Fu, Rong; Noguchi, Harkuo; Tachikawa, Hirokazu; Aiba, Miyuki; Nakamine, Shin; Kawamura, Akira; Takahashi, Hideto; Tamiya, Nanako
Social Science and Medicine175p.58 - 652017年02月-2017年02月
概要：© 2017 Elsevier Ltd It is widely documented that psychological distress is negatively associated with social networks involvement. However, despite the theoretical postulations that social networks are crucial for alleviating psychological distress, no study has yet empirically confirmed the causality of this relationship. Thus, we used the random-effects generalized least squares method to investigate the effect of one- and two-year lagged values for involvement in social networks on psychological distress. Nine years of longitudinal data were extracted from a nationally representative survey in Japan (“The Longitudinal Survey of Middle-aged and Older Persons”). We utilized the Kessler 6 (K6) score to measure psychological distress among 15,242 respondents aged 50–59 years in the baseline year (2005), and stratified participants into three layers of social networks: inner (well-established friendship ties and participating in hobby activates), intermediary (neighborly ties), and outer (involvement in community activities). We found highly significant and negative associations between all three layers and K6 scores, with the strongest association being for the inner layer. We further observed that one-year lagged involvement in the inner and intermediary layers led to significantly lower K6 scores. However, the protective influences of social networks generally diminished over time. In addition, the protective influences of social network involvement on psychological distress were stronger for women than for men. Furthermore, involvement in social networks was especially important for improving mental health among people with psychological distress. These findings would be important for policymaking to prevent mental health deterioration among middle-aged adults in Japan.
Fu, Rong; Noguchi, Haruko; Noguchi, Haruko; Noguchi, Haruko; Kawamura, Akira; Kawamura, Akira; Takahashi, Hideto; Takahashi, Hideto; Tamiya, Nanako; Tamiya, Nanako
Journal of Health Economics56p.103 - 1122017年12月-2017年12月
概要：© 2017 Elsevier B.V. We evaluate a spillover effect of the Japanese public long-term care insurance (LTCI) as a policy to stimulate family caregivers’ labor force participation. Using nationally representative data from 1995 to 2013, we apply difference-in-difference propensity score matching to investigate the spillover effect in two periods: before and after the introduction of the LTCI in 2000 and before and after its major amendment in 2006. Our results show that the LTCI introduction has significant and positive spillover effects on family caregivers’ labor force participation and the effects vary by gender and age. In contrast, the LTCI amendment is found to have generally negative spillover effects on their labor force participation. We draw attention to these spillover effects, as expanding labor market supply to sustain the economy would be a priority for Japan and other rapidly aging countries in the coming decades.
研究種別：The effect of 2006 Long-term Care Insurance Amendment on Cost Containment: an empirical evidence from nationally representative claims data
研究種別：Cost, Length of Stay, and Health Outcome: A Comprehensive Evaluation of Prospective Payment System in Japan
研究成果概要：After several revisions, I summarize the findings in an article entitled "Moral Hazard under Zero Price Policy: Evi...After several revisions, I summarize the findings in an article entitled "Moral Hazard under Zero Price Policy: Evidence from Japanese Long-term Care Claims Data" and submitted it to the European Journal of Health Economics.
研究成果概要：I have summarized the findings in a manuscript entitled "Moral Hazard under Zero Price Policy: Evidence from Japane...I have summarized the findings in a manuscript entitled "Moral Hazard under Zero Price Policy: Evidence from Japanese Long-term Care Claims Data"and submitted it to the Journal of Public Economics.
2019年度共同研究者：Haruko Noguchi, Yichen Shen
研究成果概要：In 2003, Japan experienced a reform from the fee-for-service system to the blended payment system, a system where o...In 2003, Japan experienced a reform from the fee-for-service system to the blended payment system, a system where only some procedures within inpatient care are required to be paid with the prospective payment system. Exploiting the reform, we investigate the impact of the blended payment system on cost and health outcomes. Using 1997 to 2010 health insurance claims, we show that the blended payment system does not cost less than the fee-for-service system and induces health deteriorations. The deteriorations in health are moderate in comparison with the prospective payment system. The failure to contain cost and the deterioration of health is driven by providers' compensation seeking behaviors that cause a shift of procedures paid via prospective payment system to procedures paid via the fee-for-service system. Our findings point to further reform of the blended payment system to restrict provider incentive to seeking compensations.
研究成果概要：Countries seeking to move away from a purely fee‐for‐service (FFS) systemmay consider a hybrid approach whereby onl...Countries seeking to move away from a purely fee‐for‐service (FFS) systemmay consider a hybrid approach whereby only some procedures are paid byFFS while others are paid prospectively. Yet little evidence exists whether sucha hybrid payment system contains overall costs without adverse influences onhealth outcomes. In 2003, Japan experienced a reform from FFS to a hybridpayment system in which only some inpatient procedures were paid prospectively.We exploit this reform to test how such a hybrid system affectsoverall costs and health outcomes. Briefly, we find that healthcare providersresponded opportunistically to the reform, moving some procedures out of thebundled inpatient setting to FFS services, leading to no reduction in cost.There was some evidence of a moderate deterioration in health outcomes, interms of a decline in the probability of symptoms being cured at discharge. Insum, our results suggest that in some cases, a hybrid payment system can benon‐superior to either FFS or a prospective payment system.