The effect of education on health policy reform: Evidence from Japan

This paper analyzes the effect of education on the outcomes of a reform of the health checkups that occur annually at the workplace in Japan. In April 2008, the annual checkup was redesigned to address new scientific concerns about metabolic syndrome. However, as the checkup is mandatory only for salaried workers, their participation rate is significantly higher than other workers such as the self-employed, and so salaried workers were most affected by the reform. Using this institutional information, a difference-in-difference (DID) estimation was conducted with salaried workers being the treatment group and self-employed workers the control group. We found that the reform caused significant changes in health behaviors and outcomes only among university graduates with a relatively high risk of metabolic syndrome. This more highly educated group increased physical activity, reduced energy intake, and achieved a significant weight loss, reducing BMI to a level that minimizes all-cause mortality among middle-aged Japanese. These results imply that a difference in cognitive functioning or educational success may be a key factor in explaining the heterogeneous response to health policy reforms, suggesting that more clearly articulated recommendations for healthy behaviors are needed in order to improve reform uptake.