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Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study

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  • Misuzu Fujita
  • Yasunori Sato
  • Kengo Nagashima
  • Sho Takahashi
  • Akira Hata

Abstract

The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0–74 years) who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40–59-year-old men and 60–69-year-old women, and in duration of hospitalization among 40–59 and 60–69-year-olds of both sexes and 70–74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts.

Suggested Citation

  • Misuzu Fujita & Yasunori Sato & Kengo Nagashima & Sho Takahashi & Akira Hata, 2016. "Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-19, March.
    • Handle: RePEc:plo:pone00:0151690
    DOI: 10.1371/journal.pone.0151690
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    References listed on IDEAS

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    2. Wei Pan, 2001. "Akaike's Information Criterion in Generalized Estimating Equations," Biometrics, The International Biometric Society, vol. 57(1), pages 120-125, March.
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    2. Chia-Hsien Chang & Motonobu Sakaguchi & John Weil & Thomas Verstraeten, 2018. "The incidence of medically-attended norovirus gastro-enteritis in Japan: Modelling using a medical care insurance claims database," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-14, March.
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    4. Akemi Nishide & Misuzu Fujita & Yasunori Sato & Kengo Nagashima & Sho Takahashi & Akira Hata, 2017. "Income-Related Inequalities in Access to Dental Care Services in Japan," IJERPH, MDPI, vol. 14(5), pages 1-10, May.
    5. Yuan, Yaqi, 2021. "Public satisfaction with health care system in 30 countries: The effects of individual characteristics and social contexts," Health Policy, Elsevier, vol. 125(10), pages 1359-1366.
    6. Erika Obikane & Daisuke Nishi & Akihiko Ozaki & Tomohiro Shinozaki & Norito Kawakami & Takahiro Tabuchi, 2023. "Association between Poverty and Refraining from Seeking Medical Care during the COVID-19 Pandemic in Japan: A Prospective Cohort Study," IJERPH, MDPI, vol. 20(3), pages 1-14, February.
    7. Tasuku Okui & Akie Hirata & Naoki Nakashima, 2022. "Association of Esophageal Cancer Mortality with Municipal Socioeconomic Deprivation Level in Japan, 2013–2017: An Ecological Study Using Nationwide Data," IJERPH, MDPI, vol. 19(9), pages 1-9, April.
    8. Tomoko Kobayashi & Kaori Honjo & Ehab Salah Eshak & Hiroyasu Iso & Norie Sawada & Shoichiro Tsugane & for the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT) Stu, 2017. "Work–family conflict and self-rated health among Japanese workers: How household income modifies associations," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-12, February.
    9. Sayaka Sakoda & Masaoki Tamura & Naohiko Wakutsu, 2022. "The Global Financial Crisis and Healthcare Inequality in Japan," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 161(1), pages 273-286, May.
    10. Kanade Ito & Noriko Cable & Tatsuo Yamamoto & Kayo Suzuki & Katsunori Kondo & Ken Osaka & Georgios Tsakos & Richard G. Watt & Jun Aida, 2020. "Wider Dental Care Coverage Associated with Lower Oral Health Inequalities: A Comparison Study between Japan and England," IJERPH, MDPI, vol. 17(15), pages 1-10, July.

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