Effects of Health Guidance on Outpatient and Pharmacy Expenditures: A Disease- and Drug-Specific 3-Year Observational Study Using Propensity-Score Matching

Etsuji Okamoto

doi:10.2188/jea.je20120136

Abstract

BackgroundEvidence is lacking on whether health guidance for metabolic syndrome reduces health care expenditures. The author used propensity-score matching to evaluate the effects of health guidance on health care expenditure.MethodsMen who did and did not receive health guidance from a health insurance society (approximately 60 000 covered lives) were matched (n = 397 respectively) using propensity scores. Health insurance claims were compared using cumulative health care expenditures for metabolic syndrome-related outpatient medical care and drug costs for the period from the initial consultation to 3 years later.ResultsNo difference was observed between intervention and control groups in cumulative outpatient charges or drug costs related to metabolic syndrome. However, regression analysis using the Tobit model showed that health guidance resulted in a small, nonsignificant reduction in health care expenditure.ConclusionsHealth guidance for metabolic syndrome did not reduce outpatient charges or drug costs related to metabolic syndrome during the 3-year period after the intervention. Findings from Tobit regression suggest that health guidance might eventually result in savings, but this hypothesis remains untested.

Highlights

As part of the Health Care Expenditure Containment Plans (HCECP), a program of health checks and guidance regarding metabolic syndrome was launched in April 2008
The government estimated that this program would reduce national health care expenditure by approximately 1.6 trillion yen from the expected 49 trillion yen in fiscal year (FY) 2015 and by 2.8 trillion yen from the expected 69 trillion yen in FY 2025 according to data submitted to the cabinet by the Ministry of Health, Labour and Welfare in March 2005.1 Pursuant to the Elderly Health Care Security Act, the HCECP at the prefectural level should include forecasts of health care expenditure in each prefecture
Summary comparison The number of claims/visits/days and charges incurred after initial consultations were compared between the intervention and control groups (Table 3)

Summary

Introduction

As part of the Health Care Expenditure Containment Plans (HCECP), a program of health checks and guidance regarding metabolic syndrome was launched in April 2008. The guideline states that, “Health checks and guidance will reduce the incidence of metabolic syndrome but will not reduce the number of patients already under treatment. It will be some time before the effects of health checks and guidance on health care expenditure become clear. Health insurance claims were compared using cumulative health care expenditures for metabolic syndrome-related outpatient medical care and drug costs for the period from the initial consultation to 3 years later. Conclusions: Health guidance for metabolic syndrome did not reduce outpatient charges or drug costs related to metabolic syndrome during the 3-year period after the intervention. Findings from Tobit regression suggest that health guidance might eventually result in savings, but this hypothesis remains untested

Methods

Results

Conclusion