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Effect of upfront payment on utilization and health: Evidence from a nationwide physician strike in Japan


  • Shun-ichiro Bessho

    (Faculty of Economics, Keio University)

  • Reo Takaku

    (Institute for Health Economics and Policy)


Japan Medical Association (JMA), a lobby of physicians, went on strike in July 1971 against the medical reform led by the government. While physicians of JMA resigned from the health insurance doctor, they continued to provide medical care, and even virtually continued to provide the health insurance treatment in some areas. This paper uses the regional difference of resignation as a natural experiment to examine the effect of payment method of health insurance on medial service utilization and health status. Our results suggest that the resignation substantially decreased the medical service utilization, but not affected significantly health status measured by gross mortality rate and infant mortality rate.

Suggested Citation

  • Shun-ichiro Bessho & Reo Takaku, 2014. "Effect of upfront payment on utilization and health: Evidence from a nationwide physician strike in Japan," Keio-IES Discussion Paper Series 2014-006, Institute for Economics Studies, Keio University.
  • Handle: RePEc:keo:dpaper:2014-006

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    health insurance; medical service utilization; payment method; physicians strike;

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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