Regional variations in medical expenditure and hospitalization days for heart attack patients in Japan: evidence from th
- PDF / 213,128 Bytes
- 22 Pages / 439.37 x 666.142 pts Page_size
- 101 Downloads / 192 Views
Regional variations in medical expenditure and hospitalization days for heart attack patients in Japan: evidence from the Tokai Acute Myocardial Study (TAMIS) Haruko Noguchi · Satoshi Shimizutani · Yuichiro Masuda
Received: 4 October 2007 / Accepted: 12 December 2007 / Published online: 19 January 2008 © Springer Science+Business Media, LLC 2008
Abstract In Japan, the use of percutaneous transluminal coronary angioplasty (PTCA) for the treatment of acute myocardial infarction (AMI) is extraordinarily frequent, resulting in large medical expenditure. Using chart-based data and exploiting regional variations, we explore what factors explain the frequent use of PTCA, employing propensity score matching to estimate the average treatment effects on hospital expenditure and hospital days. We find that the probability of receiving PTCA is affected by the density of medical resources in a region. Moreover, expenditure is higher for treated patients while there are no significant differences in hospitalization days, implying that the frequent use of PTCA is economically motivated. Keywords Regional variations in health care in Japan · Acute myocardial infarction (AMI) · Tokai Acute Myocardial Infarction Study (TAMIS) · Percutaneous transluminal coronary angioplasty (PTCA) · Propensity score model JEL Classification
I11
H. Noguchi (B) Department of Theoretical Social Security Research, National Institute of Population and Social Security Research, Hibiya Kokusai Building 6th Floor, 2-2-3 Uchisaiwai-cho, Chiyoda-ku, Tokyo 100-0011, Japan e-mail: [email protected] S. Shimizutani Institute for International Policy Studies, Toranomon 30 Mori Building 6th floor, Toranomon 3-2-2, Minato-ku, Tokyo 105-0001, Japan e-mail: [email protected] Y. Masuda Department of Geriatrics, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku Nagoya, Aichi 466-8550, Japan e-mail: [email protected]
123
124
H. Noguchi et al.
Introduction Heart disease is one of the most common causes of death in Japan and accounts for one of the highest shares of total medical expenditure. While Japan’s total expenditure on medical care doubled from 11 to 22 trillion yen between 1980 and 1998, the amount of expenditure for patients with ischemic heart diseases increased three-fold, from 246 to 746 billion yen during the same period.1 Among heart diseases, one of the most serious and widespread is heart attack, with acute myocardial infarctions (AMI) accounting for more than one-third of heart disease-related deaths.2 The rapid expansion in health care expenditure associated with heart diseases during the past two decades can mainly be attributed to higher per-patient costs rather than an increase in the incidence of heart diseases.3 One possibility to account for the higher costs per patient is the increasing use of high-tech AMI treatments. In fact, the level of use of high-tech treatments in Japan is quite extraordinary even among developed economies and raises the question whether the rise in expenditure on AMI treatments
Data Loading...
