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Background: The cost-sharing impact on hospital service utilization of different services is a critical issue that has not been well addressed worldwide. This study aimed to investigate the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan and provide a comprehensive examination and discussion for the reasonability of a cost-sharing system. Methods: The data were extracted from the Latter-Stage Elderly Healthcare Insurance database in the fiscal year 2016. A total of 610 182 insured people aged ≥75 years old, with 155 773 hospitalization patients, were identified. Hospitalization rate, length of stay (LOS), and total hospitalization cost were used to test the statistical significance among patients categorized by income levels. Generalized linear models for total hospitalization cost were constructed based on bed types to further assess different hospital service utilization. Results: For medical chronic care and psychiatric beds, which both required long-term care treatment, much higher hospitalization rates were observed in the patients with low- and middle-income levels than patients with high-income level. The LOS and total hospitalization cost of the patients with low- and middle-income levels were significantly higher than the patients with high-income level treated in medical chronic care and psychiatric beds. For psychiatric beds, the total hospitalization cost for patients with low-income level was significantly higher than that for patients with highincome level. Conclusion: The cost-sharing policy in Japan, especially the cap for out-of-pocket needs further determination. The importance of community-based care services needs to be emphasized, and the collaboration between hospitals and community-based care facilities should be enhanced. [ABSTRACT FROM AUTHOR]

Aims/Introduction: The present study aimed to evaluate the effects of income levels on physician visit patterns and to quantify the consequent impact of irregular physician visits on glycemic control among employees' health insurance beneficiaries in Japan. Materials and Methods: We obtained specific health checkup data of untreated diabetes patients from the Fukuoka branch of the Japanese Health Insurance Association. We selected 2,981 insurance beneficiaries and classified 650 and 2,331 patients into, respectively, the regular visit and irregular visit group. We implemented propensity score matching to select an adequate control group. Results: Compared with those with a standard monthly income <$2,000 (US$1 = ¥100), those with a higher monthly income were less likely to have irregular visits; $2,000–2,999: odds ratio 0.74 (95% confidence interval 0.56–0.98), $3,000–3,999: odds ratio 0.63 (95% confidence interval 0.46–0.87) and ≥$5,000: odds ratio 0.58 (95% confidence interval 0.39–0.86). After propensity score matching and adjusting for covariates, the irregular visit group tended to have poor glycemic control; increased glycated hemoglobin ≥0.5: odds ratio 1.90 (95% confidence interval 1.30–2.77), ≥1.0: odds ratio 2.75 (95% confidence interval 1.56–4.82) and ≥20% relatively: odds ratio 3.18 (95% confidence interval 1.46–6.92). Conclusions: We clarified that there was a significant relationship between income and irregular visits, and this consequently resulted in poor glycemic control. These findings would be useful for more effective disease management. [ABSTRACT FROM AUTHOR]