Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120

 

Presentation

Theoretical and Empirical Analysis on Japanese Mixed Medical Care Services

Authors:

Presenter: Hiromi Saito (National Graduate Institute for Policy Studies, Japan)

Discussant: David Bishai (Johns Hopkins Bloomberg School of Public Health)

Session: Lessons from the Japanese National Healthcare Program: Trend, Development, and Future

Room: Classroom C

When: Monday 5:15 p.m. - 6:45 p.m.

This study analyzes the implication of "Japanese mixed medical care prohibition and permission" in relation to public insurance coverage from an economic point of view. The Japanese mixed medical care is the combined use of insured and non-insured medical care in a series of medical cares. But this is actually prohibited in Japan. If only part of a series of medical cares is non-insured under the rule, the patients must pay for the total cost of the medical cares received. Therefore, it has been pointed out that heavy burdens restrict consultation behavior.

The purpose of this study is to analyze the mixed medical care services problem theoretically and empirically from a viewpoint of efficiency and equity. First, we analyze economic effects of the prohibition and permission of mixed medical care services within the partial equilibrium model. The result shows that the change in current system is better in term of efficiency. But we must note that the full permission can improve one side but make the other side worse according as the level of social insurance benefits. However, it also is pointed that the full prohibition on mixed medical care services could induce transfers from seriously symptomatic patients to mildly symptomatic patients.

Second, we empirically analyze the mixed medical care services problem and particularly focus on equity of accessibility on health-care. Using data collected through social inquiry corporation specializing in an Internet research, we estimate each personal demand curve for QALYs with the Contingent Valuation Method (CVM) in the case which a patient is so severe that can live no more than one year with insured medical care services. Next, we simulate patients' behavior based on the above theoretical model. The some results shows that: first, the permission can improve the effect of income distribution and benefit low income earners, second, regressiveness of co-payment evaluated at the Kakwanii index differs little when the current system changes, third, but the impacts on burden for low income earners can not be so much large, forth the kernel estimation shows that the patients' behavior are different among same income class, and so on.