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Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare

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  • Shohei Okamoto

    (Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology
    Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine
    Keio University)

  • Mizuki Sata

    (Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine
    Keio University School of Medicine
    Örebro University)

  • Megumi Rosenberg

    (World Health Organization Centre for Health Development)

  • Natsuko Nakagoshi

    (Keio University School of Medicine)

  • Kazuki Kamimura

    (Keio University
    Konan University)

  • Kohei Komamura

    (Keio University
    Keio University)

  • Erika Kobayashi

    (Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology)

  • Junko Sano

    (Keio University
    Tokyo Kasei Gakuin University)

  • Yuzuki Hirazawa

    (Keio University)

  • Tomonori Okamura

    (Keio University School of Medicine)

  • Hiroyasu Iso

    (Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine)

Abstract

Background Universal health coverage means that all people can access essential health services without incurring financial hardship. Even in countries with good service coverage and financial protection, the progress towards universal health coverage may decelerate or be limited with respect to the growing older population. This study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤). Methods Utilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members’ age (i.e. ≤64 years vs. 65 years≤) between 2004 and 2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age. Results Households with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need. Conclusions Households with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts. Different types and levels of health and financial support need to be incorporated into national health systems and social protection policies to meet the unique needs of individuals and households.

Suggested Citation

  • Shohei Okamoto & Mizuki Sata & Megumi Rosenberg & Natsuko Nakagoshi & Kazuki Kamimura & Kohei Komamura & Erika Kobayashi & Junko Sano & Yuzuki Hirazawa & Tomonori Okamura & Hiroyasu Iso, 2024. "Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare," Health Economics Review, Springer, vol. 14(1), pages 1-16, December.
    • Handle: RePEc:spr:hecrev:v:14:y:2024:i:1:d:10.1186_s13561-023-00475-2
    DOI: 10.1186/s13561-023-00475-2
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    References listed on IDEAS

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