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"MEDICAL CARE EXPENDITURES"
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The LSE companion to health policy
\"The LSE Companion to Health Policy covers a wide range of conceptual and practical issues from a number of different perspectives introducing the reader to, and summarising, the vast literature that analyses the complexities of health policy. The Companion also assesses the current state of the art.\"--Page 4 of cover.
Book
Association between Participation in the Short Version of a Workplace Oral Health Promotion Program and Medical and Dental Care Expenditures in Japanese Workers: A Longitudinal Study
Studies suggest that intensive oral health promotion programs in the workplace reduce dental and medical care expenditures. The purpose of this longitudinal study was to evaluate the short version of an oral health promotion program in the workplace from the viewpoint of dental and medical care expenditures. Data for annual expenditures and number of days of dental, periodontal, and medical treatment in fiscal year 2018 and participation in the short version of a workplace oral health promotion program of 2545 workers (20–68 years old) in a company in fiscal year 2017 and prior were obtained. Zero-inflated negative binomial regression models or negative binomial regression models were used to evaluate the association between participation in the program and expenditures or number of days of treatment after adjusting for sex and age. Program participants were more likely than non-participants to visit dentists for dental and periodontal treatment. Those who participated twice or more spent less on dental, periodontal, and medical treatment and had fewer visits to dentists than non-participants. These results suggest that the short version of an oral health promotion program in the workplace decreases expenditures for dental, periodontal, and medical treatment.
Journal Article
Medical care cost dynamics during COVID-19 pandemic: financial implications for Japanese health insurance system
Background
While the COVID-19 pandemic globally affected healthcare utilization, economic impacts on medical care costs and insurance finances remain underexamined. In Japan, where aging-related medical care cost increases are becoming serious concerns, quantitative evaluation is crucial for sustainable health insurance system design. This study analyzed the economic impact of COVID-19 on medical care expenditure and utilization rates for non–COVID-19 diseases among the working-age population in Japan.
Methods
We analyzed continuously enrolled workers aged 20–74 using medical claims data from the Japan Health Insurance Association (May 2015-December 2021). For calculating monthly medical care expenditure, we employed a two-part model of utilization rate and incurred medical care expenditure. Disease-specific allocation for incurred medical care expenditure used Bayesian-based decomposition methods. Using interrupted time series analysis with March 2020 as intervention point, we estimated pandemic impacts on medical care expenditure and utilization rates, stratified by sex, disease group, and type of care.
Results
Analysis included 5,826,233 men and 2,971,364 women. During the first state of emergency (April-May 2020), significant decreases in monthly medical care expenditure and utilization rates occurred across most disease groups. For neoplasms, from the second state of emergency (January-March 2021) onward, medical care expenditure increased persistently in outpatient care in both sexes and in inpatient care in men, exceeding utilization rate increases. For diseases of the circulatory system, notable medical care expenditure increases (up to ~ 40%) occurred in men’s inpatient care from the second state of emergency onward, while utilization rate increases remained below 25%, showing differences between the two outcomes. For diseases of the respiratory system, decreases in medical care expenditure persisted throughout the entire period in outpatient care, averaging ~ 18% (men) and ~ 27% (women) monthly. For endocrine, nutritional and metabolic diseases, pandemic impacts were minimal compared to other groups.
Conclusions
The impact of the pandemic on medical care expenditure and utilization rates varied substantially by sex, disease group, and type of care. These findings provide important policy implications for ensuring the sustainability of health insurance finances during future infectious disease crises and for establishing healthcare delivery systems that consider economic efficiency.
Journal Article
Forecasting of Future Medical Care Expenditure in Japan Using a System Dynamics Model
Background
The aim of this study was to construct a system dynamics (SD) model to estimate the future medical care expenditure and to address the dynamic issues of health care that should be resolved. In particular, the measures for promoting the spread of generic drug (GE drug) usage in Japan and reducing cancer-related medical expenses were investigated regarding their future impact on medical finances.
Methods
The SD model was constructed from FY 2018 to FY 2050. The change in the future GE drug quantity share was analyzed by using a regression equation. The impact of the increase in medical expense for cancer and the change in the future national medical care expenditure were also estimated.
Results
The annual total medical care expenditure in FY 2050 would arrive at 58.9–64.2 trillion JPY (US$ 535.1–584.0 billion) (1.3–1.5 times higher than that in FY 2018) with different trends in age groups. The cumulative total medical care expenditure was expected to decrease by about 787.0–989.4 billion JPY (US$ 7.2–9.0 billion) if the impact of the spread of GE drug usage was considered. On the other hand, due to the continuous increase in the cancer-related medical expense, the cumulative total medical care expenditure was estimated to increase about 7554.3–11715.0 billion JPY (US$ 68.7–106.5 billion).
Conclusions
If the cancer-related medical expense continues to increase in the future, an increase of 686.4–1104.2 billion JPY (US$ 6.2–10.0 billion) in FY 2050 is expected which suggests that this disease field should be prioritized regarding the measures to maintain medical finances.
Journal Article
Health and Economic Effects of Salt Reduction Interventions for Preventing Noncommunicable Diseases in Japan: A System Dynamics Simulation Study
Reducing salt intake is a vital public health measure for combating noncommunicable diseases and mitigating rising social security expenditures in Japan. We developed a system dynamics model to analyze the potential health and cost effects of salt reduction interventions among the Japanese population aged 40 years and above from 2012 to 2040. The simulation findings derived from the model indicate that, in the base run, the disability-adjusted life years (DALYs) for cardiovascular disease (CVD) and chronic kidney disease (CKD) are projected to be approximately 55 and 9.5 per 100,000 people, respectively, contributing approximately 40 trillion yen in social security expenditures by 2040. The model predicts that implementing mandatory reformulation could decrease DALYs for CVD and CKD by 5.7% and 6.2%, respectively, resulting in an approximately 6.7% reduction in social security expenditure. Additionally, voluntary reformulation is estimated to reduce the DALYs for CVD and CKD by 4.7% and 5.2%, leading to a 5.6% decrease in social security expenditure. Finally, accelerating the adoption of a low-salt diet is expected to lower the DALYs for CVD by 2.8% and CKD by 3.2%, thereby reducing social security expenditures by 3.4%. Thus, product reformulation initiatives have a greater impact on health and economic outcomes.
Journal Article
The Trends of Medical Care Expenditure with Adjustment of Lifestyle Habits and Medication; 10-Year Retrospective Follow-Up Study
In Japan, the prevention of lifestyle-related diseases is the most important issue for the optimization of medical expenditure. This study aimed to analyze the impact of lifestyle and medication status on medical expenditure. Health checkup data and medical expenditure records of a retrospective cohort of 1463 people aged between 40 and 65 years old who underwent specific health checks at least three times between 2008 and 2017 were analyzed. Regression analysis was performed with medical expenditure as the dependent variable and age, gender, waist ratio, medication status, and lifestyle habits as independent variables using a Tobit model. Focusing on the factors that increase medical expenditure, the regression coefficients of age, medication status, weight gain of 10 kg or more since the age of 20, and walking more than 1 h per day were 0.048 (95% CI 0.04 to 0.06), 1.020 (95% CI 0.88 to 1.16), 0.210 (95% CI 0.06 to 0.36), and −0.208 (95% CI −0.35 to −0.07), respectively. The estimate of 5-year cumulative medical expenditure showed that those with walking habits without medication had the lowest medical expenditure. The result of this study suggests that walking more than 1 h a day may lower health expenditure in the general population.
Journal Article
Does the Use of Solid Cooking Fuels Increase Household Out-Of-Pocket Medical Expenses? Evidence from Indonesia
Introduction/Main Objectives: The objective of this study is to assess how the utilization of solid cooking fuels influences out-of-pocket medical expenses incurred by households in Indonesia. Background Problems: Solid cooking fuel use remains prevalent in Indonesia, negatively impacting the health of household members, and consequently affecting associated medical expenses as well. Novelty: To the best of the authors’ understanding, this study is the first to explore how the use of solid cooking fuels affects the out-of-pocket medical expenses of households in Indonesia. Research Methods: This study employs instrumental variables to address existing endogeneity issues. Finding/ Results: On average, households using solid cooking fuels show a 0.0041 increased proportion of out-of-pocket medical expenses to total household expenditure compared to households using non-solid cooking fuels. Conclusion: The Indonesian government can reduce household medical expenses by improving the use of cleaner cooking fuels. Implementable policies include providing assistance with clean energy cooking equipment and ensuring the availability of clean energy in areas in need.
Journal Article
Does Population Aging Impact China’s Economic Growth?
The rapid aging of the population presents great challenges in terms of China’s social security expenditure and economic growth. This paper uses the entropy method to comprehensively measure the provincial population aging index in 2008–2019 and constructs an intermediary effect model with it as the core explanatory variable. The results show that the population aging has a significant positive impact on economic growth and on the promotion of the economic growth of more developed areas; it also has a positive impact on the endowment insurance expenditure and medical and health expenditure and on the promotion of economically backward areas. Endowment spending and health spending fully mediate the relationship between population aging and economic growth.
Journal Article