2006 Volume 18 Issue 2 Pages 105-120
There are some confusions on controversies about “mixed medical care services”. We can find the origin on differences in awareness of “market failure”, “equity”, “actual condition” and so on. Therefore, to dissolve these confusions, it is important to construct common recognitions by empirical studies. As part of efforts to develop the works, we extend Suzuki-Saito (2006) and re-examine mixed medical care services issues in the light of equity of accessibility on health-care. The results are as follows: In a case of patient with a limited life expectancy “one year” using public health-care rationings, ①permitted mixed medical care services improves income redistribution effects and does good for lower-income class. ②It was found from estimating Kakwani index that regressive degree of medical out-of-pocket was nearly constant after permitted mixed medical care services. ③We can calculate that the result is due to equivalence of increasing degrees of medical out-of-pockets between income-class. ④Then in each income-class, average ratios of medical out-of-pocket of income increase slightly. But those increases are extremely small. Therefore it seems reasonable to suppose that lower-income class does not feel burden so much. ⑤We estimate medical out-of-pocket by kernel estimation or average ratios of medical out-of-pocket within each income-class. Then, it was found that patients behave differently even if they are in same income-classes. It is concluded from the result that we can't explain patients' decision-making of medical treatment at one's own expense only due to “paying capacity”. The same things are also said of asset class. At least in a case, the results obtained were contrary to conventional suggestions. It follows from the results that it is not necessarily the case which permitted mixed medical care services makes lower income-class worse. Moreover, it is suggested that we should also consider other factors but paying capacity, which control patients' decision-making of medical treatment at one's own expense.
