forecast horizons, although in the short run the rise in the intensity of treatment leads to a decrease in the rate of doctor consultations. By estimating the structural VAR model under a recursive constraint, it was found that all of the causal links in the model constituted an invalid specification. We concluded that the increase in the patient's coinsurance rate had the effect of restraining health care costs but that a labor productivity shock did not have a permanent effect on the doctor consultation. The supply side of the health sector might absorb the change that occurred in the demand side.Coinsurance rate, Government-managed health insurance, Japan, Labor productivity, Number of beds, Structural shock, Vector autoregressive model

〈論文〉日本の高齢者の医療費は生活必需財か

[Abstract] It seems that contributions to social insurance for workers would be raised by the increases in expenditures on health care in Japan. Is health care really a necessity at the country level ? The hypothesis that health care is a necessity for the elderly was investigated in this paper. Quarterly data by age group in the 1990s was used. It was found that the characteristics of health care expenditures depend on the effect of changes in out-of-pocket payments. It was concluded that health care expenditures for the elderly is a luxury by vector error correction models when structural changes in payment are taken into consideration. [要旨] 医療費の増加によって日本では勤労者の社会保険料負担が引き上げられるであろうと目されている。 一国全体で医療は本当に生活必需財なのか。 この論文では, 医療の財としての性格が高齢者にとって生活必需財であるかが考察された。 1990年代の年齢階層別の四半期データが用いられ, 医療の財としての性格は患者自己負担の変化の効果に依存することが見出された。 自己負担の支払い方法の構造変化が考慮されたベクトル値誤差修正モデルによって, 高齢者にとって医療は奢侈財であるとの結論が得られた

Distinct impacts of high intensity caregiving on caregivers’ mental health and continuation of caregiving

Abstract Although high-intensity caregiving has been found to be associated with a greater prevalence of mental health problems, little is known about the specifics of this relationship. This study clarified the burden of informal caregivers quantitatively and provided policy implications for long-term care policies in countries with aging populations. Using data collected from a nationwide five-wave panel survey in Japan, I examined two causal relationships: (1) high-intensity caregiving and mental health of informal caregivers, and (2) high-intensity caregiving and continuation of caregiving. Considering the heterogeneity in high-intensity caregiving among informal caregivers, control function model which allows for heterogeneous treatment effects was used. This study uncovered three major findings. First, hours of caregiving was found to influence the continuation of high-intensity caregiving among non-working informal caregivers and irregular employees. Specifically, caregivers who experienced high-intensity caregiving (20–40 h) tended to continue with it to a greater degree than did caregivers who experienced ultra-high-intensity caregiving (40 h or more). Second, high-intensity caregiving was associated with worse mental health among non-working caregivers, but did not have any effect on the mental health of irregular employees. The control function model revealed that caregivers engaging in high-intensity caregiving who were moderately mentally healthy in the past tended to have serious mental illness currently. Third, non-working caregivers did not tend to continue high-intensity caregiving for more than three years, regardless of co-residential caregiving. This is because current high-intensity caregiving was not associated with the continuation of caregiving when I included high-intensity caregiving provided during the previous period in the regression. Overall, I noted distinct impacts of high-intensity caregiving on the mental health of informal caregivers and that such caregiving is persistent among non-working caregivers who experienced it for at least a year. Supporting non-working intensive caregivers as a public health issue should be considered a priority