Horizontal inequity in healthcare access under the universal coverage in Japan; 1986–2007Ryo Watanabe and Hideki Hashimoto Social Science & Medicine, 2012, vol. 75, issue 8, 1372-1378 Abstract: Universal coverage of healthcare aims at securing access to appropriate healthcare for all at an affordable cost. Since 1961, Japan’s national health insurance has provided an equal package of benefits including outpatient, inpatient, dental, and pharmaceutical services. Reduced copayment and other welfare programs are available to the elderly. However, social health insurance may not be a panacea to achieve healthcare for all, especially when facing household impoverishment due to economic stagnation. Using time-series cross-sectional data of a nationally representative survey of Japan, we assessed the degree of inequity in healthcare access in terms of the “equal treatment for equal needs” concept, to identify the impact of changing economic conditions on people’s healthcare access. Concentration indices of actual healthcare use (CM) and standardized health status as a marker of healthcare needs (CN) were obtained. We decomposed CM to identify factors contributing to inequalities in healthcare use. Results showed that horizontal inequities in healthcare access in favor of the rich gradually increased over the period with a widening health gap among the poor. The inequality in favor of the rich was specifically observed among people aged 20–64 years, whereas high horizontal equity was achieved among those aged >65 years. Decomposition of CM also demonstrated that income and health status were major contributors to widening inequality, which implies that changes in household economic conditions and copayment policy during the study period were responsible for the diminished horizontal equity. Our results suggest that the achievement of horizontal equity through universal coverage should be regarded as an ongoing project that requires continuous redesign of contribution and benefit in the nation’s healthcare system. Keywords: Japan; Healthcare access; Universal coverage; Horizontal inequity; Concentration index (search for similar items in EconPapers) Downloads: (external link) Related works: Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text Persistent link: https://EconPapers.repec.org/RePEc:eee:socmed:v:75:y:2012:i:8:p:1372-1378 Ordering information: This journal article can be ordered from DOI: 10.1016/j.socscimed.2012.06.006 Access Statistics for this article Social Science & Medicine is currently edited by Ichiro (I.) Kawachi and S.V. (S.V.) Subramanian More articles in Social Science & Medicine from Elsevier |
Is your work missing from RePEc? Here is how to contribute.
Questions or problems? Check the EconPapers FAQ or send mail to .
EconPapers is hosted by the
School of Business at Örebro University.