Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany.
Health Economics and Outcomes Research, Janssen-Cilag, Neuss, Germany.
Int J Equity Health. 2019 Jan 28;18(1):22. doi: 10.1186/s12939-019-0920-7.
Co-insurance rates in Japan decrease when patients turn 70 years of age. We aim to compare changes in medical demand for Japanese patients with rheumatoid arthritis (RA) at age 70 prior to 2014, when there was a reduction in co-insurance rates from 30 to 10%, with changes in medical demand at age 70 after 2014 when co-insurance rates decreased from 30% to only 20%.
We used administrative data from large Japanese hospitals. We employed a discontinuity regression (RD) approach to control for unobserved endogeneity in the data.
We identified a total of 7343 patients with RA, 4905 (67%) turned age 70 before April, and found that a 20% decrease in co-insurance was associated with increased utilization of more expensive biologic RA drugs, more outpatient visits and higher total medical costs. However, a 10% decrease in co-insurance for patients who turned 70 after 2014 did not significantly change demand for medical services.
For the younger cohort, we did not observe any changes in medical demand after a price decrease. We therefore conclude that the economic goal of cost sharing, namely a behavioural change towards lower health-care utilization, is not achieved in this particular cohort of chronic patients.
在日本，当患者年满 70 岁时，共同保险费率会降低。我们旨在比较 2014 年之前，当共同保险费率从 30%降至 10%时，70 岁日本类风湿关节炎（RA）患者的医疗需求变化，与 2014 年之后共同保险费率从 30%降至 20%时的医疗需求变化。
我们使用了来自大型日本医院的行政数据。我们采用了不连续回归（RD）方法来控制数据中未观察到的内生性。
我们共确定了 7343 名 RA 患者，其中 4905 名（67%）在 2014 年 4 月之前年满 70 岁，我们发现共同保险降低 20%与更昂贵的生物类 RA 药物的使用增加、更多的门诊就诊次数和更高的总医疗费用有关。然而，对于在 2014 年后年满 70 岁的患者，共同保险降低 10%并没有显著改变医疗服务的需求。
对于较年轻的患者群体，我们没有观察到价格下降后医疗需求有任何变化。因此，我们的结论是，在这一特定的慢性病患者群体中，共同保险的经济目标，即通过分担费用来改变就医行为，并没有实现。
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