Impacts of Copayment Reform on Health Behaviors among Older People in Japan: Evidence from a National Household Survey

Increasing the cost share for older people can be a policy solution for sustaining healthcare schemes in aging societies. However, its effects on health behaviours remain elusive. This study investigates the Japanese health insurance reform, which increased the copayment rate from 10% to 20% for people aged 70-74 years in 2014. Using data from the Japanese Ministry of Health, Labor and Welfare between 2013 and 2016, our analysis examined the impacts of increased copayment on positive and negative health behaviours among older people, including having regular meals, doing moderate exercise, having regular sleep, smoking, and drinking alcohol. The study found that while augmented cost sharing is associated with increased positive health behaviours, its impact on negative behaviours is complex, with no significant impact on smoking rates but mild upward alcohol consumption. The subsample analyses further reveal heterogeneous effects of increased copayment, in which individuals with higher education levels or those living in big cities are more likely to respond to the policy change by increasing positive health behaivours. This research contributes to the understanding of the complex interplay between health insurance coverage and health behaviours among older adults, highlighting the importance of considering socio-demographic factors in promoting healthy aging.