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Regional Variations in Medical Expenditure and Hospitalization Days for Heart Attack Patients in Japan: Evidence from the Tokai Acute Myocardial Study (TAMIS)

  • Noguchi, Haruko
  • Shimizutani, Satoshi
  • Masuda, Yuichiro

The use of percutaneous transluminal coronary angioplasty (PTCA), a costly high-tech treatment for patients with acute myocardial infarction (AMI), is much more frequent in Japan than in other developed countries, resulting in large medical expenditure. Using chart-based data from the Tokai Acute Myocardial Infarction Study (TAMIS) and exploiting regional variations, we explore what factors explain the intensive use of PTCA in Japan, employing propensity score matching to estimate the average treatment effects on hospital expenditure and hospital days. We find that the probability of receiving high-tech treatment is affected by a patient's characteristics as well as the density of medical resources in a region. Moreover, once heterogeneity between treated and non-treated patients is adjusted for, medical expenditure is higher for treated patients while there are no significant differences in hospitalization days. Our findings imply that the higher medical costs resulting from high-tech treatments are not associated with better outcomes and that the frequent use of high-tech treatments is economically motivated., Abstract (104 words): In Japan, the use of percutaneous transluminal coronary angioplasty (PTCA) for the treatment of acute myocardial infarction (AMI) is extraordinarily frequent, resulting in large medical expenditure. Using chart-based data and exploiting regional variations, we explore what factors explain the frequent use of PTCA, employing propensity score matching to estimate the average treatment effects on hospital expenditure and hospital days. We find that the probability of receiving PTCA is affected by the density of medical resources in a region. Moreover, expenditure is higher for treated patients while there are no significant differences in hospitalization days, implying that the frequent use of PTCA is economically motivated.

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Paper provided by Center for Intergenerational Studies, Institute of Economic Research, Hitotsubashi University in its series PIE/CIS Discussion Paper with number 341.

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Length: [32], [6] p.
Date of creation: Nov 2007
Date of revision:
Handle: RePEc:hit:piecis:341
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  1. Eric Delattre & Brigitte Dormont, 2003. "Fixed fees and physician-induced demand: A panel data study on French physicians," Health Economics, John Wiley & Sons, Ltd., vol. 12(9), pages 741-754.
  2. Feldstein, Martin S, 1970. "The Rising Price of Physicians' Services," The Review of Economics and Statistics, MIT Press, vol. 52(2), pages 121-33, May.
  3. Sascha O. Becker & Andrea Ichino, 2002. "Estimation of average treatment effects based on propensity scores," Stata Journal, StataCorp LP, vol. 2(4), pages 358-377, November.
  4. McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536 Elsevier.
  5. Victor R. Fuchs, 1978. "The Supply of Surgeons and the Demand for Operations," NBER Working Papers 0236, National Bureau of Economic Research, Inc.
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