A Survey on Policy Experiences in the Japanese Public Healthcare Systems: Effects of Patient Cost Sharing on Healthcare Utilization and Health

Since 1961, the Japanese public healthcare system based on the universal health insurance system has contributed to raising the level of health and life expectancy of the Japanese people through improving the equity in access to healthcare and the quantity and quality of healthcare services. On the other hand, the national medical care expenditure, a consideration for this contribution, has been increasing steadily. The level of patient cost sharing in the health insurance system contributes to the efficiency and sustainability of the system, but it also has an impact on the healthy and cultured life for the Japanese people as well as the state of public health policies. This paper summarizes the economic studies using Japanese data that examine the effects of patient cost sharing on healthcare utilization and health. In addition, I use individual panel data with rich individual attributes and conduct empirical exercises to confirm the robustness of the effect of the sharp reduction of the coinsurance rate from 30 percent to 10 percent at age 70 in Japan. Including my empirical results, the price elasticity with respect to healthcare is generally low and changes in patient cost sharing generally do not have a large impact on health.