ABSTRACT In Japan, health care expenditure (HCE) has increased with the rapid ageing of the population. It raises concerns on how the public health care insurance system should be sustained in the future, since the dependence on public burdens is growing under the government’s difficult financial conditions. This study investigates the cointegration relationship between HCE, GDP, and the population ageing rate (AGE) in Japan for the period 1960–2019 by using the nonlinear ARDL approach. The results revealed that per capita HCE may increase more significantly during an economic downturn than during an economic improvement in the long-run. Moreover, an increase in AGE has a positive effect on per capita HCE. These findings show the need to achieve stable economic growth and seriously address the issue of ageing for policymakers in Japan.