Medical expenditure after marginal cut of cash benefit among public assistance recipients in Japan: natural experimental evidence

[Backgrounds] Income reduction in poor households affects healthcare demands for impoverished population. However, the impact of reduced benefits for public assistance recipients, who can use medical services for free, on healthcare costs has not been examined. We hypothesised that marginal cuts in benefits increase recipients’ medical expenditure by extra demand for medical care. We tested this hypothesis using public assistance databases of Japan. [Methods] The study population comprised households in five municipalities receiving public assistance between April 2016 and September 2018. The households have a child aged 12–60 months and receive a monthly child-support income of US$150, which reduces by US$50 when the child turns 36 months of age. Our analysis comprised an age-based sharp regression-discontinuity study. [Results] We observed 4893 household-months (11 032 person-months). When a firstborn child reached 36 months, their frequency of outpatient visits and healthcare costs by recipients, except for the firstborn child, increased (0.45, 95% CI: 0.30 to 0.61; US$111.2, 95$248.6 (95% CI: 25.4 to 471.7). Inpatient medical costs increased significantly (US$64.3, 95% CI: 8.4 to 120.2). [Conclusions] Government savings through income reduction were offset by increased medical expenditure. This may be due to recipients’ behavioural change and their worsening health conditions. To prevent excessive medical expenditure, policymakers should consider how income reduction affects the behaviour and health of the impoverished population

THE EFFECT OF PATIENT COST SHARING ON HEALTH CARE UTILIZATION AMONG LOW-INCOME CHILDREN

This paper examines how health care utilization among low-income children is affected by a reduction of the coinsurance rate, exploiting an institutional change in the Medical Subsidy for Children and Infants (MSCI) system, as a natural experiment. In 2004, the maximum age for MSCI recipients in Hokkaido Prefecture was raised from 3 years to include all children of preschool age. The implied arc price elasticity of outpatient care utilization is −0.23, which is congruent with the commonly cited value (−0.2) presented in the RAND health insurance experiment

Effect of no cost sharing for paediatric care on healthcare usage by household income levels: regression discontinuity design.

OBJECTIVES: To investigate the impact of no cost sharing on paediatric care on usage and health outcomes, and whether the effect varies by household income levels. DESIGN: Regression discontinuity design. SETTING: Nationwide medical claims database in Japan. PARTICIPANTS: Children aged younger than 20 years from April 2018 to March 2022. EXPOSURE: Co-insurance rate that increases sharply from 0% to 30% at a certain age threshold (the threshold age varies between 6 and 20 years depending on region). PRIMARY OUTCOME MEASURES: The outpatient care usage (outpatient visit days and healthcare spending for outpatient care) and inpatient care (experience of any hospitalisation and healthcare spending for inpatient care). RESULTS: Of 244 549 children, 49 556 participants were in the bandwidth and thus included in our analyses. Results from the regression discontinuity analysis indicate that no cost sharing was associated with a significant increase in the number of outpatient visit days (+5.26 days; 95% CI, +4.89 to +5.82; p&lt;0.01; estimated arc price elasticity, -0.45) and in outpatient healthcare spending (+US$369; 95$344 to +US406; p<0.01; arc price elasticity, -0.55). We found no evidence that no cost sharing was associated with changes in inpatient care usage. Notably, the effect of no cost-sharing policy on outpatient healthcare usage was larger among children from high-income households (visit days +5.96 days; 95% CI, +4.88 to +7.64, spending +US511; 95% CI, +US$440 to +US$627) compared with children from low-income households (visit days +2.64 days; 95% CI, +1.54 to +4.23, spending +US$154; 95$80 to +US$249). CONCLUSIONS: No cost sharing for paediatric care was associated with a greater usage of outpatient care services, but did not affect inpatient care usage. The study found that this effect was more pronounced among children from high-income households, indicating that the no cost sharing disproportionately benefits high-income households and may contribute to larger disparities

Effect of no cost sharing for paediatric care on healthcare usage by household income levels: regression discontinuity design

Objectives To investigate the impact of no cost sharing on paediatric care on usage and health outcomes, and whether the effect varies by household income levels.Design Regression discontinuity design.Setting Nationwide medical claims database in Japan.Participants Children aged younger than 20 years from April 2018 to March 2022.Exposure Co-insurance rate that increases sharply from 0% to 30% at a certain age threshold (the threshold age varies between 6 and 20 years depending on region).Primary outcome measures The outpatient care usage (outpatient visit days and healthcare spending for outpatient care) and inpatient care (experience of any hospitalisation and healthcare spending for inpatient care).Results Of 244 549 children, 49 556 participants were in the bandwidth and thus included in our analyses. Results from the regression discontinuity analysis indicate that no cost sharing was associated with a significant increase in the number of outpatient visit days (+5.26 days; 95% CI, +4.89 to +5.82; p&lt;0.01; estimated arc price elasticity, −0.45) and in outpatient healthcare spending (+US$369; 95$344 to +US406; p<0.01; arc price elasticity, −0.55). We found no evidence that no cost sharing was associated with changes in inpatient care usage. Notably, the effect of no cost-sharing policy on outpatient healthcare usage was larger among children from high-income households (visit days +5.96 days; 95% CI, +4.88 to +7.64, spending +US511; 95% CI, +US$440 to +US$627) compared with children from low-income households (visit days +2.64 days; 95% CI, +1.54 to +4.23, spending +US$154; 95$80 to +US$249).Conclusions No cost sharing for paediatric care was associated with a greater usage of outpatient care services, but did not affect inpatient care usage. The study found that this effect was more pronounced among children from high-income households, indicating that the no cost sharing disproportionately benefits high-income households and may contribute to larger disparities