IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v7y2017i1d10.1186_s13561-017-0165-3.html
   My bibliography  Save this article

Effect of reducing cost sharing for outpatient care on children’s inpatient services in Japan

Author

Listed:
  • Hirotaka Kato

    (Kyoto University, Yoshida-honmachi)

  • Rei Goto

    (Keio University)

Abstract

Background Assessing the impact of cost sharing on healthcare utilization is a critical issue in health economics and health policy. It may affect the utilization of different services, but is yet to be well understood. Objective This paper investigates the effects of reducing cost sharing for outpatient services on hospital admissions by exploring a subsidy policy for children’s outpatient services in Japan. Methods Data were extracted from the Japanese Diagnosis Procedure Combination database for 2012 and 2013. A total of 366,566 inpatients from 1390 municipalities were identified. The impact of expanding outpatient care subsidy on the volume of inpatient care for 1390 Japanese municipalities was investigated using the generalized linear model with fixed effects. Results A decrease in cost sharing for outpatient care has no significant effect on overall hospital admissions, although this effect varies by region. The subsidy reduces the number of overall admissions in low-income areas, but increases it in high-income areas. In addition, the results for admissions by type show that admissions for diagnosis increase particularly in high-income areas, but emergency admissions and ambulatory-care-sensitive-condition admissions decrease in low-income areas. Conclusions These results suggest that outpatient and inpatient services are substitutes in low-income areas but complements in high-income ones. Although the subsidy for children’s healthcare would increase medical costs, it would not improve the health status in high-income areas. Nevertheless, it could lead to some health improvements in low-income areas and, to some extent, offset costs by reducing admissions in these regions.

Suggested Citation

  • Hirotaka Kato & Rei Goto, 2017. "Effect of reducing cost sharing for outpatient care on children’s inpatient services in Japan," Health Economics Review, Springer, vol. 7(1), pages 1-10, December.
    • Handle: RePEc:spr:hecrev:v:7:y:2017:i:1:d:10.1186_s13561-017-0165-3
    DOI: 10.1186/s13561-017-0165-3
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-017-0165-3
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1186/s13561-017-0165-3?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Hitoshi Shigeoka, 2014. "The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection," American Economic Review, American Economic Association, vol. 104(7), pages 2152-2184, July.
    2. Astrid Kiil & Kurt Houlberg, 2014. "How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 813-828, November.
    3. Besley, Timothy & Case, Anne, 1995. "Incumbent Behavior: Vote-Seeking, Tax-Setting, and Yardstick Competition," American Economic Review, American Economic Association, vol. 85(1), pages 25-45, March.
    4. Tzu-Ting Yang & Hsing-Wen Han & Hsien-Ming Lien, 2014. "Patient Cost-Sharing and Healthcare Utilization in Early Childhood: Evidence from a Regression Discontinuity Design," Working Papers 14C003, Canadian Centre for Health Economics.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Hirotaka Kato & Rei Goto & Taishi Tsuji & Katsunori Kondo, 2022. "The effects of patient cost-sharing on health expenditure and health among older people: Heterogeneity across income groups," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(5), pages 847-861, July.
    2. Wen He, 2022. "Effects of establishing a financing scheme for outpatient care on inpatient services: empirical evidence from a quasi-experiment in China," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(1), pages 7-22, February.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Naimi Johansson & Niklas Jakobsson & Mikael Svensson, 2019. "Effects of primary care cost-sharing among young adults: varying impact across income groups and gender," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(8), pages 1271-1280, November.
    2. Natalia Serna, 2021. "Cost sharing and the demand for health services in a regulated market," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1259-1275, June.
    3. Hirotaka Kato & Rei Goto & Taishi Tsuji & Katsunori Kondo, 2022. "The effects of patient cost-sharing on health expenditure and health among older people: Heterogeneity across income groups," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(5), pages 847-861, July.
    4. Eunja Park & Sookja Choi, 2020. "Who Benefits from the Fixed Copayment of Medical and Pharmaceutical Expenditure among the Korean Elderly?," IJERPH, MDPI, vol. 17(21), pages 1-11, November.
    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. 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.
    7. Ando Michihito & Takaku Reo, 2016. "Affordable False Teeth: The Effects of Patient Cost Sharing on Denture Utilization and Subjective Chewing Ability," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 16(3), pages 1387-1438, September.
    8. 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.
    9. Sandy Fréret & Denis Maguain, 2017. "The effects of agglomeration on tax competition: evidence from a two-regime spatial panel model on French data," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 24(6), pages 1100-1140, December.
    10. Tal Gross & Timothy J. Layton & Daniel Prinz, 2022. "The Liquidity Sensitivity of Healthcare Consumption: Evidence from Social Security Payments," American Economic Review: Insights, American Economic Association, vol. 4(2), pages 175-190, June.
    11. Gijs Roelofs & Daniel Vuuren, 2017. "The Decentralization of Social Assistance and the Rise of Disability Insurance Enrolment," De Economist, Springer, vol. 165(1), pages 1-21, March.
    12. Kristien Werck & Bruno Heyndels & Benny Geys, 2008. "The impact of ‘central places’ on spatial spending patterns: evidence from Flemish local government cultural expenditures," Journal of Cultural Economics, Springer;The Association for Cultural Economics International, vol. 32(1), pages 35-58, March.
    13. Padovano, Fabio & Petrarca, Ilaria, 2014. "Are the responsibility and yardstick competition hypotheses mutually consistent?," European Journal of Political Economy, Elsevier, vol. 34(C), pages 459-477.
    14. Matthieu Leprince & Sonia Paty & Emmanuelle Reulier, 2005. "Choix d'imposition et interactions spatiales entre collectivités locales. Un test sur les départements français," Recherches économiques de Louvain, De Boeck Université, vol. 71(1), pages 67-93.
    15. Alexander Klemm & Stefan Parys, 2012. "Empirical evidence on the effects of tax incentives," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 19(3), pages 393-423, June.
    16. Edoardo Di Porto & Vincent Merlin & Sonia Paty, 2013. "Cooperation among local governments to deliver public services : a "structural" bivariate response model with fixed effects and endogenous covariate," Working Papers halshs-00787600, HAL.
    17. Thushyanthan Baskaran & Sonia Bhalotra & Brian Min & Yogesh Uppal, 2024. "Women legislators and economic performance," Journal of Economic Growth, Springer, vol. 29(2), pages 151-214, June.
    18. Karen Crabbé, 2013. "Are Your Firm´s Taxes Set in Warsaw? Spatial Tax Competition in Europe," FinanzArchiv: Public Finance Analysis, Mohr Siebeck, Tübingen, vol. 69(3), pages 317-337, September.
    19. Revelli, Federico & Tovmo, Per, 2007. "Revealed yardstick competition: Local government efficiency patterns in Norway," Journal of Urban Economics, Elsevier, vol. 62(1), pages 121-134, July.
    20. Federico Boffa & Amedeo Piolatto & Giacomo A. M. Ponzetto, 2016. "Political Centralization and Government Accountability," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(1), pages 381-422.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:hecrev:v:7:y:2017:i:1:d:10.1186_s13561-017-0165-3. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com/economics/journal/13561 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.