KATO RYUTA    Department   Professional Graduate School  , Graduate School of Governance Studies    Position   Professor
Research Period	2005～2006
Research Topic	Economic Analysis of Fundamental Issues in the Existing Public Health services in Japan
Research Type	KAKENHI Research
Consignor	Japan Society for the Promotion of Science
Research Program Type	Grant-in-Aid for Scientific Research (C)
KAKENHI Grant No.	17530175
Keyword	Employed Hospital Physician, Over-work, Simulation, Public Health Services, Fee for Services, Population Aging, National Medical Expenditure, Price Difference in Medicine
Representative Person	KATO Ryuta
Details	In this research project, the fundamental issues in the current public health services have been explored in economics. The effect of an aging population of Japan on the future public medical expenditure under the current public health services system has also been studied by using a simulation method. The following points are particularly important : First of all, under the current fee-for-services, the current supply-side cost sharing system results in over-dosing of medicine and over-giving of medical treatment. Secondly, although it is usually recognized that a positive difference in prices of medicine between the legitimately fixed price and the actual purchasing price from pharmaceutical companies, which is so called "yakka-saeki", induces over-dosing of medicine, this research has shown that the current fee-for-service system itself induces over-dosing of medicine even without the "yakka-saeki". Thirdly, it has also shown that the current fee-for-service induces under-provision of labor supply of self-employed medical physicians with over-dosing of medicine. Fourthly, in terms of hospital employed medical physicians, it has shown that there is a possibility that over-supply of labor by hospital employed medical physicians would happen. The condition of the over-supply of labor depends upon several conditions, and it has shown that there is a possible situation that the reform of the trainee system of medical physicians resulted in the over-supply of labor of the hospital employed medical physician. Since it is likely to result in more risks in medical supply with over-working of hospital employed medical physicians, the reform of the trainee system would induce higher risks in medical supply in Japan. In terms of the effect of an aging population on the national medical expenditure, the ratio of the expenditure to GDP (the GDP ratio) will keep increasing by 1% for the next 10 years, resulting the ratio to be 9.6% in year 2050. In the simulations of an increase in the co-payment rate from 15% to 20% and 30%, it has been found that the national burden ratio would slightly decrease. Since the increase in the co-payment rate induces an increase in precautionary savings due to the reason that the individuals' medical expenditure when they get old would increase, the increase in the co-payment rate results in higher economic growth. If the co-payment increases from 15% to 20%, then the national burden ratio would decrease by 1% in a new steady state, and if the co-payment rate increases to 30%, then the national burden ratio would decrease by 3% in a new steady state.