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

Impact of increased reimbursement for ambulance transportation on hospital acceptance in Japan: a difference-in-difference study

Objective Emergency medical services (EMS) often face difficulties in finding accepting hospitals in Japan. The universal medical insurance system in Japan increased the reimbursement for ambulance transportation acceptance at night, and on Sundays and holidays from 1 April 2016. This study investigated the effect of the reimbursement increase on the number of EMS calls, and transportation time from arrival at the scene to arrival at the hospital.Design A difference-in-difference study. The treatment group consisted of people who called an ambulance at night while the control group consisted of people who called an ambulance during the daytime.Setting The national ambulance records of the Fire and Disaster Management Agency in Japan from 1 April 2015 to 31 December 2016.Participants 7 625 463 ambulance dispatches were eligible for inclusion.Primary and secondary outcome measures The changes in EMS calls, transportation time and the number of ambulance transports per 1000 population in one month in a comparison of daytime and night-time transport.Results The treatment effect (night-time vs daytime) on the number of EMS calls was −0.013 (95% CI, −0.023 to −0.004), which was significant. The transportation time decreased slightly by 0.080 min (95% CI, −0.157 to −0.004). No impact was observed on the number of ambulance transports per 1000 population per month (0.00; 95% CI, −0.008 to 0.002).Conclusion An increase in reimbursement for ambulance transportation acceptance was associated with a decrease in the number of EMS calls. Further strategies for decreasing the number of EMS calls are needed to avoid delays in the treatment of emergency patients with critical illness

SARS-CoV-2 suppression and early closure of bars and restaurants: a longitudinal natural experiment

Abstract Despite severe economic damage, full-service restaurants and bars have been closed in hopes of suppressing the spread of SARS-CoV-2 worldwide. This paper explores whether the early closure of restaurants and bars in February 2021 reduced symptoms of SARS-CoV-2 in Japan. Using a large-scale nationally representative longitudinal survey, we found that the early closure of restaurants and bars decreased the utilization rate among young persons (OR 0.688; CI95 0.515–0.918) and those who visited these places before the pandemic (OR 0.754; CI95 0.594–0.957). However, symptoms of SARS-CoV-2 did not decrease in these active and high-risk subpopulations. Among the more inactive and low-risk subpopulations, such as elderly persons, no discernible impacts are observed in both the utilization of restaurants and bars and the symptoms of SARS-CoV-2. These results suggest that the early closure of restaurants and bars without any other concurrent measures does not contribute to the suppression of SARS-CoV-2