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Anticipation and Adaptation: Cost-Sharing Responses and Mortality Among the Oldest-Old

Author

Listed:
  • Rong Fu

    (Faculty of Commerce, Waseda University, and Waseda Institute of Social & Human Capital Studies (WISH))

  • Masato Oikawa

    (Faculty of Education and Integrated Arts and Sciences, Waseda University, and WISH)

  • Akira Kawamura

    (Faculty of Human Sciences, Waseda University, and WISH)

  • Haruko Noguchi

    (Faculty of Political Science and Economics, Waseda University, and WISH)

Abstract

We study a Japanese reform that doubled coinsurance rates for higher-income enrollees aged 75+, using administrative data linking insurance claims to tax records for nearly the entire oldest-old population over 26 months. Patients exhibit a last-minute anticipatory surge, then persistently reduce utilization by cutting visit frequency rather than treatment intensity. Responses follow a gradient of service discretionarity, and a binding expenditure cap shields the most medically intensive patients from the reform’s financial impact. Despite utilization reductions, we find no detectable adverse effect on 15-month mortality. Cost-sharing increases, paired with effective safety nets, can restrain utilization without detectable mortality consequences.

Suggested Citation

  • Rong Fu & Masato Oikawa & Akira Kawamura & Haruko Noguchi, 2026. "Anticipation and Adaptation: Cost-Sharing Responses and Mortality Among the Oldest-Old," Working Papers 2610, Waseda University, Faculty of Political Science and Economics.
    • Handle: RePEc:wap:wpaper:2610
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    More about this item

    Keywords

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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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