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Influence of Copayment on Health Service Utilization: Analyses Considering Age, Income, and Diseases

Research Project

Project/Area Number 18H03021
Research Category

Grant-in-Aid for Scientific Research (B)

Allocation TypeSingle-year Grants
Section一般
Review Section Basic Section 58010:Medical management and medical sociology-related
Research InstitutionThe University of Tokyo

Principal Investigator

KOBAYASHI YASUKI  東京大学, 大学院医学系研究科(医学部), 教授 (70178341)

Project Period (FY) 2018-04-01 – 2021-03-31
Project Status Completed (Fiscal Year 2020)
Budget Amount *help
¥17,420,000 (Direct Cost: ¥13,400,000、Indirect Cost: ¥4,020,000)
Fiscal Year 2020: ¥3,900,000 (Direct Cost: ¥3,000,000、Indirect Cost: ¥900,000)
Fiscal Year 2019: ¥5,980,000 (Direct Cost: ¥4,600,000、Indirect Cost: ¥1,380,000)
Fiscal Year 2018: ¥7,540,000 (Direct Cost: ¥5,800,000、Indirect Cost: ¥1,740,000)
Keywords医療保険 / 介護保険 / 自己負担 / 受療行動 / レセプト / 自然の実験
Outline of Final Research Achievements

Using claims data and econometric methods, the following results were obtained. (1) Income-based co-payment rates appeared to reduce disparity in access to brand-name drugs across income groups, in addition to reducing total medical expenditures among high-income group. (2) Both inertia and heterogeneity in brand preferences have substantial effects on the choice of brand-name pitavastatin or generic ones. Counterfactual simulations suggest that a nudging policy that removes inertia from previous brand-name users may have substantial effects and enable patients to choose optimally. (3) Regarding the impacts of medical subsidy for children, no significant effect of the stop-loss policy on health services expenditures was observed, while the free prescription policy significantly increased prescription drug expenditures among children with relatively good health status. The stop-loss policy for children is potentially efficient in terms of the policy of medical subsidy for children.

Academic Significance and Societal Importance of the Research Achievements

医療費の自己負担の要点は、必要な受療を抑制せずに、不要な受療を減らすことのできる適切な負担額の設定である。自己負担の効果は、患者の年齢、疾患の種類や重症度、所得などにも影響される。しかし、わが国では、種々の交絡要因の調整が可能な個票データを用いて、自己負担の影響をみた研究はきわめて少ない。本研究は、レセプトデータと計量経済学的手法を用いて、後期高齢者制度における自己負担率やInertiaと後発医薬品選択割合の関連、子ども医療費助成や介護保険の自己負担の影響を量的に明らかにした研究であり、独創性が高い。今後のわが国の医療経済・医療政策研究の発展ならびに実際の政策形成に資するものと考えられる。

Report

(4 results)
  • 2020 Annual Research Report   Final Research Report ( PDF )
  • 2019 Annual Research Report
  • 2018 Annual Research Report
  • Research Products

    (10 results)

All 2020 2019 Other

All Journal Article (6 results) (of which Int'l Joint Research: 2 results,  Peer Reviewed: 6 results,  Open Access: 6 results) Presentation (2 results) Remarks (2 results)

  • [Journal Article] Tuberculosis screening and management of latent tuberculosis infection prior to biologic treatment in patients with immune‐mediated inflammatory diseases: A longitudinal population‐based analysis using claims data2020

    • Author(s)
      Iba Arisa、Tomio Jun、Yamana Hayato、Sugiyama Takehiro、Yoshiyama Takashi、Kobayashi Yasuki
    • Journal Title

      Health Science Reports

      Volume: 3 Issue: 4

    • DOI

      10.1002/hsr2.216

    • Related Report
      2020 Annual Research Report
    • Peer Reviewed / Open Access
  • [Journal Article] The effect of inertia on brand-name versus generic drug choices2020

    • Author(s)
      Ito Yuki、Hara Konan、Kobayashi Yasuki
    • Journal Title

      Journal of Economic Behavior & Organization

      Volume: 172 Pages: 364-379

    • DOI

      10.1016/j.jebo.2019.12.022

    • Related Report
      2019 Annual Research Report
    • Peer Reviewed / Open Access
  • [Journal Article] Risk-Stratified Incidence of Renal Replacement Therapy Initiation: A Longitudinal Analysis Using Medical Claims and Health Checkup Data2019

    • Author(s)
      Sugiyama Takehiro、Oba Koji、Kobayashi Yasuki
    • Journal Title

      The Tohoku Journal of Experimental Medicine

      Volume: 248 Issue: 2 Pages: 125-135

    • DOI

      10.1620/tjem.248.125

    • NAID

      130007668328

    • ISSN
      0040-8727, 1349-3329
    • Related Report
      2019 Annual Research Report
    • Peer Reviewed / Open Access / Int'l Joint Research
  • [Journal Article] Receiving the home care service offered by certified care workers prior to a patients’ death and the probability of a home death: observational research using an instrumental variable method from Japan2019

    • Author(s)
      Abe Kazuhiro、Miyawaki Atsushi、Kobayashi Yasuki、Noguchi Haruko、Takahashi Hideto、Tamiya Nanako
    • Journal Title

      BMJ Open

      Volume: 9 Issue: 8 Pages: e026238-e026238

    • DOI

      10.1136/bmjopen-2018-026238

    • NAID

      120007127677

    • Related Report
      2019 Annual Research Report
    • Peer Reviewed / Open Access
  • [Journal Article] Effect of a medical subsidy on health service utilization among schoolchildren: A community-based natural experiment in Japan2019

    • Author(s)
      Miyawaki Atsushi、Kobayashi Yasuki
    • Journal Title

      Health Policy

      Volume: 123 Issue: 4 Pages: 353-359

    • DOI

      10.1016/j.healthpol.2019.02.003

    • Related Report
      2018 Annual Research Report
    • Peer Reviewed / Open Access
  • [Journal Article] Can income-based co-payment rates improve disparity? The case of the choice between brand-name and generic drugs2019

    • Author(s)
      Ito Yuki、Hara Konan、Yoo Byung-Kwang、Tomio Jun、Kobayashi Yasuki
    • Journal Title

      BMC Health Services Research

      Volume: 19 Issue: 1 Pages: 1-10

    • DOI

      10.1186/s12913-019-4598-8

    • Related Report
      2018 Annual Research Report
    • Peer Reviewed / Open Access / Int'l Joint Research
  • [Presentation] レセプトデータを用いた機械学習による要介護リスク予測方法の開発2020

    • Author(s)
      福西広晃、小林廉毅
    • Organizer
      第79回日本公衆衛生学会総会
    • Related Report
      2020 Annual Research Report
  • [Presentation] 後発医薬品の使用割合に関連する要因:NDBを用いた分析2019

    • Author(s)
      小林廉毅、原湖楠、宮脇敦士、伊藤佑樹
    • Organizer
      日本公衆衛生学会
    • Related Report
      2019 Annual Research Report
  • [Remarks] 慣性(Inertia)が患者の薬剤選択に影響を与える ~ 「ナッジ」が後発医薬品促進に有効 ~

    • URL

      http://www.m.u-tokyo.ac.jp/news/admin/release_20200121.pdf

    • Related Report
      2019 Annual Research Report
  • [Remarks] 小児医療費助成の政策評価 ~ 子どもの健康と医療費効率化の両立は可能か? ~

    • URL

      https://www.m.u-tokyo.ac.jp/news/admin/release_20190402.pdf

    • Related Report
      2018 Annual Research Report

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Published: 2018-04-23   Modified: 2022-01-27  

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