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Does free healthcare improve children's healthcare use and outcomes? Evidence from Japan's healthcare subsidy for young children

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  • Kang, Cheolmin
  • Kawamura, Akira
  • Noguchi, Haruko

Abstract

We investigate the extent to which the subsidy for children's healthcare in Japan affects children's healthcare use and outcomes. The subsidy, which made children's healthcare services essentially free for patients, was introduced and expanded to preschool-age children in the 1990s. We use a difference-in-differences framework by exploiting variations in subsidy status, as the introduction timing and eligibility age differ across municipalities. We find that the subsidy significantly increased the use of outpatient care, as measured by the number of patients, visit intervals, and monthly spending. We also find evidence on the increase of inpatient use only for infants under 12 months of age (i.e., aged zero). Furthermore, the subsidy significantly improved children's subjective health symptoms reported by parents and contributed to reducing the mortality rate for infants by 0.79/1,000 individuals. In summary, our results suggest that free healthcare for children improves their access to healthcare as well as health outcomes, thus prioritizing this investment as part of national healthcare plans.

Suggested Citation

  • Kang, Cheolmin & Kawamura, Akira & Noguchi, Haruko, 2022. "Does free healthcare improve children's healthcare use and outcomes? Evidence from Japan's healthcare subsidy for young children," Journal of Economic Behavior & Organization, Elsevier, vol. 202(C), pages 372-406.
    • Handle: RePEc:eee:jeborg:v:202:y:2022:i:c:p:372-406
    DOI: 10.1016/j.jebo.2022.08.018
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    1. James P. Smith, 2009. "The Impact of Childhood Health on Adult Labor Market Outcomes," The Review of Economics and Statistics, MIT Press, vol. 91(3), pages 478-489, August.
    2. Newhouse, Joseph P., 1984. "Cream skimming, asymmetric information, and a competitive insurance market," Journal of Health Economics, Elsevier, vol. 3(1), pages 97-100, April.
    3. Zarek C. Brot-Goldberg & Amitabh Chandra & Benjamin R. Handel & Jonathan T. Kolstad, 2017. "What does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 132(3), pages 1261-1318.
    4. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 431-466.
    5. Toshiaki Iizuka & Hitoshi Shigeoka, 2018. "Free for Children? Patient Cost-sharing and Healthcare Utilization," NBER Working Papers 25306, National Bureau of Economic Research, Inc.
    6. Dolores De La Mata, 2012. "The Effect Of Medicaid Eligibility On Coverage, Utilization, And Children'S Health," Health Economics, John Wiley & Sons, Ltd., vol. 21(9), pages 1061-1079, September.
    7. Jeffrey Clemens & Joshua D. Gottlieb, 2017. "In the Shadow of a Giant: Medicare’s Influence on Private Physician Payments," Journal of Political Economy, University of Chicago Press, vol. 125(1), pages 1-39.
    8. Andrew Goodman-Bacon, 2018. "Public Insurance and Mortality: Evidence from Medicaid Implementation," Journal of Political Economy, University of Chicago Press, vol. 126(1), pages 216-262.
    9. Liran Einav & Amy Finkelstein, 2018. "Moral Hazard in Health Insurance: What We Know and How We Know It," Journal of the European Economic Association, European Economic Association, vol. 16(4), pages 957-982.
    10. Thompson, Owen, 2017. "The long-term health impacts of Medicaid and CHIP," Journal of Health Economics, Elsevier, vol. 51(C), pages 26-40.
    11. Sarah R. Cohodes & Daniel S. Grossman & Samuel A. Kleiner & Michael F. Lovenheim, 2016. "The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 727-759.
    12. Michael Baker & Jonathan Gruber & Kevin Milligan, 2008. "Universal Child Care, Maternal Labor Supply, and Family Well-Being," Journal of Political Economy, University of Chicago Press, vol. 116(4), pages 709-745, August.
    13. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    14. Currie, Janet, 2000. "Child health in developed countries," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 19, pages 1053-1090, Elsevier.
    15. Boudreaux, Michel H. & Golberstein, Ezra & McAlpine, Donna D., 2016. "The long-term impacts of Medicaid exposure in early childhood: Evidence from the program's origin," Journal of Health Economics, Elsevier, vol. 45(C), pages 161-175.
    16. Currie, Janet & Decker, Sandra & Lin, Wanchuan, 2008. "Has public health insurance for older children reduced disparities in access to care and health outcomes?," Journal of Health Economics, Elsevier, vol. 27(6), pages 1567-1581, December.
    17. Almond, Douglas & Currie, Janet, 2011. "Human Capital Development before Age Five," Handbook of Labor Economics, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 4, chapter 15, pages 1315-1486, Elsevier.
    18. Alexander Bick, 2016. "The Quantitative Role Of Child Care For Female Labor Force Participation And Fertility," Journal of the European Economic Association, European Economic Association, vol. 14(3), pages 639-668, June.
    19. Amy Finkelstein & James Poterba, 2004. "Adverse Selection in Insurance Markets: Policyholder Evidence from the U.K. Annuity Market," Journal of Political Economy, University of Chicago Press, vol. 112(1), pages 183-208, February.
    20. Hsing-Wen Han & Hsien-Ming Lien & Tzu-Ting Yang, 2020. "Patient Cost-Sharing and Healthcare Utilization in Early Childhood: Evidence from a Regression Discontinuity Design," American Economic Journal: Economic Policy, American Economic Association, vol. 12(3), pages 238-278, August.
    21. Takaku, Reo, 2016. "Effects of reduced cost-sharing on children's health: Evidence from Japan," Social Science & Medicine, Elsevier, vol. 151(C), pages 46-55.
    22. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    23. Kenshi Itaoka & Alan Krupnick & Makoto Akai & Anna Alberini & Maureen Cropper & Nathalie Simon, 2007. "Age, health, and the willingness to pay for mortality risk reductions: a contingent valuation survey of Shizuoka, Japan, residents," Environmental Economics and Policy Studies, Springer;Society for Environmental Economics and Policy Studies - SEEPS, vol. 8(3), pages 211-237, September.
    24. Jaap H. Abbring & James J. Heckman & Pierre-André Chiappori & Jean Pinquet, 2003. "Adverse Selection and Moral Hazard In Insurance: Can Dynamic Data Help to Distinguish?," Journal of the European Economic Association, MIT Press, vol. 1(2-3), pages 512-521, 04/05.
    25. Katherine Baicker & Dana Goldman, 2011. "Patient Cost-Sharing and Healthcare Spending Growth," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 47-68, Spring.
    26. Prashant Bharadwaj & Katrine Vellesen L?ken & Christopher Neilson, 2013. "Early Life Health Interventions and Academic Achievement," American Economic Review, American Economic Association, vol. 103(5), pages 1862-1891, August.
    27. Sarah Miller & Laura R. Wherry, 2019. "The Long-Term Effects of Early Life Medicaid Coverage," Journal of Human Resources, University of Wisconsin Press, vol. 54(3), pages 785-824.
    28. Nilsson, Anton & Paul, Alexander, 2018. "Patient cost-sharing, socioeconomic status, and children's health care utilization," Journal of Health Economics, Elsevier, vol. 59(C), pages 109-124.
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    More about this item

    Keywords

    Child health; Healthcare subsidy; Patient cost-sharing; Healthcare utilization; Child mortality;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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