2015 Volume 27 Issue 1 Pages 40-54
About one-sixth of all insured persons under Japan's National Health Insurance (NHI) scheme are replaced every year, largely through inter-scheme transfers of the insured from NHI to other schemes such as Employees' Health Insurance (EHI). This study aimed to identify the fiscal impact of inter-scheme mobility of the insured on NHI's average medical expenditure, by utilizing annual panel data of municipality level between 2009 and 2012, derived from existing statistics.
Three major findings of this study are as follow:
First, the increase in transfers from EHI to NHI brought about a significant decrease in average medical expenditure, resulting from insured persons with lower risk for medical expenditure transferred from EHI to NHI due to retirement, career changes from employee to self-employment, and unemployment caused by bankruptcy or dismissal.
Second, the increase in transfers from NHI to public assistance significantly increased average medical expenditure. This could be ascribed to the fact that public assistance was often induced by health shock.
Third, the increase in the admission rate to the "late-stage medical care system for the elderly" resulted in increase in the average medical expenditure. The relationship was observed even after adjusting for age component of schemes, suggesting that beneficiaries younger than age 75 who transferred from NHI to the late-stage medical care system for the elderly due to disabilities contributed to increased expenditure.
Results above support that NHI's medical expenditure is affected not only by known factors such as age composition, income, and supply-side factors, but also by the inter-scheme mobility of the insured that is beyond insurers' control. Findings indicated that compensation through fiscal adjustment may be necessary to close an inter-scheme gap in cost burden.
