Graduate School of Economics and Management, Tohoku University, Sendai, Japan.
Front Public Health. 2022 Jun 23;10:895679. doi: 10.3389/fpubh.2022.895679. eCollection 2022.
The public assistance system in Japan provides detailed and comprehensive livelihood support for low-income families with various needs. As one example, and the beneficiaries of the public welfare program in Japan can receive the same medical treatments as those insured of the universal public health insurance without any financial burdens. This system has greatly contributed to maintaining and improving the health of public assistance beneficiaries but may cause excessive healthcare utilization: moral hazard. This study uses a large sample taken from two nationally representative claim data for public assistance and public health insurance patients to estimate the magnitude of moral hazard effect in basic outpatient utilization. The results of the fixed-effect regression analysis utilizing the concept of pseudo panel data analysis and those of propensity score matching show that the average treatment effect of public assistance assignment on healthcare utilization is significantly positive. Specifically, public assistance assignment increases monthly healthcare expenditure by 17.5 to 22.9 percent and the monthly number of doctor visits by 23.1 to 27.8 percent, respectively. In addition, the average treatment effects on the treated are also significantly positive, suggesting that monthly healthcare expenditure significantly decreases by 22.7 to 25.0 percent and the number of visits by 27.6 to 29.7 percent, respectively, when imposing a copayment on public assistance beneficiaries. However, the estimated price elasticity based on these results is very small, approximately -0.02, indicating that the level of copayment rate has little effect on the intensive margin of outpatient healthcare utilization.
日本的公共援助制度为有各种需求的低收入家庭提供了详细和全面的生计支持。例如，公共福利计划的受益人可以像参加全民健康保险的人一样接受同样的医疗待遇，而无需承担任何经济负担。这一制度极大地促进了公共援助受益人的健康维护和改善，但可能导致过度的医疗保健利用：道德风险。本研究利用两个全国代表性的公共援助和公共健康保险患者索赔数据的大样本，来估计基本门诊利用中道德风险效应的大小。利用伪面板数据分析概念的固定效应回归分析结果和倾向评分匹配结果表明，公共援助分配对医疗保健利用的平均处理效应是显著正的。具体来说，公共援助分配使每月医疗支出增加 17.5%至 22.9%，每月就诊次数增加 23.1%至 27.8%。此外，对处理组的平均处理效应也是显著正的，表明当对公共援助受益人征收共付额时，每月医疗支出显著减少 22.7%至 25.0%，就诊次数减少 27.6%至 29.7%。然而，根据这些结果估计的价格弹性非常小，约为-0.02，表明共付率水平对门诊医疗保健利用的密集边际几乎没有影响。
