Suchergebnisse

BACKGROUNDS: Income reduction in poor households affects healthcare demands for impoverished population. However, the impact of reduced benefits for public assistance recipients, who can use medical services for free, on healthcare costs has not been examined. We hypothesised that marginal cuts in benefits increase recipients' medical expenditure by extra demand for medical care. We tested this hypothesis using public assistance databases of Japan. METHODS: The study population comprised households in five municipalities receiving public assistance between April 2016 and September 2018. The households have a child aged 12–60 months and receive a monthly child-support income of US$150, which reduces by US$50 when the child turns 36 months of age. Our analysis comprised an age-based sharp regression-discontinuity study. RESULTS: We observed 4893 household-months (11 032 person-months). When a firstborn child reached 36 months, their frequency of outpatient visits and healthcare costs by recipients, except for the firstborn child, increased (0.45, 95% CI: 0.30 to 0.61; US$111.2, 95% CI: 20.7 to 201.7), while those of the firstborn child did not increase significantly. The monthly medical expenditure per household increased by US$248.6 (95% CI: 25.4 to 471.7). Inpatient medical costs increased significantly (US$64.3, 95% CI: 8.4 to 120.2). CONCLUSIONS: Government savings through income reduction were offset by increased medical expenditure. This may be due to recipients' behavioural change and their worsening health conditions. To prevent excessive medical expenditure, policymakers should consider how income reduction affects the behaviour and health of the impoverished population.

BACKGROUND: Children's healthy development is important. While governmental public assistance benefits financially troubled families, it cannot compensate for a lack of social support. Single-parenthood is a health risk factor for children owing to low-income-associated food insecurity and stress. No study has investigated the association between single-parenthood and health status in children from families receiving public assistance. This study aimed to examine the association between single-parent households and children's health among public assistance recipients in Japan by using linkage data of two municipal public assistance databases and administrative medical assistance data. METHODS: We performed a retrospective cohort study. Public assistance for households below the poverty line ensures income security and medical care. The study population included all children aged 15 or younger availing public assistance in January 2016. We extracted recipients' sociodemographic factors from January 2016 and identified the incidence of childhood diseases' diagnosis until December 2016 as the outcome, including 1) acute upper respiratory infections; 2) influenza and pneumonia; 3) injuries, including fractures; 4) intestinal infectious diseases; 5) conjunctivitis; 6) asthma; 7) allergic rhinitis; 8) dermatitis and eczema, including atopic dermatitis; and 9) diseases of the oral cavities, salivary glands, and jaws, such as tooth decay or dental caries. RESULTS: Among the 573 children, 383 (66.8%) lived in single-parent households. A multivariable Poisson regression, with a robust standard error estimator, showed that single-parenthood is associated with a higher prevalence of asthma (incidence ratio [IR] = 1.62; 95% confidence interval [CI], 1.16–2.26), allergic rhinitis (IR = 1.41; 95% CI, 1.07–1.86), dermatitis and eczema (IR = 1.81; 95% CI, 1.21–2.70), and dental diseases (IR = 1.79; 95% CI, 1.33–2.42) compared to non-single parent households, whereas little association was found between single-parenthood and ...

OBJECTIVES: Using linkage data from two municipal public assistance databases and medical assistance claim data, this study aimed to identify characteristics associated with frequent outpatient attendance by people on public assistance, who can access medical care services without copayment in Japan, with simultaneous consideration of supplier factors. DESIGN: We performed a retrospective cohort study. SETTING: We used secondary data from the public assistance databases of two suburban municipalities in Japan. PARTICIPANTS: The study population included all adults on public assistance in January 2016, who were observed until December 2016. A total of 6016 people was included in the analysis. Among them, 2956 (49.1%) were men, and 2030 (33.7%) were living alone. OUTCOME MEASURE: We adopted the definition of frequent outpatient attendance by the Japanese Ministry of Health, Labour and Welfare, visiting the same medical facility 15 times or more in a month for the same health problem. RESULTS: Of 6016 included people, 139 (2.3%) were engaged in frequent outpatient attendance. Multiple Poisson regression showed that, as for the individual factors, the adjusted incidence ratio for frequent outpatient attendance was 1.58 (95% CI 1.05 to 2.39) for people living alone (vs living with others). As for the suppliers, the adjusted incidence ratio for frequent outpatient attendance was 1.74 (95% CI 1.20 to 2.52) for private institutions (vs medical corporations). There were no significant associations between frequent outpatient attendance and individual disability certificate or long-term care needs. CONCLUSIONS: This study suggests that among recipients of public assistance who can access medical services without copayment, social isolation may be associated with frequent outpatient attendance. Private clinics may also be associated with this phenomenon. Interventions to prevent social isolation—by for example, providing health and social care in a more integrated manner—may thus be efficacious in reducing the healthcare ...

BACKGROUND: Maintaining oral health is one of the global public health challenges. Income and out-of-pocket payments for dental care services are predictors of dental care utilisation. Although public assistance programmes guarantee income security for impoverished people, access barriers other than financial costs may cause unmet dental care needs. We aimed to explore the potential sociodemographic factors determining dental care utilisation among recipients of public assistance in Japan using linkage data of public assistance database and medical assistance claim data administered by municipalities. METHODS: This was a retrospective cohort study involving a sample of public assistance recipients. We extracted the recipients' sociodemographic data (age, sex, household number, employment status, nationality, disability certificates, and long-term care status) in January 2016 and observed them until December 2016 to identify incidences of dental care utilisation as outcomes. We performed a multivariable modified Poisson regression analysis with a robust standard error estimator to calculate the incidence ratio (IR) of dental care utilisation in each variable. RESULTS: We identified a total of 4497 recipients at risk. Among them, 839 recipients used dental care services. Younger age was associated with a higher incidence of dental care utilisation. The female recipients had a higher incidence of dental care utilisation when compared to the male ones (adjusted IR, 1.22; 95% confidence interval [CI], 1.08–1.38). Immigrant recipients had a higher incidence of dental care utilisation than the Japanese ones (IR, 1.53; 95% CI, 1.16–2.01). Recipients with mental disabilities had higher incidences than those without disability certificates (IR, 1.30; 95% CI, 1.08–1.56). CONCLUSIONS: Non-financial sociodemographic inequities in dental care utilisation stemming from age, sex, nationality, and presence of mental disability were found despite minimum income protection and equitable financial dental service access amongst ...