ArticleJournal of epidemiology and community health2021
Medical expenditure after marginal cut of cash benefit among public assistance recipients in Japan: natural experimental evidence.
Article in Journal of epidemiology and community health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed, 5 citations in OpenAlex.
- No Cost Sharing for Public Assistance Recipients and Health Service Usage in Japan.JAMA health forum · 2025Article
- Health Statuses of People in Poverty Receiving Public Assistance in Japan: A Scoping Review.JMA journal · 2024Article
- A Review of Research Studies Using Data from the Administrative Claims Databases in Japan.Drugs - real world outcomes · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundsIncome 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.
methodsThe 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.
resultsWe 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).
conclusionsGovernment 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.
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