start-ver=1.4 cd-journal=joma no-vol=19 cd-vols= no-issue=3 article-no= start-page=465 end-page=475 dt-received= dt-revised= dt-accepted= dt-pub-year=2003 dt-pub=20038 dt-online= en-article= kn-article= en-subject= kn-subject= en-title= kn-title=Effects of an increase in patient copayments on medical service demands of the insured in japan en-subtitle= kn-subtitle= en-abstract= kn-abstract=

Objectives:To examine quantitatively the effects of an increase in patient copayments from 10% to 20% on the demand for medical services in Japan.
Methods: The subjects of the study were the employees insured by the 1,797 health insurance societies, belonging to the National Federation of Health Insurance Societies, in 1996 and 1998. Indicators of medical service demands analyzed include the inpatient, outpatient, and dental case rates, the number of serviced days per case, the medical cost per day and the medical cost per insured.
Results: When the effects of an increase in patient copayments from 10% to 20% were evaluated, taking into account the average age, the average monthly salary, the total number, the gender (male-tofemale) ratio and the dependent ratio of the insured, the estimated change in the case rate was −6.96% for inpatient, −4.79% for outpatient, and −5.77% for dental care. The estimated change in the number of serviced day per case was −4.66% for inpatient, −5.67% for outpatient, and −1.82% for dental care. The estimated change in the medical cost per day was −3.15% for inpatient, −13.00% for outpatient, and −11.48% for dental care. The estimated change in the medical cost per insured was −14.08% for inpatient, −21.54% for outpatient, and −18.11% for dental care.
Conclusions: The increase in patient copayments from 10% to 20% enabled insurers to substantially reduce medical costs by cost shifting from the insurer to the insured, with resultant changes in the case rate and the number of service days per case.

en-copyright= kn-copyright= en-aut-name=BabazonoAkira en-aut-sei=Babazono en-aut-mei=Akira kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=1 ORCID= en-aut-name=TsudaToshihide en-aut-sei=Tsuda en-aut-mei=Toshihide kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=2 ORCID= en-aut-name=YamamotoEiji en-aut-sei=Yamamoto en-aut-mei=Eiji kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=3 ORCID= en-aut-name=MinoYoshio en-aut-sei=Mino en-aut-mei=Yoshio kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=4 ORCID= en-aut-name=UneHiroshi en-aut-sei=Une en-aut-mei=Hiroshi kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=5 ORCID= en-aut-name=HillmanAlan L. en-aut-sei=Hillman en-aut-mei=Alan L. kn-aut-name= kn-aut-sei= kn-aut-mei= aut-affil-num=6 ORCID= affil-num=1 en-affil= kn-affil=Kyushu University affil-num=2 en-affil= kn-affil=Okayama University affil-num=3 en-affil= kn-affil=Okayama University of Science affil-num=4 en-affil= kn-affil=Osaka Prefecture University affil-num=5 en-affil= kn-affil=Fukuoka University affil-num=6 en-affil= kn-affil=University of Pennsylvania, US en-keyword=Copayments kn-keyword=Copayments en-keyword=Health insurance kn-keyword=Health insurance en-keyword=Health policy kn-keyword=Health policy en-keyword=Japan kn-keyword=Japan END