Abstract
BackgroundJapan’s stagnant economy has produced increasing income disparities, and the effect of poverty on health and health-care utilization is a significant issue. Co-payments could be a trade-off for patients when seeking medical care and limit health-care utilization. We sought primary care physicians’ experiences in dealing with financially deprived patients and their perspectives about reducing co-payments by low-income patients.MethodsWe used a convergent mixed-methods approach in a mail survey; it was distributed to 1989 primary care physicians practicing in areas with the highest proportions of socially disadvantaged individuals in Tokyo. The survey items included an open-ended question, seeking the participants’ perspectives about reducing co-payments by low-income patients from the current 30%, and closed questions, asking their experience of patient behavior related to financial burdens during the previous 6 months.ResultsWe analyzed the responses of 365 physicians. Sixty-two percent of the primary care physicians agreed with lowering co-payments for financially deprived patients; however, the remainder disagreed or were uncertain. Those who disagreed were less likely to have experienced patient behavior related to financial burdens. The participants suggested challenges and potential measures for reducing co-payments by low-income patients in light of tight governmental financial resources and rapidly increasing health-care expenditures in Japan. The physicians were also concerned about the moral hazard in health-care utilization among patients receiving social welfare who obtain care at no cost.ConclusionsFrom their experience in having dealt with low-income patients, the majority of physicians were positive about lowering co-payments by such patients; the remainder were negative or uncertain. It may be necessary to raise awareness of patients’ socioeconomic status among primary care physicians as a possible deterrent for seeking care. To maintain health-care equity, policy makers should consider balancing co-payments among individuals with differing financial levels and health-care needs.
Highlights
Japan’s stagnant economy has produced increasing income disparities, and the effect of poverty on health and health-care utilization is a significant issue
Owing to the country’s longstanding stagnant economy [3], income disparities are increasing in Japan; the impact of poverty on health and health-care utilization has become a highlighted issue [4]
The exception is for individuals receiving public social welfare: they can obtain medical care at no charge, all such care being covered by the government
Summary
Japan’s stagnant economy has produced increasing income disparities, and the effect of poverty on health and health-care utilization is a significant issue. Co-payments could be a trade-off for patients when seeking medical care and limit health-care utilization. Owing to the country’s longstanding stagnant economy [3], income disparities are increasing in Japan; the impact of poverty on health and health-care utilization has become a highlighted issue [4]. Under Japan’s current policy, all patients aged under 70 years have to pay 30% of the total health-care costs—regardless of their income—as a co-payment every time they see a primary care doctor [1]. Since copayment is not a fixed amount, patients with complex, multiple long-term conditions face a greater financial burden when receiving medical care. Most individuals in relative or absolute poverty did not receive social welfare: some failed to meet the criteria for receipt; many others did not choose to receive it owing to the social stigma or sense of shame
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