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Background: Cost sharing, including copayment and coinsurance, is often used to contain medical expenditure by decreasing unnecessary or excessive use of healthcare resources. Previous studies in Japan have reported the effects of a coinsurance rate reduction for healthcare from 30 to 10% on the demand for healthcare among 70–74-year-old individuals. However, the coinsurance rate for this age group has recently increased from 10 to 20%. This study aimed to estimate the economic impact of coinsurance rate revision on healthcare resource utilization. Methods: We collected claims data from beneficiaries of the municipality National Health Insurance and the Japanese Health Insurance Association in Fukuoka Prefecture. We categorized subjects born between March 2, 1944 and April 1, 1944 into the 20% coinsurance rate reduction group and those born between April 2, 1944 and May 1, 1944 into the 10% reduction group. An interrupted time-series analysis for multiple groups was employed to compare healthcare resource utilization trends before and after coinsurance rate reduction at 70 years. Results: The 10% coinsurance rate reduction led to a significant increase in healthcare expenditure for outpatient care. The 20% reduction group showed a significantly sharper increase in healthcare expenditure for outpatient care than the 10% reduction group. Similarly, the 10% coinsurance group significantly increased in the number of ambulatory visits. The 20% coinsurance rate reduction group had more frequent ambulatory care visits than the 10% reduction group. Conclusions: These results suggest that increasing the coinsurance rate among the elderly would reduce outpatient healthcare resource utilization; however, it would not necessarily reduce overall healthcare resource utilization. [ABSTRACT FROM AUTHOR]

Background: Preventing lifestyle-related disease requires realistic, cost-effective programs that patients will embrace. We sought to determine whether patient-motivated lifestyle changes would better enhance healthcare outcomes compared with usual care. In addition, we performed an incremental cost-identification analysis of the intervention. Methods: Participants were members of the National Health Insurance in Umi Town, Fukuoka Prefecture, Japan. Ninety-nine patients consented to participate in the study and were then randomized into the Patientmotivated Health Promotion Program group (intervention group) or the conventional support group (control group). The intervention group had a support team—consisting of qualified dietitians, health exercise instructors, and public health nurses—who encouraged patients to set their own goals and to select their own lifestyle improvements. Follow-up support was performed twice during the first year. These follow-up interventions were made in the patients' homes. The control group received the results of their health examinations and instructions on how to enhance exercise via leaflets only. The control group did not receive services from support staff or have the benefit of the two home visits. All patients underwent health center visits for blood testing and reindoctrination, which were conducted at the end of 4, 6, and 12 months. Main outcome measures included changes in vegetable intake and physical activity (measured as number of steps taken per day). Other health measures included bodyweight, body mass index, blood pressure, cholesterol levels, and General Health Questionnaire. Results: The intervention program significantly increased the number of steps per day, increased the likelihood of consuming ≥2 servings of any type of vegetable, and increased the likelihood of consuming green and yellow vegetables after 1 year compared with the control group. However, there were no significant differences between groups with respect to measures of bodyweight, body mass index, blood pressure, cholesterol levels, and General Health Questionnaire score after 1 year. The incremental cost per person-year and the adjusted incremental cost per person-year were ¥27 495 ($US250) and ¥25 819 ($US235), respectively. Conclusions: Health-oriented lifestyle changes can be achieved at nominal additional cost by targeting patient motivation. Patient self-determination in goal-setting should be included in lifestyle-related health programs and program activities should take place, when possible, in patients' homes. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori is regarded as an important cause of both peptic ulcer and chronic gastritis. In particular, seropositivity is highest in patients with duodenal ulcer. No studies have determined whether there are differences in the direct medical costs associated with gastric/duodenal ulcer or inflammation, between seropositive and seronegative patients.Objective: To examine the relationship between seropositivity for H. pylori and outpatient visits and direct medical costs for gastric/duodenal ulcer or inflammation in Japan from the perspective of the payor and patients.Methods: Participants were males (n = 653) who worked for an agricultural co-operative in Fukuoka Prefecture, attended an annual health examination (including a written lifestyle and medical survey), belonged to the same health insurance society consistently for 4 years from April 1996 to March 2000, and provided a blood sample. The survey asked about lifestyle, including smoking and drinking, and past medical history. We retrospectively analysed the annual number of outpatient visits per person and outpatient medical cost (Yen, 2000 values) per person for visits relating to gastric or duodenal ulcer or inflammation using International Classification of Diseases (9th edition) -- Clinical Modification codes. We assessed for potential confounding factors using analysis of covariance and the chi-square test.Results: The annual outpatient incidence of disease, the number of visits to physicians, and the medical costs for gastric or duodenal ulcer or inflammation were about 2-fold greater in individuals with antibodies to H. pylori compared with those without antibodies.Conclusion: Population-based studies and/or randomised controlled clinical trials that target high-risk groups and account for the unique way in which data are collected in Japan are needed to determine whether medical costs for gastric and duodenal ulcer might be reduced by treating asymptomatic patients who have antibodies to H. pylori. [ABSTRACT FROM AUTHOR]