Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Better accessibility of healthcare services among elderly is a key step in the mitigation of health disparities. For a rapid increase in the aging population of industrialized nations, policy makers often draw an important distinction between access to and utilization of healthcare services. In this session, four papers frame a trend of the national healthcare program, its development, and the future of the Japanese national healthcare program. Four papers basically focus on the efficiency of health care in Japan; furthermore, three papers (Noguch et al., 2nd paper; Murata et al., 3rd paper; and Sito and Suzuki, 4th paper) among four discuss the current national healthcare program in Japan to improve healthcare delivery while one paper by Kakihara and Furukawa (1st paper) emphasizes an improvement of health education and health knowledge. In addition, Saito and Suzuki analyze the rising problems of the uninsured people who evade the health insurance tax under the national health insurance program.

As the U.S. has been experienced, it is an interesting phenomenon under the national health insurance and healthcare system to increase the uninsured population and the problems with access to healthcare services. The papers in this session will bring a very interesting argument and an intellectual stimulation of healthcare issues.

Kakihara and Furukawa scrutinize the variation of health knowledge and its influence on the patient's consultation behavior of different diseases at different diagnosis and treatment units. They find that health education is applied most efficiently from the economic view point. Thus, early detection and prevention of the diseases would lead to mitigate a rapid rise in healthcare expenditures in the aging society.

Noguch et al. investigate impacts of the current national long-term care insurance system which was revised in 2006. They also explore not only the financial burden by the elderly, i.e. price and income sensitivity of home care and preventive care, but also the caregiver's physical and mental burden. Noguch et al. competently extend their analysis to link the national long-term scheme with the female labor market participation.

Murata et al. more directly exhibits barriers to necessary health care by the elderly. They conducted a large-scale community survey conducted in 7 municipalities in 2006. They underline the financial barrier of healthcare service of the current increase in premium and co-insurance for healthcare services. They conclude that the policy makers need to understand the seeking behavior of healthcare services by the elderly under the new healthcare program.

Interestingly, Saito and Suzuki analyze the uninsured population under the national health insurance program. Unlike the U.S., in Japan the health insurance premium is compulsory. However, the lack of structure of the health insurance scheme and its weak enforcement of premium collection has recently raised the uninsured population. Saito and Suzuki theoretically and empirically entangle the problem from a viewpoint of efficiency and equity.