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ObjectivesThis study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤).MethodsUtilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members’ age (i.e. ≤ 64 years vs. 65 years≤) between 2004–2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age.ResultsHouseholds with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need.ConclusionsHouseholds with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts, though the health consequences of this unmet need could not be determined.

ObjectivesWhile the development of vaccines against the novel coronavirus (COVID-19) brought the hope of establishing herd immunity, which might help end the global pandemic, vaccine hesitancy can hinder the progress towards herd immunity. In this study, we assess the determinants of vaccine hesitancy, reasons for hesitation, and effectiveness of vaccine passports in relaxing public health restrictions.MethodsThrough an online survey that includes a conjoint experiment of a demographically representative sample of 5,000 Japanese adults aged 20–74, we assess the determinants of vaccine hesitancy, reasons for hesitation, and effectiveness of hypothetical vaccine passports.ResultsWe found that about 30% of respondents did not intend to vaccinate or have not yet decided, with major reasons for vaccine hesitancy being related to concerns about the safety and side effects of the vaccine. In line with previous findings, younger age, lower socioeconomic status, and psychological factors such as weaker COVID-19 fear were associated with vaccine hesitancy. The easing of public health restrictions such as travel, wearing face masks, and dining out at night was associated with an increase in vaccine acceptance by 4–10%.ConclusionVaccine hesitancy can be reduced by mitigating the concerns about vaccine safety and side effects, as well as by relaxing public health restrictions. However, the feasibility of vaccine passports needs to be sufficiently assessed, taking the ethical issues of passports and the public health impacts of the relaxation of restrictions into careful consideration.Strengths and limitations of this study□This study includes timely data on COVID-19 vaccine hesitancy, obtained from a demographically representative sample of 5,000 Japanese adults.□A conjoint experiment allows assessing the effectiveness of easing public health restrictions on vaccine acceptance.□Actual behaviour may diverge from the survey responses or fluctuate due to the pandemic situation and the timing of the survey.□Results may not be applicable in other countries, since the pandemic situation, government responses to the pandemic, and reasons for vaccine hesitancy can vary across countries.

巻頭言

To estimate the average treatment effect of working past the current retirement age on the health of Japanese men.We used publicly available data from the National Survey of Japanese Elderly, extracting a sample of 1288 men who were 60 years or older. Survey respondents were followed-up for at most 15 years for the onset of four health outcomes: death, cognitive decline, stroke and diabetes. By using the propensity score method, we adjusted for the healthy worker effect by incorporating economic, sociodemographic and health data in the form of independent variables. By calculating the differences in times to a health outcome between those in employment and those not employed, we estimated the average treatment effects on health of being in paid work past retirement age.Compared with those not employed, those in employment lived 1.91 years longer (95% confidence interval, CI: 0.70 to 3.11), had an additional 2.22 years (95% CI: 0.27 to 4.17) before experiencing cognitive decline, and had a longer period before the onset of diabetes and stroke of 6.05 years (95% CI: 4.44 to 7.65) and 3.35 years (95% CI: 1.42 to 5.28), respectively. We also observed differences between employees and the self-employed: the self-employed had longer life expectancies than employees. In terms of years to onset of diabetes or stroke, however, we only observed significant benefits to health of being an employee but not self-employed.Our study found that being in employment past the current age of retirement had a positive impact on health.Estimer l'effet moyen du traitement « Travailler après l'âge actuel de la retraite » sur la santé des hommes japonais.Nous avons utilisé les données publiquement disponibles d'une enquête nationale menée auprès de personnes âgées japonaises, en extrayant un échantillon de 1 288 hommes de 60 ans ou plus. Les personnes ayant participé à cette enquête ont été suivies pendant au maximum 15 ans pour détecter la survenue de quatre événements de santé: décès, déclin cognitif, incident ischémique et diabète. En utilisant la méthode du score de propension, nous avons procédé à un ajustement pour compenser l'effet du travailleur en bonne santé, en incorporant des données économiques, sociodémographiques et des données de santé, sous la forme de variables indépendantes. En calculant les différences constatées -entre les hommes qui travaillaient et ceux qui ne travaillaient pas- dans les délais d'apparition de ces événements de santé, nous avons fait une estimation des effets moyens sur la santé du fait d'avoir un travail rémunéré après l'âge de la retraite.Comparativement aux hommes qui ne travaillaient pas, les hommes qui avaient un travail ont vécu 1,91 année de plus (intervalle de confiance -IC- à 95%: de 0,70 à 3,11), ils ont bénéficié de 2,22 années supplémentaires avant de connaître un déclin cognitif (IC à 95%: de 0,27 à 4,17) et ils ont bénéficié d'une différence de délai encore plus importante avant l'apparition de problèmes de diabète ou d'incidents ischémiques, à savoir 6,05 années (IC à 95%: de 4,44 à 7,65) et 3,35 années (IC à 95%: de 1,42 à 5,28) respectivement. Nous avons également constaté des différences entre les personnes salariées et les travailleurs indépendants, avec une espérance de vie plus élevée chez les travailleurs indépendants. Néanmoins, concernant le délai d'apparition du diabète ou d'incidents ischémiques, nous avons uniquement observé des avantages significatifs pour la santé au fait d’être salarié, mais pas au fait d’être travailleur indépendant.Notre étude révèle que le fait de travailler après l'âge de la retraite actuellement en vigueur a un impact positif sur la santé.Estimar el efecto medio del tratamiento de trabajar después de la edad de jubilación actual en la salud de los hombres japoneses.Se utilizaron los datos disponibles públicamente de la Encuesta Nacional a la Tercera edad de Japón, de donde se obtuvo una muestra de 1288 hombres de 60 años o más. A los encuestados se les realizó un seguimiento durante un máximo de 15 años de la aparición de cuatro resultados de salud: muerte, deterioro cognitivo, accidentes cerebrovasculares y diabetes. Mediante el uso del método de puntuación de propensión, se ajustó el efecto del trabajador sano mediante la incorporación de datos económicos, sociodemográficos y de salud en forma de variables independientes. Mediante el cálculo de las diferencias temporales hasta un resultado de salud entre los que trabajan y los que no, se estimaron los efectos del tratamiento promedio sobre la salud de estar en un trabajo remunerado después de la edad de jubilación.En comparación con los que no trabajan, los trabajadores vivían 1,91 años más (95 % intervalo de confianza, IC: 0,70 a 3,11), tenían 2,22 años adicionales (IC del 95 %: 0,27 a 4,17) antes de experimentar un declive cognitivo y un periodo más largo antes de la aparición de diabetes y accidentes cerebrovasculares de 6,05 (IC del 95 %: 4,44 a 7,65) y 3,35 años (IC del 95 %: 1,42 a 5,28), respectivamente. También se observaron diferencias entre los trabajadores por cuenta ajena y por cuenta propia: los últimos tenían una esperanza de vida más larga que los primeros. Sin embargo, en términos de años hasta la aparición de diabetes o accidentes cerebrovasculares, solo se observaron beneficios significativos para la salud en trabajar por cuenta ajena, pero no por cuenta propia.El estudio concluyó que tener trabajo después de la edad de jubilación actual tuvo un impacto positivo en la salud.تقدير ​​التأثير المتوسط للعلاج بعد سن التقاعد الحالي على صحة الرجال اليابانيين.اعتمدنا على البيانات المتاحة للعامة من المسح الوطني للمسنين اليابانيين، حيث استخرجنا عينة من 1288 رجلاً تبلغ أعمارهم 60 عامًا أو أكثر. وتمت متابعة المشاركين في المسح لمدة 15 سنة على الأكثر لمتابعة ظهور أربع نتائج صحية: الموت، والتدهور الإدراكي، والسكتة الدماغية، والسكري. وباستخدام طريقة النزعة الطبيعية، قمنا بتعديل تأثير العامل الصحي من خلال دمج البيانات الاقتصادية والاجتماعية والسكانية والصحية في شكل متغيرات مستقلة. وباحتساب الاختلافات في أوقات النتيجة صحية بين أولئك الذين مازالوا يعملون، وأولئك الذين لا يعملون، فقد قمنا بتقدير التأثير المتوسط للعلاج على الصحة في العمل المدفوع الأجر بعد سن التقاعد.مقارنة مع أولئك الذين لا يعملون، عاش الذين يعملون فترة أطول بـ 1.91 سنة (فاصل الثقة 95%: 0.70 إلى 3.11)، ومر عليهم 2.22 سنة إضافية (فاصل الثقة 95%: 0.27 إلى 4.17) قبل أن يتعرضوا للتدهور الإدراكي، كما كان لديهم فترة أطول قبل ظهور مرض السكري والسكتة الدماغية وهي 6.05 سنوات (فاصل الثقة 95%: 4.44 إلى 7.65)، و3.35 سنوات (فاصل الثقة 95%: 1.42 إلى 5.28) على الترتيب. كما لاحظنا أيضا الاختلافات بين الموظفين وأصحاب المهن الحرة: حيث كان لدى أصحاب المهن الحرة متوسط ​​حياة أطول من الموظفين. إلا أنه فيما يتعلق بسنوات الإصابة بمرض السكري أو السكتة الدماغية، لاحظنا فقط مزايا ملموسة لدى الموظفين وليس لدى أصحاب المهن الحرة.وجدت دراستنا أن التواجد في العمل بعد سن التقاعد الحالي كان له تأثير إيجابي على الصحة.旨在评估日本男性在当前退休年龄后参与就业对健康的平均疗效。.我们采用日本老年人全国性调查 (National Survey of the Japanese Elderly) 的公开数据，提取了由 1288 名 60 岁或以上男性组成的样本。对参与调查的受访者的四种健康结果，即死亡、认知能力下降、中风和糖尿病，进行了至多 15 年的随访。我们使用倾向性评分法，以独立变量的形式纳入经济、社会人口统计学和健康数据，对健康工人效应进行调整。通过计算就业者与未就业者健康结果之间的时间差异，我们估算了当前退休年龄后参与有偿工作对健康的平均疗效。.与未就业者相比，就业者的寿命延长了 1.91 年（95％ 置信区间，CI：0.70 至 3.11)，认知能力下降推迟了 2.22 年（95% 置信区间，CI：0.27 至 4.17)，糖尿病和中风推迟的时间更久，分别推迟了 6.05 年（95% 置信区间，CI：4.44 至 7.65）和 3.35 年（95% 置信区间，CI：1.42 至 5.28）。我们还观察到雇员与自雇者之间的差异：自雇者的预期寿命比雇员更长。然而，我们仅发现雇员较自雇者在糖尿病或中风发病年限上有显著优势。.研究发现，在当前退休年龄后参与就业对健康产生了积极影响。.Оценить полезное влияние трудовой занятости после достижения текущего пенсионного возраста на здоровье японских мужчин.Использовались общедоступные данные Национального исследования пожилых японцев, в ходе которого была получена выборка из 1288 мужчин в возрасте 60 лет и старше. Участники исследования наблюдались на протяжении максимум 15 лет до наступления четырех исходов в отношении здоровья: смерти, снижения когнитивных способностей, инсульта и диабета. Используя метод оценки предрасположенности, исследователи скорректировали производительность здорового работника с учетом экономических, социально-демографических и медицинских показателей в виде независимых переменных. Путем вычисления разницы во времени до наступления исходов в отношении здоровья между работающими и неработающими пенсионерами авторы оценили полезное влияние трудовой занятости на здоровье после достижения пенсионного возраста.В сравнении с неработающими пенсионерами продолжительность жизни работающих пенсионеров составила на 1,91 года больше (95%-й ДИ: 0,70–3,11), начало снижения когнитивных способностей наступало на 2,22 года позже (95%-й ДИ: 0,27–4,17), у них был более длительный период до развития диабета и инсульта — 6,05 года (95%-й ДИ: 4,44–7,65) и 3,35 года (95%-й ДИ: 1,42–5,28) соответственно. Исследователи также наблюдали различия между работающими по найму и самостоятельно занятыми пенсионерами: у самостоятельно занятых была большая продолжительность жизни, чем у работающих по найму. Тем не менее пенсионеры, работающие по найму, продемонстрировали лучшие результаты в отношении количества лет до развития диабета или инсульта по сравнению с самостоятельно занятыми пенсионерами.Исследование показало, что сохранение трудовой занятости после достижения текущего пенсионного возраста оказывает положительное влияние на здоровье.

Objectives Although providing incentives for a better lifestyle has been of increasing concern, there is insufficient evidence about its effect. Therefore, this research aims to discover new insights by verifying the effect of rewards to motivate persistence in a project for health promotion.Methods A total of 7,622 participants of an incentivized project for health promotion (Wellness Point Project) were recruited from 6 municipalities in Japan, namely Tohoku, Chubu, Kanto, Kinki, and Chugoku, of which the 4,291 individuals who had the necessary information for estimation were analyzed. Persistence in the project was judged by whether there was information about daily steps and/or participation in some fitness classes every month for one year at most. In addition, we used the reason participants chose certain rewards in order to categorize the characteristic of rewards, and estimated opt-out hazard ratios from the project using survival time analysis. Furthermore, the estimation in the model included individual features such as age, education, status of physical activity before joining the project, lifestyles such as smoking, drinking, and so on.Results A multivariate analysis reveals that those who had chosen a reward for regional contribution were more likely to opt out than those who had chosen a certain reward because it is close to cash. The opt-out hazard ratio was 1.63 (95% CI: 1.18-2.25) among men and 1.40 (95% CI: 1.08-1.81) among women. In addition, insufficient physical activity, smoking, working for men, and physical condition for women were associated with opt-out.Conclusions This research verified that a reward that participants felt was close to cash, compared to the internal motivation of regional contribution, could enhance the persistence rate of the project. Moreover, it was found that not only giving incentives but also considering participants' conditions is necessary to enhance persistence.

Using the society-managed health insurance data, which is cross-sectional time-series and covers 1670 health insurance societies for seven years (FY1995–2001), we found for the first time in Japan that the majority of the employers' contribution to health insurance is shifting back onto the employees in the form of wage reduction. On the other hand, we cannot find such evidence for the contribution to long-term care insurance using a two-year (FY2000–2001) panel data set. The difference can be theoretically explained by how employees value the contribution relative to social security benefits they enjoy. J. Japanese Int. Economies 18 (4) (2004) 565–581.

Using the society-managed health insurance data, which is cross-sectional time-series and covers 1,670 health insurance societies for seven years (FY1995-2001), we found for the first time in Japan that the majority of the employer's contribution to health insurance is shifting back onto the employees in the form of wage reduction. On the other hand, we cannot find such evidence for the contribution to long-term care insurance using a two-year (FY2000-01) panel data set.