Avantages sanitaires de la réduction du partage des coûts au Japon

Translated title of the contribution: Health benefits of reduced patient cost sharing in Japan

Akihiro Nishi*, J. Michael McWilliams, Haruko Noguchi, Hideki Hashimoto, Nanako Tamiya, Ichiro Kawachi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Objective To assess the effect on out-of-pocket medical spending and physical and mental health of Japan's reduction in health-care cost sharing from 30% to 10% when people turn 70 years of age. Methods Study data came from a 2007 nationally-representative cross-sectional survey of 10 293 adults aged 64 to 75 years. Physical health was assessed using a 16-point scale based on self-reported data on general health, mobility, self-care, activities of daily living and pain. Mental health was assessed using a 24-point scale based on the Kessler-6 instrument for nonspecific psychological distress. The effect of reduced cost sharing was estimated using a regression discontinuity design. Findings For adults aged 70 to 75 years whose income made them ineligible for reduced cost sharing, neither out-of-pocket spending nor health outcomes differed from the values expected on the basis of the trend observed in 64- to 69-year-olds. However, for eligible adults aged 70 to 75 years, out-of-pocket spending was significantly lower (P < 0.001) and mental health was significantly better (P < 0.001) than expected. These differences emerged abruptly at the age of 70 years. Moreover, the mental health benefits were similar in individuals who were and were not using health-care services (P = 0.502 for interaction). The improvement in physical health after the age of 70 years in adults eligible for reduced cost-sharing tended to be greater than in non-eligible adults (P = 0.084). Conclusion Reduced cost sharing was associated with lower out-of-pocket medical spending and improved mental health in older Japanese adults.

Translated title of the contributionHealth benefits of reduced patient cost sharing in Japan
Original languageFrench
Pages (from-to)426-435A
JournalBulletin of the World Health Organization
Issue number6
Publication statusPublished - 2012 May
Externally publishedYes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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