Cost-Sharing Effects on Hospital Service Utilization Among Older People in Fukuoka Prefecture, Japan

Document Type : Original Article


1 Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

2 Health Administration Program, Faculty of Business & Management, Universiti Teknologi MARA, Selangor, Malaysia

3 Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan


The cost-sharing impact on hospital service utilization of different services is a critical issue that has not been well addressed worldwide. This study aimed to investigate the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan and provide a comprehensive examination and discussion for the reasonability of a cost-sharing system.
The data were extracted from the Latter-Stage Elderly Healthcare Insurance database in the fiscal year 2016. A total of 610 182 insured people aged ≥75 years old, with 155 773 hospitalization patients, were identified. Hospitalization rate, length of stay (LOS), and total hospitalization cost were used to test the statistical significance among patients categorized by income levels. Generalized linear models for total hospitalization cost were constructed based on bed types to further assess different hospital service utilization.
For medical chronic care and psychiatric beds, which both required long-term care treatment, much higher hospitalization rates were observed in the patients with low- and middle-income levels than patients with high-income level. The LOS and total hospitalization cost of the patients with low- and middle-income levels were significantly higher than the patients with high-income level treated in medical chronic care and psychiatric beds. For psychiatric beds, the total hospitalization cost for patients with low-income level was significantly higher than that for patients with high-income level.
The cost-sharing policy in Japan, especially the cap for out-of-pocket needs further determination. The importance of community-based care services needs to be emphasized, and the collaboration between hospitals and community-based care facilities should be enhanced.


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Volume 11, Issue 4
April 2022
Pages 489-497
  • Receive Date: 22 November 2019
  • Revise Date: 16 September 2020
  • Accept Date: 28 September 2020
  • First Publish Date: 13 October 2020