The Disparity in Rate of Deductible of Social Health Insurance with Respect to Age and Gender and Its Resolution in Post-War Japan: Whether It Has Influenced Healthcare Utilization and Longevity?

In post-war Japan, healthcare system has been constructed so that every Japanese could utilize health service of modern medicine free of charge or at low cost. When this system started in 1961, the employed and their dependents were obligated to enroll in so-called “social health insurance” plans. The medical expenses charged on the employed were all covered by these plans, whereas those charged on their dependents were covered only by 50%. The other people such as the self-employed including farmers, retirees, and their dependents were compelled to enroll in so-called “national health insurance” plans, which covered 70% of their medical expenses. The disparity in rate of deductible was based on occupational status, which was closely related to age and gender. This disparity has been reduced bit by bit until the year of 2003 when irrespective of occupational status, the deductible rate for those 70 years and over of age was 10%, whereas that for those under 70 years of age was 30 %; in either case, monthly total out-of-pocket expense was capped. In this paper, change in (a)disparity in out-of-pocket expense of healthcare service utilization, (b)health care utilization rate and rate of deaths in medical institutions broken down by gender and age, and (c)life expectancy at birth, 20 years of age, and 65 years of age broken down by gender, in post-war Japan will be examined, and by comparing between the patterns of chronological change of (a) and (b), and between those of (b) and (c), it will be analyzed how the change in (a) has influenced (b), and how the change in (b) has influenced (c).