IDEAS home Printed from https://ideas.repec.org/p/tky/fseres/2014cf948.html
   My bibliography  Save this paper

Factor Decomposition of Inter-prefectural Health Care Expenditure Disparities in Japan

Author

Listed:
  • Masayoshi Hayashi

    (Faculty of Economics, The University of Tokyo)

  • Akiko Oyama

    (International Operations Division, Dai-ichi Life Insurance Company)

Abstract

Despite frequent discussions on regional variations in health care expenditure (HCE), few studies account for the sources of such regional disparities. This study bridges this gap in the literature by taking the following two steps. First, we explore the determinants of regional HCE in Japan, covering a data period that expands the scope of previous studies (i.e., the 2000s). Second, we decompose the variations in regional HCE into contributions explained by the HCE determinants examined in the first step, utilizing a regression-based decomposition method. In the regression analysis, we find that the effect of the number of hospital beds on per capita HCE is larger than that of the other determinants, except the proportion of the elderly population. In particular, a 1% increase in the number of hospital beds induces a .22−.43% increase in HCE, in line with Roemer’s Law. The decomposition analysis also finds the salient effect of the number of hospital beds. In particular, this variable accounts for a large proportion of inequality (between 37.6% and 83.9%). This finding also corroborates Roemer’s Law. Our results strongly suggest that the national policy in Japan of reducing hospital beds regionally has been an effective instrument for containing rapidly increasing HCE.

Suggested Citation

  • Masayoshi Hayashi & Akiko Oyama, 2014. "Factor Decomposition of Inter-prefectural Health Care Expenditure Disparities in Japan," CIRJE F-Series CIRJE-F-948, CIRJE, Faculty of Economics, University of Tokyo.
  • Handle: RePEc:tky:fseres:2014cf948
    as

    Download full text from publisher

    File URL: http://www.cirje.e.u-tokyo.ac.jp/research/dp/2014/2014cf948.pdf
    Download Restriction: no

    Other versions of this item:

    References listed on IDEAS

    as
    1. David Cantarero, 2005. "Decentralization and health care expenditure: the Spanish case," Applied Economics Letters, Taylor & Francis Journals, vol. 12(15), pages 963-966.
    2. Fang, Pengqian & Dong, Siping & Xiao, Jingjing & Liu, Chaojie & Feng, Xianwei & Wang, Yiping, 2010. "Regional inequality in health and its determinants: Evidence from China," Health Policy, Elsevier, vol. 94(1), pages 14-25, January.
    3. Parkin, David & McGuire, Alistair & Yule, Brian, 1987. "Aggregate health care expenditures and national income : Is health care a luxury good?," Journal of Health Economics, Elsevier, vol. 6(2), pages 109-127, June.
    4. Ulf‐G. Gerdtham, 1992. "Pooling international health care expenditure data," Health Economics, John Wiley & Sons, Ltd., vol. 1(4), pages 217-231, December.
    5. Jonathan Morduch & Terry Sicular, 2002. "Rethinking Inequality Decomposition, With Evidence from Rural China," Economic Journal, Royal Economic Society, vol. 112(476), pages 93-106, January.
    6. Joseph P. Newhouse, 1977. "Medical-Care Expenditure: A Cross-National Survey," Journal of Human Resources, University of Wisconsin Press, vol. 12(1), pages 115-125.
    7. Huang, Bihong & Chen, Kang, 2012. "Are intergovernmental transfers in China equalizing?," China Economic Review, Elsevier, vol. 23(3), pages 534-551.
    8. Hitiris, Theo & Posnett, John, 1992. "The determinants and effects of health expenditure in developed countries," Journal of Health Economics, Elsevier, vol. 11(2), pages 173-181, August.
    9. James Thornton & Jennifer Rice, 2008. "Determinants of healthcare spending: a state level analysis," Applied Economics, Taylor & Francis Journals, vol. 40(22), pages 2873-2889.
    10. Skinner, Jonathan & Fisher, Elliott, 1997. "Regional Disparities in Medicare Expenditures: An Opportunity for Reform," National Tax Journal, National Tax Association;National Tax Journal, vol. 50(3), pages 413-425, September.
    11. Yin Heng, 2008. "Fiscal Disparities and the Equalization Effects of Fiscal Transfers at the County Level in China," Annals of Economics and Finance, Society for AEF, vol. 9(1), pages 115-149, May.
    12. Fan, Victoria Y. & Savedoff, William D., 2014. "The health financing transition: A conceptual framework and empirical evidence," Social Science & Medicine, Elsevier, vol. 105(C), pages 112-121.
    13. Zijun Wang, 2009. "The determinants of health expenditures: evidence from US state-level data," Applied Economics, Taylor & Francis Journals, vol. 41(4), pages 429-435.
    14. Munic Boungnarasy, 2011. "Health care expenditures in Asia countries: Panel data analysis," Economics Bulletin, AccessEcon, vol. 31(4), pages 3169-3178.
    15. Tokita, Tadahiko & Chino, Tetsuro & Kitaki, Hideaki, 2000. "Healthcare Expenditure and the Major Determinants in Japan," Hitotsubashi Journal of Economics, Hitotsubashi University, vol. 41(1), pages 1-16, June.
    16. Wan, Guanghua, 2004. "Accounting for income inequality in rural China: a regression-based approach," Journal of Comparative Economics, Elsevier, vol. 32(2), pages 348-363, June.
    17. Carlos Murillo & Cyrille Piatecki & Marc Saez, 1993. "Health care expenditure and income in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 2(2), pages 127-138, July.
    18. Hansen, Paul & King, Alan, 1996. "The determinants of health care expenditure: A cointegration approach," Journal of Health Economics, Elsevier, vol. 15(1), pages 127-137, February.
    19. Shorrocks, A F, 1982. "Inequality Decomposition by Factor Components," Econometrica, Econometric Society, vol. 50(1), pages 193-211, January.
    20. Skinner, Jonathan & Fisher, Elliott, 1997. "Regional Disparities in Medicare Expenditures: An Opportunity for Reform," National Tax Journal, National Tax Association, vol. 50(3), pages 413-25, September.
    21. Gerdtham, Ulf-G. & Jonsson, Bengt, 2000. "International comparisons of health expenditure: Theory, data and econometric analysis," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.),Handbook of Health Economics, edition 1, volume 1, chapter 1, pages 11-53, Elsevier.
    22. Gbesemete, Kwame P. & Gerdtham, Ulf-G., 1992. "Determinants of health care expenditure in Africa: A cross-sectional study," World Development, Elsevier, vol. 20(2), pages 303-308, February.
    23. Carla Blazquez-Fernandez & David Cantarero & Patricio Perez, 2014. "Disentangling the heterogeneous income elasticity and dynamics of health expenditure," Applied Economics, Taylor & Francis Journals, vol. 46(16), pages 1839-1854, June.
    24. Hingstman, L. & Boon, H., 1989. "Regional dispersion of independent professionals in primary health care in the Netherlands," Social Science & Medicine, Elsevier, vol. 28(2), pages 121-129, January.
    25. Victoria Fan and William Savedoff, 2014. "The Health Financing Transition: A Conceptual Framework and Empirical Evidence - Working Paper 358," Working Papers 358, Center for Global Development.
    26. Gerdtham, Ulf-G. & Sogaard, Jes & Andersson, Fredrik & Jonsson, Bengt, 1992. "An econometric analysis of health care expenditure: A cross-section study of the OECD countries," Journal of Health Economics, Elsevier, vol. 11(1), pages 63-84, May.
    27. Donald Freeman, 2003. "Is health care a necessity or a luxury? Pooled estimates of income elasticity from US state-level data," Applied Economics, Taylor & Francis Journals, vol. 35(5), pages 495-502.
    28. Louise Sheiner & David M. Cutler, 1999. "The Geography of Medicare," American Economic Review, American Economic Association, vol. 89(2), pages 228-233, May.
    29. Shinjo, Daisuke & Aramaki, Toshiharu, 2012. "Geographic distribution of healthcare resources, healthcare service provision, and patient flow in Japan: A cross sectional study," Social Science & Medicine, Elsevier, vol. 75(11), pages 1954-1963.
    30. Tsui, Kai-yuen, 2005. "Local tax system, intergovernmental transfers and China's local fiscal disparities," Journal of Comparative Economics, Elsevier, vol. 33(1), pages 173-196, March.
    31. Joan Costa-Font & Ana Rico, 2006. "Devolution and the Interregional Inequalities in Health and Healthcare in Spain," Regional Studies, Taylor & Francis Journals, vol. 40(8), pages 875-887.
    Full references (including those not matched with items on IDEAS)

    More about this item

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H73 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Interjurisdictional Differentials and Their Effects

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:tky:fseres:2014cf948. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (CIRJE administrative office). General contact details of provider: http://edirc.repec.org/data/ritokjp.html .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.