Miyawaki Atsushi, Mafi John N, Fukui Tsuguya, Kimura Yuya, Kobayashi Daiki, Odawara Sara, Abe Kazuhiro, Goto Rei, Tsugawa Yusuke
Public Health Research Group, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
medRxiv. 2025 Aug 26:2025.08.21.25334207. doi: 10.1101/2025.08.21.25334207.
As healthcare costs continue to rise, high-income countries-including Japan-face the urgent task of reducing healthcare spending incurred by low-value care. However, evidence is limited as to which low-value care services contribute most to unnecessary healthcare spending outside of the United States.
To identify which low-value care services contribute the most to unnecessary healthcare spending in Japan.
The cross-sectional study of all beneficiaries using a population-based claims database from April 1, 2022, to March 31, 2023, encompassing all age groups, reflecting approximately 2% of the total Japanese population.
We identified 52 low-value care services based on clinical evidence, and examined their contributions to healthcare spending using two versions of claims-based measures with different sensitivities and specificities (broader and narrower definitions). Each service was categorized into four groups based on its average per-service price: very low (<1,000 Japanese yen [JPY] = 8 US dollars [USD] in 2022), low (1,000-9,999 JPY), medium (10,000-99,999 JPY), or high (≥100,000 JPY).
Among 1,923,484 beneficiaries (mean [SD] age 58.6 [23.5] years; 52.7% female), we identified 3.1 million (narrower definition) to 3.7 million (broader definition) episodes of low-value care services (1.6-1.9 per capita), with 36-40% of patients receiving at least one low-value care service. These services accounted for 0.7-1.0% of total healthcare spending, amounting to 207-331 billion JPY (1.7-2.6 billion USD) when extrapolated nationwide with adjustments for age, sex, and region. When applying narrower definitions, over 99% of low-value care episodes involved very-low-cost or low-cost services, which accounted for 67% of unnecessary healthcare spending-far exceeding the 33% attributed to medium-cost or high-cost services.
Over one in three Japanese individuals received low-value care during 2022-2023, contributing to 0.7-1.0% of total healthcare spending. Among these services, low-cost services contributed to virtually all low-value care utilization and over two-thirds of unnecessary healthcare spending. Compared to focusing solely on high-cost services, targeting the reduction of frequently performed, lower-cost services may be a more effective strategy for reducing wasteful spending.
随着医疗成本持续上升，包括日本在内的高收入国家面临着减少低价值医疗所产生的医疗支出这一紧迫任务。然而，在美国以外，关于哪些低价值医疗服务对不必要的医疗支出贡献最大的证据有限。
确定在日本，哪些低价值医疗服务对不必要的医疗支出贡献最大。
设计、设置和参与者：一项横断面研究，研究对象为2022年4月1日至2023年3月31日期间使用基于人群的理赔数据库的所有受益人，涵盖所有年龄组，约占日本总人口的2%。
我们基于临床证据确定了52项低价值医疗服务，并使用两种具有不同敏感性和特异性的基于理赔的衡量指标版本（更宽泛和更狭义的定义）来研究它们对医疗支出的贡献。每项服务根据其每项服务的平均价格分为四组：极低（<1000日元[2022年相当于8美元]）、低（1000 - 9999日元）、中（10000 - 99999日元）或高（≥100000日元）。
在1923484名受益人中（平均[标准差]年龄58.6[23.5]岁；52.7%为女性），我们确定了310万（狭义定义）至370万（广义定义）例低价值医疗服务事件（人均1.6 - 1.9例），36% - 40%的患者接受了至少一项低价值医疗服务。这些服务占医疗总支出的0.7% - 1.0%，在对年龄、性别和地区进行调整后推算至全国范围时，金额达2070亿 - 3310亿日元（17亿 - 26亿美元）。采用狭义定义时，超过99%的低价值医疗事件涉及极低成本或低成本服务，这些服务占不必要医疗支出的67%，远远超过中成本或高成本服务所占的33%。
在2022 - 2023年期间，超过三分之一的日本人接受了低价值医疗，占医疗总支出的0.7% - 1.0%。在这些服务中，低成本服务几乎构成了所有低价值医疗的使用情况以及超过三分之二的不必要医疗支出。与仅关注高成本服务相比，针对减少频繁进行的低成本服务可能是减少浪费性支出的更有效策略。
