Understanding the Impact of Health Policy : 10% Co-payments for Medical Services Reduce Compliance with Necessary Care Among Elderly Patients with Chronic Disease in Japan

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  • Babazono Akira
    Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University ・ Institute of Health Science, Kyushu University
  • Miyazaki Motonobu
    Department of Hygiene and Preventive Medicine, School of Medicine, Fukuoka University
  • Une Hiroshi
    Department of Hygiene and Preventive Medicine, School of Medicine, Fukuoka University
  • Yamamoto Eiji
    Department of Information Science, Okayama University of Science
  • Tsuda Toshihide
    Social, Environmental, and Life Sciences, Okayama University Graduate School
  • Mino Yoshio
    College of Social Welfare, Osaka Prefecture University
  • Hillman Alan L.
    Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pennsylvania ・ Center for Health Policy, Leonard Davis Institute of Health Economics, University of Penssylvania ・ Department of Health Care Management, The Wharton School, University of Pennsylvania

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Other Title
  • Understanding the Impact of Health Policy 10パーセント Co payments for Medical Services Reduce Compliance with Necessary Care Among Elderly Patients with Chronic Disease in Japan

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Abstract

Co-payments help determine how expensive an individual health service is both to payers and to enrollees. The Japanese government had provided its elderly with first dollar coverage, including pharmaceuticals, until January 2001 when it introduced 10% co-payments in an effort to contain costs. We evaluated whether the Japanese increase in co-payments reduced compliance with necessary care, including prescription pharmaceuticals, in elderly patients with chronic illness. Subjects were members of the Health Care System for the Aged (persons age 70 or older) who belonged to a health insurance society located in Fukuoka Prefecture continuously from January 2000 to December 2001. We defined 234 highly compliant patients with hypertension and 35 with diabetes mellitus who visited physicians at least once per month during every month of the 6-month period from January to June 2000. We used time series analyses to compare medical service use during 6 months before and 12 months after the 10% co-payments were introduced. During this study, medical visits were necessary to obtain prescriptions for pharmaceuticals in Japan. Compliance decreased significantly for both hypertension and diabetes mellitus patients after the introduction of 10% co-payments, controlling for the possible impact of secular trends. The impact on necessary pharmaceutical use was likewise affected. However, the impact on costs was not as marked. Co-payments have a major impact on patient compliance and recommended medical service use (but perhaps not on costs), especially in the elderly with chronic diseases.

Journal

  • 健康科学

    健康科学 28 15-23, 2006-03-25

    Institute of Health Science, Kyushu University

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