How does health insurance copayment affect the use of medical services and health outcomes

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This project is aimed at investigating the effects of health insurance and related health policies on health outcomes. The data of Comprehensive Survey of Living Conditions (CSLC) were obtained to facilitate analyzing the health policy impacts on health outcomes of individuals in Japan. Since the co-payment of medical fees differs for those below 70 and between 70 and 74, and the share of medical fees changed in 2014, the threshold at age 70 and policy changes provide natural experiments to estimate the causal effects of coinsurance on health outcomes. By utilizing the data in 2013 and 2016, the method of difference-in-differences (DID) is adopted to estimate the average treatment effects of the change in co-payment on health outcomes. The results indicate that in general, decrease in health insurance coverage (i.e., increase in co-payment) reduces positive health behaviour. However, the impact on risky health behaviour is mixed. Furthermore, people with higher education level tend to have a stronger change in their behaviour for both positive and negative health behaviour. Besides, males have a larger decline in smoking but have a significant increase in alcohol consumption compared to females. The findings of the study have significant implications for policy-making: by understanding the effects of health insurance coverage on various health behaviors, policymakers can develop targeted interventions and strategies to encourage positive behavioral changes in different population segments.