The medical assistance system and inpatient health care provision: Empirical evidence from short-term hospitalizations in Japan.

Michio Yuda,Jacobus P Van Wouwe

doi:10.1371/journal.pone.0204798

Abstract

This paper uses two nationally representative sets of medical claims data from medical assistance and universal public health insurance systems to examine how medical assistance system assignment affects short-term inpatient health care provision. In Japan, the medical assistance system, which is part of a public assistance system, provides medical care services for its beneficiaries without imposing any financial burdens, such as copayments or advance premium payments. These circumstances can lead to inpatient costs, as physicians may provide more treatments because there is a financial incentive. Because the assignment of public assistance in Japan is not random but is subject to means testing by the local government, I employ the instrumental variable model to control the potential correlation. I find that medical expenditure is significantly higher for medical assistance patients than for universal public health insurance patients, with an arc elasticity of approximately 0.20. This elasticity is slightly greater than that found for inpatient care in the randomized RAND Health Insurance Experiment and recent empirical studies on low-income populations. In addition, the elasticities for patients who receive medication, treatment and surgery are greater.

Highlights

Welfare systems guarantee a minimum standard of living and provide independence for those who are destitute based on their level of need
The sample used in this study consists of patients admitted to a medical institution for a length of stay not exceeding 31 days in May each year because using repeated cross-sectional data for a certain month in a year is not appropriate for analyses that track the course of a patient’s disease. These data are useful to estimate the correct effect of medical assistance (MA) assignment on inpatient health care provision in the short term because short-term hospitalization has a high likelihood of representing a complete episode
I use two nationally representative sets of medical claims data from the MHLW in Japan to examine how assignment to the MA system affects the provision of short-term inpatient health care for MA beneficiaries

Summary

Introduction

Welfare systems guarantee a minimum standard of living and provide independence for those who are destitute based on their level of need. One possible major reason for this expansion is that MA patients receive medical treatments at no cost to them; The Government Revitalization Unit [10] and The Fiscal System Council [11] proposed introducing copayments for MA patients and mandating prescriptions of generic drugs Because the former policy reform would be a drastic environmental change for MA patients, it is necessary to strictly predict the policy effect on MA patients’ health and health care utilization. Chandra et al [7] used exogenous variation in the copayments faced by low-income enrollees in the Massachusetts Commonwealth Care Program (MCCP) to examine the impact of patient cost-sharing increases on health care utilization They found that the price elasticity with respect to hospital spending is estimated as –0.115, which is lower than that of the randomized RAND HIE. Elasticities for patients who receive medication and treatment and operation are more elastic

Materials and methods

Results

Discussion